|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,640.69 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: BCBS Trust/PPO |
$6,693.46
|
| Rate for Payer: BCN Commercial |
$6,693.46
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,078.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$6,645.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,050.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,640.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,131.91
|
| Rate for Payer: UHC Core |
$6,767.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,078.33
|
|
|
HC TX MISSED AB 1ST TRI SURG
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,428.81 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna Medicare |
$2,107.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,532.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,532.64
|
| Rate for Payer: BCBS Complete |
$1,500.13
|
| Rate for Payer: BCBS MAPPO |
$2,026.11
|
| Rate for Payer: BCBS Trust/PPO |
$6,662.66
|
| Rate for Payer: BCN Commercial |
$6,662.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,026.11
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,026.11
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,078.33
|
| Rate for Payer: Mclaren Medicaid |
$1,428.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,127.42
|
| Rate for Payer: Meridian Medicaid |
$1,500.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,330.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,228.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$6,645.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PACE Senior Care Partners |
$1,924.80
|
| Rate for Payer: PACE SWMI |
$2,026.11
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: PHP Medicare Advantage |
$2,026.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,428.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,050.86
|
| Rate for Payer: Priority Health Medicare |
$2,046.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,640.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2,026.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,131.91
|
| Rate for Payer: UHC Core |
$6,767.21
|
| Rate for Payer: UHC Exchange |
$2,026.11
|
| Rate for Payer: UHC Medicaid |
$1,428.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,026.11
|
| Rate for Payer: UHCCP Medicaid |
$1,428.81
|
| Rate for Payer: VA VA |
$2,026.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,078.33
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
OP
|
$791.16
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.48 |
| Max. Negotiated Rate |
$712.04 |
| Rate for Payer: Aetna Commercial |
$672.49
|
| Rate for Payer: Aetna Medicare |
$205.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.24
|
| Rate for Payer: BCBS Complete |
$146.44
|
| Rate for Payer: BCBS MAPPO |
$197.79
|
| Rate for Payer: BCBS Trust/PPO |
$650.41
|
| Rate for Payer: BCN Commercial |
$650.41
|
| Rate for Payer: BCN Medicare Advantage |
$197.79
|
| Rate for Payer: Cash Price |
$632.93
|
| Rate for Payer: Cofinity Commercial |
$680.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.79
|
| Rate for Payer: Healthscope Commercial |
$712.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.37
|
| Rate for Payer: Mclaren Medicaid |
$139.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.68
|
| Rate for Payer: Meridian Medicaid |
$146.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.49
|
| Rate for Payer: Nomi Health Commercial |
$648.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.37
|
| Rate for Payer: PACE Senior Care Partners |
$187.90
|
| Rate for Payer: PACE SWMI |
$197.79
|
| Rate for Payer: PHP Commercial |
$672.49
|
| Rate for Payer: PHP Medicare Advantage |
$197.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$688.31
|
| Rate for Payer: Priority Health Medicare |
$199.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.65
|
| Rate for Payer: Railroad Medicare Medicare |
$197.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.22
|
| Rate for Payer: UHC Core |
$660.62
|
| Rate for Payer: UHC Exchange |
$197.79
|
| Rate for Payer: UHC Medicaid |
$139.48
|
| Rate for Payer: UHC Medicare Advantage |
$197.79
|
| Rate for Payer: UHCCP Medicaid |
$139.48
|
| Rate for Payer: VA VA |
$197.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.37
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE, SIMPLE CLOSURE
|
Facility
|
IP
|
$791.16
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
76100243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.65 |
| Max. Negotiated Rate |
$712.04 |
| Rate for Payer: Aetna Commercial |
$672.49
|
| Rate for Payer: BCBS Trust/PPO |
$653.42
|
| Rate for Payer: BCN Commercial |
$653.42
|
| Rate for Payer: Cash Price |
$632.93
|
| Rate for Payer: Cofinity Commercial |
$680.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.93
|
| Rate for Payer: Healthscope Commercial |
$712.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.49
|
| Rate for Payer: Nomi Health Commercial |
$648.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.37
|
| Rate for Payer: PHP Commercial |
$672.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$688.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.22
|
| Rate for Payer: UHC Core |
