|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.06 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$178.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.58
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: BCBS MAPPO |
$171.66
|
| Rate for Payer: BCBS Trust/PPO |
$564.50
|
| Rate for Payer: BCN Commercial |
$564.50
|
| Rate for Payer: BCN Medicare Advantage |
$171.66
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.66
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Mclaren Medicaid |
$121.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.25
|
| Rate for Payer: Meridian Medicaid |
$127.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Senior Care Partners |
$163.08
|
| Rate for Payer: PACE SWMI |
$171.66
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$171.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$597.39
|
| Rate for Payer: Priority Health Medicare |
$173.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.92
|
| Rate for Payer: Railroad Medicare Medicare |
$171.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.26
|
| Rate for Payer: UHC Core |
$573.36
|
| Rate for Payer: UHC Exchange |
$171.66
|
| Rate for Payer: UHC Medicaid |
$121.06
|
| Rate for Payer: UHC Medicare Advantage |
$171.66
|
| Rate for Payer: UHCCP Medicaid |
$121.06
|
| Rate for Payer: VA VA |
$171.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.92 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: BCBS Trust/PPO |
$567.11
|
| Rate for Payer: BCN Commercial |
$567.11
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$597.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.26
|
| Rate for Payer: UHC Core |
$573.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.06 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$178.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.58
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: BCBS MAPPO |
$171.66
|
| Rate for Payer: BCBS Trust/PPO |
$564.50
|
| Rate for Payer: BCN Commercial |
$564.50
|
| Rate for Payer: BCN Medicare Advantage |
$171.66
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.66
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Mclaren Medicaid |
$121.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.25
|
| Rate for Payer: Meridian Medicaid |
$127.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Senior Care Partners |
$163.08
|
| Rate for Payer: PACE SWMI |
$171.66
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$171.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$597.39
|
| Rate for Payer: Priority Health Medicare |
$173.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.92
|
| Rate for Payer: Railroad Medicare Medicare |
$171.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.26
|
| Rate for Payer: UHC Core |
$573.36
|
| Rate for Payer: UHC Exchange |
$171.66
|
| Rate for Payer: UHC Medicaid |
$121.06
|
| Rate for Payer: UHC Medicare Advantage |
$171.66
|
| Rate for Payer: UHCCP Medicaid |
$121.06
|
| Rate for Payer: VA VA |
$171.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.92 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: BCBS Trust/PPO |
$567.11
|
| Rate for Payer: BCN Commercial |
$567.11
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$597.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.26
|
| Rate for Payer: UHC Core |
$573.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$741.19
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.67 |
| Max. Negotiated Rate |
$667.07 |
| Rate for Payer: Aetna Commercial |
$630.01
|
| Rate for Payer: Aetna Medicare |
$192.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.62
|
| Rate for Payer: BCBS Complete |
$137.19
|
| Rate for Payer: BCBS MAPPO |
$185.30
|
| Rate for Payer: BCBS Trust/PPO |
$609.33
|
| Rate for Payer: BCN Commercial |
$609.33
|
| Rate for Payer: BCN Medicare Advantage |
$185.30
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Commercial |
$637.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.30
|
| Rate for Payer: Healthscope Commercial |
$667.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.89
|
| Rate for Payer: Mclaren Medicaid |
$130.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.56
|
| Rate for Payer: Meridian Medicaid |
$137.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Nomi Health Commercial |
$607.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: PACE Senior Care Partners |
$176.03
|
| Rate for Payer: PACE SWMI |
$185.30
|
| Rate for Payer: PHP Commercial |
$630.01
|
| Rate for Payer: PHP Medicare Advantage |
$185.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$644.84
|
| Rate for Payer: Priority Health Medicare |
$187.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$515.87
|
| Rate for Payer: Railroad Medicare Medicare |
$185.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.25
|
| Rate for Payer: UHC Core |
$618.89
|
| Rate for Payer: UHC Exchange |
$185.30
|
| Rate for Payer: UHC Medicaid |
$130.67
|
| Rate for Payer: UHC Medicare Advantage |
$185.30
|
| Rate for Payer: UHCCP Medicaid |
$130.67
|
| Rate for Payer: VA VA |
$185.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.89
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$741.19
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.87 |
| Max. Negotiated Rate |
$667.07 |
| Rate for Payer: Aetna Commercial |
$630.01
|
| Rate for Payer: BCBS Trust/PPO |
$612.15
|
| Rate for Payer: BCN Commercial |
$612.15
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Commercial |
$637.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Healthscope Commercial |
$667.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Nomi Health Commercial |
$607.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: PHP Commercial |
