|
HC SUBCLASS IGG4, SERUM
|
Facility
|
IP
|
$132.60
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: BCBS Trust/PPO |
$108.24
|
| Rate for Payer: BCN Commercial |
$102.47
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.08
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.71
|
| Rate for Payer: Nomi Health Commercial |
$108.73
|
| Rate for Payer: PHP Commercial |
$112.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.19
|
| Rate for Payer: Priority Health HMO/PPO |
$115.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.69
|
| Rate for Payer: UHC Core |
$110.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.45
|
|
|
HC SUBCLASS IGG4, SERUM
|
Facility
|
OP
|
$132.60
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
30100720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: Aetna Medicare |
$34.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.44
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS MAPPO |
$33.15
|
| Rate for Payer: BCBS Trust/PPO |
$109.01
|
| Rate for Payer: BCN Commercial |
$103.10
|
| Rate for Payer: BCN Medicare Advantage |
$33.15
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.15
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.45
|
| Rate for Payer: Mclaren Medicaid |
$5.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.81
|
| Rate for Payer: Meridian Medicaid |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.71
|
| Rate for Payer: Nomi Health Commercial |
$108.73
|
| Rate for Payer: PACE Senior Care Partners |
$31.49
|
| Rate for Payer: PACE SWMI |
$33.15
|
| Rate for Payer: PHP Commercial |
$112.71
|
| Rate for Payer: PHP Medicare Advantage |
$33.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.19
|
| Rate for Payer: Priority Health HMO/PPO |
$115.36
|
| Rate for Payer: Priority Health Medicare |
$33.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.84
|
| Rate for Payer: Railroad Medicare Medicare |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.69
|
| Rate for Payer: UHC Core |
$110.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.15
|
| Rate for Payer: UHC Exchange |
$33.15
|
| Rate for Payer: UHC Medicare Advantage |
$33.15
|
| Rate for Payer: UHCCP Medicaid |
$5.80
|
| Rate for Payer: VA VA |
$33.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.45
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
OP
|
$8,109.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.89 |
| Max. Negotiated Rate |
$7,298.10 |
| Rate for Payer: Aetna Commercial |
$6,892.65
|
| Rate for Payer: Aetna Medicare |
$2,108.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,534.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,534.06
|
| Rate for Payer: BCBS Complete |
$2,412.36
|
| Rate for Payer: BCBS MAPPO |
$2,027.25
|
| Rate for Payer: BCBS Trust/PPO |
$6,666.41
|
| Rate for Payer: BCN Commercial |
$6,304.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,027.25
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$6,973.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,027.25
|
| Rate for Payer: Healthscope Commercial |
$7,298.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,081.75
|
| Rate for Payer: Mclaren Medicaid |
$2,297.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,128.61
|
| Rate for Payer: Meridian Medicaid |
$2,412.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,331.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,925.89
|
| Rate for Payer: PACE SWMI |
$2,027.25
|
| Rate for Payer: PHP Commercial |
$6,892.65
|
| Rate for Payer: PHP Medicare Advantage |
$2,027.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,297.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health HMO/PPO |
$7,054.83
|
| Rate for Payer: Priority Health Medicare |
$2,047.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,433.03
|
| Rate for Payer: Railroad Medicare Medicare |
$2,027.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,135.92
|
| Rate for Payer: UHC Core |
$6,771.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,027.25
|
| Rate for Payer: UHC Exchange |
$2,027.25
|
| Rate for Payer: UHC Medicare Advantage |
$2,027.25
|
| Rate for Payer: UHCCP Medicaid |
$2,297.33
|
| Rate for Payer: VA VA |
$2,027.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,081.75
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Facility
|
IP
|
$8,109.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,270.85 |
| Max. Negotiated Rate |
$7,298.10 |
| Rate for Payer: Aetna Commercial |
$6,892.65
|
| Rate for Payer: BCBS Trust/PPO |
$6,619.38
|
| Rate for Payer: BCN Commercial |
$6,266.64
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$6,973.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Healthscope Commercial |
$7,298.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,081.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: PHP Commercial |
$6,892.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health HMO/PPO |
$7,054.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,433.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,135.92
|
| Rate for Payer: UHC Core |
$6,771.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,081.75