$660.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.37
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
OP
|
$342.77
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.43 |
| Max. Negotiated Rate |
$308.49 |
| Rate for Payer: Aetna Commercial |
$291.35
|
| Rate for Payer: Aetna Medicare |
$89.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.12
|
| Rate for Payer: BCBS Complete |
$63.45
|
| Rate for Payer: BCBS MAPPO |
$85.69
|
| Rate for Payer: BCBS Trust/PPO |
$281.79
|
| Rate for Payer: BCN Commercial |
$281.79
|
| Rate for Payer: BCN Medicare Advantage |
$85.69
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Commercial |
$294.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.69
|
| Rate for Payer: Healthscope Commercial |
$308.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.08
|
| Rate for Payer: Mclaren Medicaid |
$60.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.98
|
| Rate for Payer: Meridian Medicaid |
$63.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$94.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.35
|
| Rate for Payer: Nomi Health Commercial |
$281.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.08
|
| Rate for Payer: PACE Senior Care Partners |
$81.41
|
| Rate for Payer: PACE SWMI |
$85.69
|
| Rate for Payer: PHP Commercial |
$291.35
|
| Rate for Payer: PHP Medicare Advantage |
$85.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.21
|
| Rate for Payer: Priority Health Medicare |
$86.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.57
|
| Rate for Payer: Railroad Medicare Medicare |
$85.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.64
|
| Rate for Payer: UHC Core |
$286.21
|
| Rate for Payer: UHC Exchange |
$85.69
|
| Rate for Payer: UHC Medicaid |
$60.43
|
| Rate for Payer: UHC Medicare Advantage |
$85.69
|
| Rate for Payer: UHCCP Medicaid |
$60.43
|
| Rate for Payer: VA VA |
$85.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.08
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
IP
|
$342.77
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.57 |
| Max. Negotiated Rate |
$308.49 |
| Rate for Payer: Aetna Commercial |
$291.35
|
| Rate for Payer: BCBS Trust/PPO |
$283.09
|
| Rate for Payer: BCN Commercial |
$283.09
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Commercial |
$294.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Healthscope Commercial |
$308.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.35
|
| Rate for Payer: Nomi Health Commercial |
$281.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.08
|
| Rate for Payer: PHP Commercial |
$291.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.64
|
| Rate for Payer: UHC Core |
$286.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.08
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
IP
|
$4,370.70
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,042.01 |
| Max. Negotiated Rate |
$3,933.63 |
| Rate for Payer: Aetna Commercial |
$3,715.09
|
| Rate for Payer: Aetna Commercial |
$5,572.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,609.76
|
| Rate for Payer: BCBS Trust/PPO |
$5,414.64
|
| Rate for Payer: BCN Commercial |
$3,609.76
|
| Rate for Payer: BCN Commercial |
$5,414.64
|
| Rate for Payer: Cash Price |
$3,496.56
|
| Rate for Payer: Cash Price |
$5,244.84
|
| Rate for Payer: Cofinity Commercial |
$5,638.20
|
| Rate for Payer: Cofinity Commercial |
$3,758.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,496.56
|
| Rate for Payer: Healthscope Commercial |
$3,933.63
|
| Rate for Payer: Healthscope Commercial |
$5,900.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,278.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,917.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,715.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,572.64
|
| Rate for Payer: Nomi Health Commercial |
$3,583.97
|
| Rate for Payer: Nomi Health Commercial |
$5,375.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,278.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,917.04
|
| Rate for Payer: PHP Commercial |
$5,572.64
|
| Rate for Payer: PHP Commercial |
$3,715.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,703.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,802.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,042.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,563.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,846.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,769.32
|
| Rate for Payer: UHC Core |
$3,649.53
|
| Rate for Payer: UHC Core |
$5,474.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,278.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,917.04
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
OP
|
$4,370.70
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$770.55 |
| Max. Negotiated Rate |
$3,933.63 |
| Rate for Payer: Aetna Commercial |
$3,715.09
|
| Rate for Payer: Aetna Commercial |
$5,572.64
|
| Rate for Payer: Aetna Medicare |
$1,704.57
|
| Rate for Payer: Aetna Medicare |
$1,136.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,048.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,365.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,365.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,048.77
|
| Rate for Payer: BCBS Complete |
$809.02
|