$630.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$644.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$515.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.25
|
| Rate for Payer: UHC Core |
$618.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.89
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$676.26
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.22 |
| Max. Negotiated Rate |
$608.63 |
| Rate for Payer: Aetna Commercial |
$574.82
|
| Rate for Payer: Aetna Medicare |
$175.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.33
|
| Rate for Payer: BCBS Complete |
$125.18
|
| Rate for Payer: BCBS MAPPO |
$169.06
|
| Rate for Payer: BCBS Trust/PPO |
$555.95
|
| Rate for Payer: BCN Commercial |
$555.95
|
| Rate for Payer: BCN Medicare Advantage |
$169.06
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Commercial |
$581.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.06
|
| Rate for Payer: Healthscope Commercial |
$608.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.19
|
| Rate for Payer: Mclaren Medicaid |
$119.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.52
|
| Rate for Payer: Meridian Medicaid |
$125.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: Nomi Health Commercial |
$554.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.19
|
| Rate for Payer: PACE Senior Care Partners |
$160.61
|
| Rate for Payer: PACE SWMI |
$169.06
|
| Rate for Payer: PHP Commercial |
$574.82
|
| Rate for Payer: PHP Medicare Advantage |
$169.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$588.35
|
| Rate for Payer: Priority Health Medicare |
$170.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.68
|
| Rate for Payer: Railroad Medicare Medicare |
$169.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.11
|
| Rate for Payer: UHC Core |
$564.68
|
| Rate for Payer: UHC Exchange |
$169.06
|
| Rate for Payer: UHC Medicaid |
$119.22
|
| Rate for Payer: UHC Medicare Advantage |
$169.06
|
| Rate for Payer: UHCCP Medicaid |
$119.22
|
| Rate for Payer: VA VA |
$169.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.19
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$676.26
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.68 |
| Max. Negotiated Rate |
$608.63 |
| Rate for Payer: Aetna Commercial |
$574.82
|
| Rate for Payer: BCBS Trust/PPO |
$558.52
|
| Rate for Payer: BCN Commercial |
$558.52
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Commercial |
$581.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Healthscope Commercial |
$608.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: Nomi Health Commercial |
$554.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.19
|
| Rate for Payer: PHP Commercial |
$574.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$588.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.11
|
| Rate for Payer: UHC Core |
$564.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.19
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,962.46
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,061.87 |
| Max. Negotiated Rate |
$2,666.21 |
| Rate for Payer: Aetna Commercial |
$2,518.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,446.70
|
| Rate for Payer: BCN Commercial |
$2,446.70
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cofinity Commercial |
$2,547.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,369.97
|
| Rate for Payer: Healthscope Commercial |
$2,666.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.09
|
| Rate for Payer: Nomi Health Commercial |
$2,429.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,221.84
|
| Rate for Payer: PHP Commercial |
$2,518.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,577.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,061.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,606.96
|
| Rate for Payer: UHC Core |
$2,473.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,221.84
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,962.46
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$522.28 |
| Max. Negotiated Rate |
$2,666.21 |
| Rate for Payer: Aetna Commercial |
$2,518.09
|
| Rate for Payer: Aetna Medicare |
$770.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$925.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$925.77
|
| Rate for Payer: BCBS Complete |
$548.35
|
| Rate for Payer: BCBS MAPPO |
$740.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.44
|
| Rate for Payer: BCN Commercial |
$2,435.44
|
| Rate for Payer: BCN Medicare Advantage |
$740.62
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cofinity Commercial |
$2,547.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,369.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$740.62
|
| Rate for Payer: Healthscope Commercial |
$2,666.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,221.84
|
| Rate for Payer: Mclaren Medicaid |
$522.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$777.65
|
| Rate for Payer: Meridian Medicaid |
$548.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$851.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$814.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.09
|
| Rate for Payer: Nomi Health Commercial |
$2,429.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,221.84
|
| Rate for Payer: PACE Senior Care Partners |
$703.58
|
| Rate for Payer: PACE SWMI |
$740.62
|
| Rate for Payer: PHP Commercial |
$2,518.09
|
| Rate for Payer: PHP Medicare Advantage |
$740.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,577.34
|
| Rate for Payer: Priority Health Medicare |
$748.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,061.87
|
| Rate for Payer: Railroad Medicare Medicare |
$740.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,606.96
|
| Rate for Payer: UHC Core |
$2,473.65
|
| Rate for Payer: UHC Exchange |