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
OP
|
$12,163.50
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,297.33 |
| Max. Negotiated Rate |
$10,947.15 |
| Rate for Payer: Aetna Commercial |
$10,338.98
|
| Rate for Payer: Aetna Medicare |
$3,162.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,801.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,801.09
|
| Rate for Payer: BCBS Complete |
$2,412.36
|
| Rate for Payer: BCBS MAPPO |
$3,040.88
|
| Rate for Payer: BCBS Trust/PPO |
$9,999.61
|
| Rate for Payer: BCN Commercial |
$9,457.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,040.88
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cofinity Commercial |
$10,460.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,730.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,040.88
|
| Rate for Payer: Healthscope Commercial |
$10,947.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,122.62
|
| Rate for Payer: Mclaren Medicaid |
$2,297.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,192.92
|
| Rate for Payer: Meridian Medicaid |
$2,412.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,497.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,338.98
|
| Rate for Payer: Nomi Health Commercial |
$9,974.07
|
| Rate for Payer: PACE Senior Care Partners |
$2,888.83
|
| Rate for Payer: PACE SWMI |
$3,040.88
|
| Rate for Payer: PHP Commercial |
$10,338.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,040.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,297.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,906.28
|
| Rate for Payer: Priority Health HMO/PPO |
$10,582.24
|
| Rate for Payer: Priority Health Medicare |
$3,071.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,149.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,040.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,703.88
|
| Rate for Payer: UHC Core |
$10,156.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,040.88
|
| Rate for Payer: UHC Exchange |
$3,040.88
|
| Rate for Payer: UHC Medicare Advantage |
$3,040.88
|
| Rate for Payer: UHCCP Medicaid |
$2,297.33
|
| Rate for Payer: VA VA |
$3,040.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,122.62
|
|
|
HC SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL BILAT
|
Facility
|
IP
|
$12,163.50
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
76100378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,906.28 |
| Max. Negotiated Rate |
$10,947.15 |
| Rate for Payer: Aetna Commercial |
$10,338.98
|
| Rate for Payer: BCBS Trust/PPO |
$9,929.07
|
| Rate for Payer: BCN Commercial |
$9,399.95
|
| Rate for Payer: Cash Price |
$9,730.80
|
| Rate for Payer: Cofinity Commercial |
$10,460.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,730.80
|
| Rate for Payer: Healthscope Commercial |
$10,947.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,122.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,338.98
|
| Rate for Payer: Nomi Health Commercial |
$9,974.07
|
| Rate for Payer: PHP Commercial |
$10,338.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,906.28
|
| Rate for Payer: Priority Health HMO/PPO |
$10,582.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,149.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,703.88
|
| Rate for Payer: UHC Core |
$10,156.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,122.62
|
|
|
HC SUCTION A&A LINE
|
Facility
|
IP
|
$32.13
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$28.92 |
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: BCBS Trust/PPO |
$26.23
|
| Rate for Payer: BCN Commercial |
$24.83
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health HMO/PPO |
$27.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.27
|
| Rate for Payer: UHC Core |
$26.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
|
|
HC SUCTION A&A LINE
|
Facility
|
OP
|
$32.13
|
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$28.92 |
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: Aetna Medicare |
$8.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.04
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS MAPPO |
$8.03
|
| Rate for Payer: BCBS Trust/PPO |
$26.41
|
| Rate for Payer: BCN Commercial |
$24.98
|
| Rate for Payer: BCN Medicare Advantage |
$8.03
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.03
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: PACE Senior Care Partners |
$7.63
|
| Rate for Payer: PACE SWMI |
$8.03
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: PHP Medicare Advantage |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health HMO/PPO |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$8.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.53
|
| Rate for Payer: Railroad Medicare Medicare |
$8.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.27
|
| Rate for Payer: UHC Core |
$26.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.03
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$8.03
|
| Rate for Payer: VA VA |
$8.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
IP
|
$44.37
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$39.93 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: BCBS Trust/PPO |