| Rate for Payer: BCBS Complete |
$1,213.52
|
| Rate for Payer: BCBS MAPPO |
$1,092.67
|
| Rate for Payer: BCBS MAPPO |
$1,639.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,593.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,389.73
|
| Rate for Payer: BCN Commercial |
$5,389.73
|
| Rate for Payer: BCN Commercial |
$3,593.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,639.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,092.67
|
| Rate for Payer: Cash Price |
$3,496.56
|
| Rate for Payer: Cash Price |
$5,244.84
|
| Rate for Payer: Cofinity Commercial |
$3,758.80
|
| Rate for Payer: Cofinity Commercial |
$5,638.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,244.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,496.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,639.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,092.67
|
| Rate for Payer: Healthscope Commercial |
$3,933.63
|
| Rate for Payer: Healthscope Commercial |
$5,900.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,278.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,917.04
|
| Rate for Payer: Mclaren Medicaid |
$1,155.83
|
| Rate for Payer: Mclaren Medicaid |
$770.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,720.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,147.31
|
| Rate for Payer: Meridian Medicaid |
$809.02
|
| Rate for Payer: Meridian Medicaid |
$1,213.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,884.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,256.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,802.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,201.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,572.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,715.09
|
| Rate for Payer: Nomi Health Commercial |
$5,375.96
|
| Rate for Payer: Nomi Health Commercial |
$3,583.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,278.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,917.04
|
| Rate for Payer: PACE Senior Care Partners |
$1,557.06
|
| Rate for Payer: PACE Senior Care Partners |
$1,038.04
|
| Rate for Payer: PACE SWMI |
$1,639.01
|
| Rate for Payer: PACE SWMI |
$1,092.67
|
| Rate for Payer: PHP Commercial |
$3,715.09
|
| Rate for Payer: PHP Commercial |
$5,572.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,092.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,639.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,155.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,703.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,802.51
|
| Rate for Payer: Priority Health Medicare |
$1,655.40
|
| Rate for Payer: Priority Health Medicare |
$1,103.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,042.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,563.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,092.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,639.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,846.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,769.32
|
| Rate for Payer: UHC Core |
$5,474.30
|
| Rate for Payer: UHC Core |
$3,649.53
|
| Rate for Payer: UHC Exchange |
$1,639.01
|
| Rate for Payer: UHC Exchange |
$1,092.67
|
| Rate for Payer: UHC Medicaid |
$1,155.83
|
| Rate for Payer: UHC Medicaid |
$770.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,092.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,639.01
|
| Rate for Payer: UHCCP Medicaid |
$770.55
|
| Rate for Payer: UHCCP Medicaid |
$1,155.83
|
| Rate for Payer: VA VA |
$1,092.67
|
| Rate for Payer: VA VA |
$1,639.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,917.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,278.03
|
|
|
HC TYMPANOMETRY
|
Facility
|
IP
|
$34.96
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$31.46 |
| Rate for Payer: Aetna Commercial |
$29.72
|
| Rate for Payer: BCBS Trust/PPO |
$28.87
|
| Rate for Payer: BCN Commercial |
$28.87
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$30.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.97
|
| Rate for Payer: Healthscope Commercial |
$31.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.72
|
| Rate for Payer: Nomi Health Commercial |
$28.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.22
|
| Rate for Payer: PHP Commercial |
$29.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.76
|
| Rate for Payer: UHC Core |
$29.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.22
|
|
|
HC TYMPANOMETRY
|
Facility
|
OP
|
$34.96
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$31.46 |
| Rate for Payer: Aetna Commercial |
$29.72
|
| Rate for Payer: Aetna Medicare |
$9.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.93
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$28.74
|
| Rate for Payer: BCN Commercial |
$28.74
|
| Rate for Payer: BCN Medicare Advantage |
$8.74
|
| Rate for Payer: Cash Price |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$30.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$31.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.22
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.18
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.72
|
| Rate for Payer: Nomi Health Commercial |
$28.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.22
|
| Rate for Payer: PACE Senior Care Partners |