$740.62
|
| Rate for Payer: UHC Medicaid |
$522.28
|
| Rate for Payer: UHC Medicare Advantage |
$740.62
|
| Rate for Payer: UHCCP Medicaid |
$522.28
|
| Rate for Payer: VA VA |
$740.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,221.84
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$466.11
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.18 |
| Max. Negotiated Rate |
$419.50 |
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna Medicare |
$121.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.66
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$116.53
|
| Rate for Payer: BCBS Trust/PPO |
$383.19
|
| Rate for Payer: BCN Commercial |
$383.19
|
| Rate for Payer: BCN Medicare Advantage |
$116.53
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cofinity Commercial |
$400.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.53
|
| Rate for Payer: Healthscope Commercial |
$419.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.58
|
| Rate for Payer: Mclaren Medicaid |
$82.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.35
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Nomi Health Commercial |
$382.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.58
|
| Rate for Payer: PACE Senior Care Partners |
$110.70
|
| Rate for Payer: PACE SWMI |
$116.53
|
| Rate for Payer: PHP Commercial |
$396.19
|
| Rate for Payer: PHP Medicare Advantage |
$116.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$405.52
|
| Rate for Payer: Priority Health Medicare |
$117.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.41
|
| Rate for Payer: Railroad Medicare Medicare |
$116.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.18
|
| Rate for Payer: UHC Core |
$389.20
|
| Rate for Payer: UHC Exchange |
$116.53
|
| Rate for Payer: UHC Medicaid |
$82.18
|
| Rate for Payer: UHC Medicare Advantage |
$116.53
|
| Rate for Payer: UHCCP Medicaid |
$82.18
|
| Rate for Payer: VA VA |
$116.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.58
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$466.11
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.41 |
| Max. Negotiated Rate |
$419.50 |
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: BCBS Trust/PPO |
$384.96
|
| Rate for Payer: BCN Commercial |
$384.96
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cofinity Commercial |
$400.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.89
|
| Rate for Payer: Healthscope Commercial |
$419.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Nomi Health Commercial |
$382.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.58
|
| Rate for Payer: PHP Commercial |
$396.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$405.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.18
|
| Rate for Payer: UHC Core |
$389.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.58
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$374.61
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.73 |
| Max. Negotiated Rate |
$337.15 |
| Rate for Payer: Aetna Commercial |
$318.42
|
| Rate for Payer: BCBS Trust/PPO |
$309.39
|
| Rate for Payer: BCN Commercial |
$309.39
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cofinity Commercial |
$322.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.69
|
| Rate for Payer: Healthscope Commercial |
$337.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.42
|
| Rate for Payer: Nomi Health Commercial |
$307.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.96
|
| Rate for Payer: PHP Commercial |
$318.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.66
|
| Rate for Payer: UHC Core |
$312.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.96
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$374.61
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$337.15 |
| Rate for Payer: Aetna Commercial |
$318.42
|
| Rate for Payer: Aetna Medicare |
$97.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.07
|
| Rate for Payer: BCBS Complete |
$69.34
|
| Rate for Payer: BCBS MAPPO |
$93.65
|
| Rate for Payer: BCBS Trust/PPO |
$307.97
|
| Rate for Payer: BCN Commercial |
$307.97
|
| Rate for Payer: BCN Medicare Advantage |
$93.65
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cofinity Commercial |
$322.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.65
|
| Rate for Payer: Healthscope Commercial |
$337.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.96
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.34
|
| Rate for Payer: Meridian Medicaid |
$69.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.42
|
| Rate for Payer: Nomi Health Commercial |
$307.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.96
|
| Rate for Payer: PACE Senior Care Partners |
$88.97
|
| Rate for Payer: PACE SWMI |
$93.65
|
| Rate for Payer: PHP Commercial |
$318.42
|
| Rate for Payer: PHP Medicare Advantage |
$93.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.91
|
| Rate for Payer: Priority Health Medicare |
$94.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.73
|
| Rate for Payer: Railroad Medicare Medicare |
$93.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.66
|
| Rate for Payer: UHC Core |
$312.80
|
| Rate for Payer: UHC Exchange |
$93.65
|
| Rate for Payer: UHC Medicaid |
$66.04
|
| Rate for Payer: UHC Medicare Advantage |
$93.65
|
| Rate for Payer: UHCCP Medicaid |
$66.04
|
| Rate for Payer: VA VA |
$93.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.96
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$9,202.56
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,622.41 |
| Max. Negotiated Rate |
$8,282.30 |
| Rate for Payer: Aetna Commercial |
$7,822.18
|
| Rate for Payer: Aetna Medicare |
$2,392.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,875.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,875.80