$36.22
|
| Rate for Payer: BCN Commercial |
$34.29
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health HMO/PPO |
$38.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.05
|
| Rate for Payer: UHC Core |
$37.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
|
|
HC SUMP VENTRICULAR LIVANOVA
|
Facility
|
OP
|
$44.37
|
|
| Hospital Charge Code |
27000659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$39.93 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$11.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.87
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: BCBS MAPPO |
$11.09
|
| Rate for Payer: BCBS Trust/PPO |
$36.48
|
| Rate for Payer: BCN Commercial |
$34.50
|
| Rate for Payer: BCN Medicare Advantage |
$11.09
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.09
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: PACE Senior Care Partners |
$10.54
|
| Rate for Payer: PACE SWMI |
$11.09
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: PHP Medicare Advantage |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health HMO/PPO |
$38.60
|
| Rate for Payer: Priority Health Medicare |
$11.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.73
|
| Rate for Payer: Railroad Medicare Medicare |
$11.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.05
|
| Rate for Payer: UHC Core |
$37.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.09
|
| Rate for Payer: UHC Exchange |
$11.09
|
| Rate for Payer: UHC Medicare Advantage |
$11.09
|
| Rate for Payer: VA VA |
$11.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.71
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC SUMP VENTRICULAR MEDTRONIC
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000122
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$34.97
|
| Rate for Payer: BCN Commercial |
$33.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
OP
|
$157.10
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$141.39 |
| Rate for Payer: Aetna Commercial |
$133.54
|
| Rate for Payer: Aetna Medicare |
$40.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.09
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS MAPPO |
$39.28
|
| Rate for Payer: BCBS Trust/PPO |
$129.15
|
| Rate for Payer: BCN Commercial |
$122.15
|
| Rate for Payer: BCN Medicare Advantage |
$39.28
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.28
|
| Rate for Payer: Healthscope Commercial |
$141.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: PACE Senior Care Partners |
$37.31
|
| Rate for Payer: PACE SWMI |
$39.28
|
| Rate for Payer: PHP Commercial |
$133.54
|
| Rate for Payer: PHP Medicare Advantage |
$39.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: Priority Health HMO/PPO |
$136.68
|
| Rate for Payer: Priority Health Medicare |
$39.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.26
|
| Rate for Payer: Railroad Medicare Medicare |
$39.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.25
|
| Rate for Payer: UHC Core |
$131.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.28
|
| Rate for Payer: UHC Exchange |
$39.28
|
| Rate for Payer: UHC Medicare Advantage |
$39.28
|
| Rate for Payer: VA VA |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.82
|
|
|
HC SUPERVISION & HANDLING
|
Facility
|
IP
|
$157.10
|
|
|
Service Code
|
CPT 77790
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$141.39 |
| Rate for Payer: Aetna Commercial |
$133.54
|
| Rate for Payer: BCBS Trust/PPO |
$128.24
|
| Rate for Payer: BCN Commercial |
$121.41
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$141.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.54
|
| Rate for Payer: Nomi Health Commercial |
$128.82
|
| Rate for Payer: PHP Commercial |
$133.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.12
|
| Rate for Payer: Priority Health HMO/PPO |
$136.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.25
|
| Rate for Payer: UHC Core |
$131.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.82
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
OP
|
$86.70
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: BCBS Complete |
$18.30
|
| Rate for Payer: BCBS MAPPO |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$71.28
|
| Rate for Payer: BCN Commercial |
$67.41
|
| Rate for Payer: BCN Medicare Advantage |
$21.68
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$74.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.02
|
| Rate for Payer: Mclaren Medicaid |
$17.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.76
|
| Rate for Payer: Meridian Medicaid |
$18.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Nomi Health Commercial |
$71.09
|
| Rate for Payer: PACE Senior Care Partners |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.68
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: PHP Medicare Advantage |
$21.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health HMO/PPO |
$75.43
|
| Rate for Payer: Priority Health Medicare |
$21.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.09
|
| Rate for Payer: Railroad Medicare Medicare |
$21.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.30
|
| Rate for