$8.30
|
| Rate for Payer: PACE SWMI |
$8.74
|
| Rate for Payer: PHP Commercial |
$29.72
|
| Rate for Payer: PHP Medicare Advantage |
$8.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.42
|
| Rate for Payer: Priority Health Medicare |
$8.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.33
|
| Rate for Payer: Railroad Medicare Medicare |
$8.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.76
|
| Rate for Payer: UHC Core |
$29.19
|
| Rate for Payer: UHC Exchange |
$8.74
|
| Rate for Payer: UHC Medicaid |
$6.16
|
| Rate for Payer: UHC Medicare Advantage |
$8.74
|
| Rate for Payer: UHCCP Medicaid |
$6.16
|
| Rate for Payer: VA VA |
$8.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.22
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$151.90
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$105.72 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: BCBS Trust/PPO |
$125.45
|
| Rate for Payer: BCN Commercial |
$125.45
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.67
|
| Rate for Payer: UHC Core |
$126.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.92
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: Aetna Medicare |
$39.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.47
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: BCBS MAPPO |
$37.98
|
| Rate for Payer: BCBS Trust/PPO |
$124.88
|
| Rate for Payer: BCN Commercial |
$124.88
|
| Rate for Payer: BCN Medicare Advantage |
$37.98
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.98
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.92
|
| Rate for Payer: Mclaren Medicaid |
$26.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.87
|
| Rate for Payer: Meridian Medicaid |
$28.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PACE Senior Care Partners |
$36.08
|
| Rate for Payer: PACE SWMI |
$37.98
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: PHP Medicare Advantage |
$37.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.15
|
| Rate for Payer: Priority Health Medicare |
$38.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.72
|
| Rate for Payer: Railroad Medicare Medicare |
$37.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.67
|
| Rate for Payer: UHC Core |
$126.84
|
| Rate for Payer: UHC Exchange |
$37.98
|
| Rate for Payer: UHC Medicaid |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$37.98
|
| Rate for Payer: UHCCP Medicaid |
$26.78
|
| Rate for Payer: VA VA |
$37.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.92
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
OP
|
$1,369.17
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.38 |
| Max. Negotiated Rate |
$1,232.25 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna Commercial |
$1,745.69
|
| Rate for Payer: Aetna Medicare |
$533.98
|
| Rate for Payer: Aetna Medicare |
$355.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$641.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$641.80
|
| Rate for Payer: BCBS Complete |
$253.43
|
| Rate for Payer: BCBS Complete |
$380.15
|
| Rate for Payer: BCBS MAPPO |
$342.29
|
| Rate for Payer: BCBS MAPPO |
$513.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,125.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,688.39
|
| Rate for Payer: BCN Commercial |
$1,688.39
|
| Rate for Payer: BCN Commercial |
$1,125.59
|
| Rate for Payer: BCN Medicare Advantage |
$513.44
|
| Rate for Payer: BCN Medicare Advantage |
$342.29
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Cofinity Commercial |
$1,766.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$513.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.29
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Healthscope Commercial |
$1,848.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,540.31
|
| Rate for Payer: Mclaren Medicaid |
$362.08
|
| Rate for Payer: Mclaren Medicaid |
$241.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$539.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.41
|
| Rate for Payer: Meridian Medicaid |
$253.43
|
| Rate for Payer: Meridian Medicaid |
$380.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$590.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$564.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$376.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Nomi Health Commercial |
$1,684.08
|
| Rate for Payer: Nomi Health Commercial |
$1,122.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: PACE Senior Care Partners |
$487.77
|
| Rate for Payer: PACE Senior Care Partners |
$325.18
|
| Rate for Payer: PACE SWMI |
$513.44
|
| Rate for Payer: PACE SWMI |
$342.29
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: PHP Commercial |
$1,745.69
|
| Rate for Payer: PHP Medicare Advantage |
$342.29
|
| Rate for Payer: PHP Medicare Advantage |
$513.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,786.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,191.18
|
| Rate for Payer: Priority Health Medicare |
$518.57
|
| Rate for Payer: Priority Health Medicare |
$345.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$952.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,429.41
|
| Rate for Payer: Railroad Medicare Medicare |
$342.29
|
| Rate for Payer: Railroad Medicare Medicare |