|
| Rate for Payer: BCBS Complete |
$1,703.39
|
| Rate for Payer: BCBS MAPPO |
$2,300.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,565.42
|
| Rate for Payer: BCN Commercial |
$7,565.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,300.64
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cofinity Commercial |
$7,914.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,362.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,300.64
|
| Rate for Payer: Healthscope Commercial |
$8,282.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,901.92
|
| Rate for Payer: Mclaren Medicaid |
$1,622.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,415.67
|
| Rate for Payer: Meridian Medicaid |
$1,703.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,645.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,530.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,822.18
|
| Rate for Payer: Nomi Health Commercial |
$7,546.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,901.92
|
| Rate for Payer: PACE Senior Care Partners |
$2,185.61
|
| Rate for Payer: PACE SWMI |
$2,300.64
|
| Rate for Payer: PHP Commercial |
$7,822.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,300.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,622.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,006.23
|
| Rate for Payer: Priority Health Medicare |
$2,323.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,404.98
|
| Rate for Payer: Railroad Medicare Medicare |
$2,300.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,098.25
|
| Rate for Payer: UHC Core |
$7,684.14
|
| Rate for Payer: UHC Exchange |
$2,300.64
|
| Rate for Payer: UHC Medicaid |
$1,622.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,300.64
|
| Rate for Payer: UHCCP Medicaid |
$1,622.41
|
| Rate for Payer: VA VA |
$2,300.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,901.92
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$9,202.56
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,404.98 |
| Max. Negotiated Rate |
$8,282.30 |
| Rate for Payer: Aetna Commercial |
$7,822.18
|
| Rate for Payer: BCBS Trust/PPO |
$7,600.39
|
| Rate for Payer: BCN Commercial |
$7,600.39
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cofinity Commercial |
$7,914.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,362.05
|
| Rate for Payer: Healthscope Commercial |
$8,282.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,901.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,822.18
|
| Rate for Payer: Nomi Health Commercial |
$7,546.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,901.92
|
| Rate for Payer: PHP Commercial |
$7,822.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,006.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,404.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,098.25
|
| Rate for Payer: UHC Core |
$7,684.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,901.92
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
OP
|
$4,880.19
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$860.38 |
| Max. Negotiated Rate |
$4,392.17 |
| Rate for Payer: Aetna Commercial |
$4,148.16
|
| Rate for Payer: Aetna Medicare |
$1,268.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,525.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,525.06
|
| Rate for Payer: BCBS Complete |
$903.32
|
| Rate for Payer: BCBS MAPPO |
$1,220.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,012.00
|
| Rate for Payer: BCN Commercial |
$4,012.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,220.05
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cofinity Commercial |
$4,196.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,904.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,220.05
|
| Rate for Payer: Healthscope Commercial |
$4,392.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.14
|
| Rate for Payer: Mclaren Medicaid |
$860.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,281.05
|
| Rate for Payer: Meridian Medicaid |
$903.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,403.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,342.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,148.16
|
| Rate for Payer: Nomi Health Commercial |
$4,001.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.14
|
| Rate for Payer: PACE Senior Care Partners |
$1,159.05
|
| Rate for Payer: PACE SWMI |
$1,220.05
|
| Rate for Payer: PHP Commercial |
$4,148.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,220.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,245.77
|
| Rate for Payer: Priority Health Medicare |
$1,232.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,396.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,220.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,294.57
|
| Rate for Payer: UHC Core |
$4,074.96
|
| Rate for Payer: UHC Exchange |
$1,220.05
|
| Rate for Payer: UHC Medicaid |
$860.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,220.05
|
| Rate for Payer: UHCCP Medicaid |
$860.38
|
| Rate for Payer: VA VA |
$1,220.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.14
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
IP
|
$4,880.19
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,396.61 |
| Max. Negotiated Rate |
$4,392.17 |
| Rate for Payer: Aetna Commercial |
$4,148.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,030.55
|
| Rate for Payer: BCN Commercial |
$4,030.55
|
| Rate for Payer: Cash Price |
$3,904.15
|
| Rate for Payer: Cofinity Commercial |
$4,196.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,904.15
|
| Rate for Payer: Healthscope Commercial |
$4,392.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,660.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,148.16