$513.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,204.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,807.30
|
| Rate for Payer: UHC Core |
$1,714.88
|
| Rate for Payer: UHC Core |
$1,143.26
|
| Rate for Payer: UHC Exchange |
$513.44
|
| Rate for Payer: UHC Exchange |
$342.29
|
| Rate for Payer: UHC Medicaid |
$362.08
|
| Rate for Payer: UHC Medicaid |
$241.38
|
| Rate for Payer: UHC Medicare Advantage |
$342.29
|
| Rate for Payer: UHC Medicare Advantage |
$513.44
|
| Rate for Payer: UHCCP Medicaid |
$241.38
|
| Rate for Payer: UHCCP Medicaid |
$362.08
|
| Rate for Payer: VA VA |
$342.29
|
| Rate for Payer: VA VA |
$513.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,540.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.88
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
IP
|
$1,369.17
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$952.94 |
| Max. Negotiated Rate |
$1,232.25 |
| Rate for Payer: Aetna Commercial |
$1,163.79
|
| Rate for Payer: Aetna Commercial |
$1,745.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.19
|
| Rate for Payer: BCN Commercial |
$1,130.80
|
| Rate for Payer: BCN Commercial |
$1,696.19
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cofinity Commercial |
$1,766.22
|
| Rate for Payer: Cofinity Commercial |
$1,177.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Healthscope Commercial |
$1,232.25
|
| Rate for Payer: Healthscope Commercial |
$1,848.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,540.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Nomi Health Commercial |
$1,122.72
|
| Rate for Payer: Nomi Health Commercial |
$1,684.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: PHP Commercial |
$1,745.69
|
| Rate for Payer: PHP Commercial |
$1,163.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,786.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,191.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$952.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,429.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,204.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,807.30
|
| Rate for Payer: UHC Core |
$1,143.26
|
| Rate for Payer: UHC Core |
$1,714.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,540.31
|
|
|
HC TYPE III HOME STUDY
|
Facility
|
OP
|
$694.43
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
92000015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$122.43 |
| Max. Negotiated Rate |
$624.99 |
| Rate for Payer: Aetna Commercial |
$590.27
|
| Rate for Payer: Aetna Medicare |
$180.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.01
|
| Rate for Payer: BCBS Complete |
$128.54
|
| Rate for Payer: BCBS MAPPO |
$173.61
|
| Rate for Payer: BCBS Trust/PPO |
$570.89
|
| Rate for Payer: BCN Commercial |
$570.89
|
| Rate for Payer: BCN Medicare Advantage |
$173.61
|
| Rate for Payer: Cash Price |
$555.54
|
| Rate for Payer: Cofinity Commercial |
$597.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.61
|
| Rate for Payer: Healthscope Commercial |
$624.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.82
|
| Rate for Payer: Mclaren Medicaid |
$122.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.29
|
| Rate for Payer: Meridian Medicaid |
$128.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$190.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.27
|
| Rate for Payer: Nomi Health Commercial |
$569.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.82
|
| Rate for Payer: PACE Senior Care Partners |
$164.93
|
| Rate for Payer: PACE SWMI |
$173.61
|
| Rate for Payer: PHP Commercial |
$590.27
|
| Rate for Payer: PHP Medicare Advantage |
$173.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$604.15
|
| Rate for Payer: Priority Health Medicare |
$175.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$483.32
|
| Rate for Payer: Railroad Medicare Medicare |
$173.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.10
|
| Rate for Payer: UHC Core |
$579.85
|
| Rate for Payer: UHC Exchange |
$173.61
|
| Rate for Payer: UHC Medicaid |
$122.43
|
| Rate for Payer: UHC Medicare Advantage |
$173.61
|
| Rate for Payer: UHCCP Medicaid |
$122.43
|
| Rate for Payer: VA VA |
$173.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.82
|
|
|
HC TYPE III HOME STUDY
|
Facility
|
IP
|
$694.43
|
|
|
Service Code
|
CPT 95800
|
| Hospital Charge Code |
92000015
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$483.32 |
| Max. Negotiated Rate |
$624.99 |
| Rate for Payer: Aetna Commercial |
$590.27
|
| Rate for Payer: BCBS Trust/PPO |
$573.53
|
| Rate for Payer: BCN Commercial |
$573.53
|
| Rate for Payer: Cash Price |
$555.54
|
| Rate for Payer: Cofinity Commercial |
$597.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.54
|
| Rate for Payer: Healthscope Commercial |
$624.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.27
|
| Rate for Payer: Nomi Health Commercial |
$569.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.82
|
| Rate for Payer: PHP Commercial |
$590.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$604.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$483.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.10
|
| Rate for Payer: UHC Core |
$579.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.82
|
|
|
HC TYPE III HOME STUDY W/EFFORT AND FLOW
|
Facility
|
IP
|
$762.72
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$530.85 |
| Max. Negotiated Rate |
$686.45 |
| Rate for Payer: Aetna Commercial |
$648.31
|
| Rate for Payer: BCBS Trust/PPO |
$629.93
|
| Rate for Payer: BCN Commercial |
$629.93
|
| Rate for Payer: Cash Price |
$610.18
|
| Rate for Payer: Cofinity Commercial |
$655.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.18
|
| Rate for Payer: Healthscope Commercial |
$686.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.31
|
| Rate for Payer: Nomi Health Commercial |
$625.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.04
|
| Rate for Payer: PHP Commercial |
$648.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$663.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.19
|
| Rate for Payer: UHC Core |
$636.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.04
|
|
|
HC TYPE III HOME STUDY W/EFFORT AND FLOW
|
Facility
|
OP
|
$762.72
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$134.47 |
| Max. Negotiated Rate |
$686.45 |
| Rate for Payer: Aetna Commercial |
$648.31
|
| Rate for Payer: Aetna Medicare |
$198.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.35
|
| Rate for Payer: BCBS Complete |
$141.18
|
| Rate for Payer: BCBS MAPPO |
$190.68
|
| Rate for Payer: BCBS Trust/PPO |
$627.03
|
| Rate for Payer: BCN Commercial |
$627.03
|
| Rate for Payer: BCN Medicare Advantage |
$190.68
|
| Rate for Payer: Cash Price |
$610.18
|
| Rate for Payer: Cofinity Commercial |
$655.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.68
|
| Rate for Payer: Healthscope Commercial |
$686.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.04
|
| Rate for Payer: Mclaren Medicaid |
$134.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.21
|
| Rate for Payer: Meridian Medicaid |
$141.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$209.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.31
|
| Rate for Payer: Nomi Health Commercial |
$625.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.04
|
| Rate for Payer: PACE Senior Care Partners |
$181.15
|
| Rate for Payer: PACE SWMI |
$190.68
|
| Rate for Payer: PHP Commercial |
$648.31
|
| Rate for Payer: PHP Medicare Advantage |
$190.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$663.57
|
| Rate for Payer: Priority Health Medicare |
$192.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.85
|
| Rate for Payer: Railroad Medicare Medicare |
$190.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.19
|
| Rate for Payer: UHC Core |
$636.87
|
| Rate for Payer: UHC Exchange |
$190.68
|
| Rate for Payer: UHC Medicaid |
$134.47
|
| Rate for Payer: UHC Medicare Advantage |
$190.68
|
| Rate for Payer: UHCCP Medicaid |
$134.47
|
| Rate for Payer: VA VA |
$190.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.04
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$22.72
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCN Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Nomi Health Commercial |
$18.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.99
|
| Rate for Payer: UHC Core |
$18.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.04
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$22.72
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Medicare |
$5.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.10
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$5.68
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.68
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.68
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.04
|
| Rate for Payer: Mclaren Medicaid |
$4.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.96
|
| Rate for Payer: Meridian Medicaid |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Nomi Health Commercial |
$18.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PACE Senior Care Partners |
$5.40
|
| Rate for Payer: PACE SWMI |
$5.68
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Medicare Advantage |
$5.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.77
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: Railroad Medicare Medicare |
$5.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.99
|
| Rate for Payer: UHC Core |
$18.97
|
| Rate for Payer: UHC Exchange |
$5.68
|
| Rate for Payer: UHC Medicaid |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$5.68
|
| Rate for Payer: UHCCP Medicaid |
$4.01
|
| Rate for Payer: VA VA |
$5.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.04
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$38.61
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$34.75 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna Medicare |
$10.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.07
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS MAPPO |
$9.65
|
| Rate for Payer: BCBS Trust/PPO |
$31.74
|
| Rate for Payer: BCN Commercial |
$31.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.65
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.96
|
| Rate for Payer: Mclaren Medicaid |
$6.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.14
|
| Rate for Payer: Meridian Medicaid |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Nomi Health Commercial |
$31.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PACE Senior Care Partners |