|
| Rate for Payer: Nomi Health Commercial |
$4,001.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,660.14
|
| Rate for Payer: PHP Commercial |
$4,148.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,245.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,396.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,294.57
|
| Rate for Payer: UHC Core |
$4,074.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,660.14
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCN Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.63
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.45
|
| Rate for Payer: BCN Commercial |
$17.45
|
| Rate for Payer: BCN Medicare Advantage |
$5.31
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.31
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$3.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.04
|
| Rate for Payer: PACE SWMI |
$5.31
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UHC Medicaid |
$3.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.31
|
| Rate for Payer: UHCCP Medicaid |
$3.74
|
| Rate for Payer: VA VA |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
OP
|
$40.22
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$36.20 |
| Rate for Payer: Aetna Commercial |
$34.19
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.57
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$10.05
|
| Rate for Payer: BCBS Trust/PPO |
$33.06
|
| Rate for Payer: BCN Commercial |
$33.06
|
| Rate for Payer: BCN Medicare Advantage |
$10.05
|
| Rate for Payer: Cash Price |
$32.18
|
| Rate for Payer: Cofinity Commercial |
$34.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.05
|
| Rate for Payer: Healthscope Commercial |
$36.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.16
|
| Rate for Payer: Mclaren Medicaid |
$7.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.56
|
| Rate for Payer: Meridian Medicaid |
$7.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.19
|
| Rate for Payer: Nomi Health Commercial |
$32.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.16
|
| Rate for Payer: PACE Senior Care Partners |
$9.55
|
| Rate for Payer: PACE SWMI |
$10.05
|
| Rate for Payer: PHP Commercial |
$34.19
|
| Rate for Payer: PHP Medicare Advantage |
$10.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.99
|
| Rate for Payer: Priority Health Medicare |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.39
|
| Rate for Payer: UHC Core |
$33.58
|
| Rate for Payer: UHC Exchange |
$10.05
|
| Rate for Payer: UHC Medicaid |
$7.09
|
| Rate for Payer: UHC Medicare Advantage |
$10.05
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.16
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
IP
|
$40.22
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$36.20 |
| Rate for Payer: Aetna Commercial |
$34.19
|
| Rate for Payer: BCBS Trust/PPO |
$33.22
|
| Rate for Payer: BCN Commercial |
$33.22
|
| Rate for Payer: Cash Price |
$32.18
|
| Rate for Payer: Cofinity Commercial |
$34.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.18
|
| Rate for Payer: Healthscope Commercial |
$36.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.19
|
| Rate for Payer: Nomi Health Commercial |
$32.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.16
|
| Rate for Payer: PHP Commercial |
$34.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.39
|
| Rate for Payer: UHC Core |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.16
|
|
|
HC UREAPLASMA PCR
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna Medicare |
$22.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.40
|
| Rate for Payer: BCBS Complete |
$16.23
|
| Rate for Payer: BCBS MAPPO |
$21.92
|
| Rate for Payer: BCBS Trust/PPO |
$72.08
|
| Rate for Payer: BCN Commercial |
$72.08
|
| Rate for Payer: BCN Medicare Advantage |
$21.92
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Mclaren Medicaid |
$15.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.02
|
| Rate for Payer: Meridian Medicaid |
$16.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.76
|
| Rate for Payer: PACE Senior Care Partners |
$20.82
|
| Rate for Payer: PACE SWMI |
$21.92
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: PHP Medicare Advantage |
$21.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.28
|
| Rate for Payer: Priority Health Medicare |
$22.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.03
|
| Rate for Payer: Railroad Medicare Medicare |
$21.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.16
|
| Rate for Payer: UHC Core |
$73.21
|
| Rate for Payer: UHC Exchange |
$21.92
|
| Rate for Payer: UHC Medicaid |
$15.46
|
| Rate for Payer: UHC Medicare Advantage |
$21.92
|
| Rate for Payer: UHCCP Medicaid |
$15.46
|
| Rate for Payer: VA VA |
$21.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC UREAPLASMA PCR
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: BCBS Trust/PPO |
$72.41
|
| Rate for Payer: BCN Commercial |
$72.41
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.76
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.16
|
| Rate for Payer: UHC Core |
$73.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
IP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.72 |
| Max. Negotiated Rate |
$56.54 |
| Rate for Payer: Aetna Commercial |
$53.40
|
| Rate for Payer: BCBS Trust/PPO |
$51.88
|
| Rate for Payer: BCN Commercial |
$51.88
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Commercial |
$54.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$56.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$51.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PHP Commercial |
$53.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.28
|
| Rate for Payer: UHC Core |
$52.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.12
|
|