$9.17
|
| Rate for Payer: PACE SWMI |
$9.65
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: PHP Medicare Advantage |
$9.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.59
|
| Rate for Payer: Priority Health Medicare |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.87
|
| Rate for Payer: Railroad Medicare Medicare |
$9.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.98
|
| Rate for Payer: UHC Core |
$32.24
|
| Rate for Payer: UHC Exchange |
$9.65
|
| Rate for Payer: UHC Medicaid |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$9.65
|
| Rate for Payer: UHCCP Medicaid |
$6.81
|
| Rate for Payer: VA VA |
$9.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.96
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$38.61
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$34.75 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: BCBS Trust/PPO |
$31.89
|
| Rate for Payer: BCN Commercial |
$31.89
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Nomi Health Commercial |
$31.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.98
|
| Rate for Payer: UHC Core |
$32.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.96
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,861.10
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.41 |
| Max. Negotiated Rate |
$2,574.99 |
| Rate for Payer: Aetna Commercial |
$2,431.93
|
| Rate for Payer: Aetna Medicare |
$743.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$894.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$894.09
|
| Rate for Payer: BCBS Complete |
$529.59
|
| Rate for Payer: BCBS MAPPO |
$715.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,352.11
|
| Rate for Payer: BCN Commercial |
$2,352.11
|
| Rate for Payer: BCN Medicare Advantage |
$715.27
|
| Rate for Payer: Cash Price |
$2,288.88
|
| Rate for Payer: Cofinity Commercial |
$2,460.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,288.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.27
|
| Rate for Payer: Healthscope Commercial |
$2,574.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,145.82
|
| Rate for Payer: Mclaren Medicaid |
$504.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.04
|
| Rate for Payer: Meridian Medicaid |
$529.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$822.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$786.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,431.93
|
| Rate for Payer: Nomi Health Commercial |
$2,346.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,145.82
|
| Rate for Payer: PACE Senior Care Partners |
$679.51
|
| Rate for Payer: PACE SWMI |
$715.27
|
| Rate for Payer: PHP Commercial |
$2,431.93
|
| Rate for Payer: PHP Medicare Advantage |
$715.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,489.16
|
| Rate for Payer: Priority Health Medicare |
$722.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,991.33
|
| Rate for Payer: Railroad Medicare Medicare |
$715.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,517.77
|
| Rate for Payer: UHC Core |
$2,389.02
|
| Rate for Payer: UHC Exchange |
$715.27
|
| Rate for Payer: UHC Medicaid |
$504.41
|
| Rate for Payer: UHC Medicare Advantage |
$715.27
|
| Rate for Payer: UHCCP Medicaid |
$504.41
|
| Rate for Payer: VA VA |
$715.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,145.82
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,861.10
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.33 |
| Max. Negotiated Rate |
$2,574.99 |
| Rate for Payer: Aetna Commercial |
$2,431.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,362.98
|
| Rate for Payer: BCN Commercial |
$2,362.98
|
| Rate for Payer: Cash Price |
$2,288.88
|
| Rate for Payer: Cofinity Commercial |
$2,460.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,288.88
|
| Rate for Payer: Healthscope Commercial |
$2,574.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,145.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,431.93
|
| Rate for Payer: Nomi Health Commercial |
$2,346.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,145.82
|
| Rate for Payer: PHP Commercial |
$2,431.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,489.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,991.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,517.77
|
| Rate for Payer: UHC Core |
$2,389.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,145.82
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.82 |
| 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 |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.79
|
| Rate for Payer: BCN Commercial |
$17.79
|
| Rate for Payer: BCN Medicare Advantage |
$5.41
|
| 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 |
$3.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.68
|
| Rate for Payer: Meridian Medicaid |
$4.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| 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 |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.83
|
| Rate for Payer: Priority Health Medicare |
$5.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.06
|
| 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 Exchange |
$5.41
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.41
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.23
|
|
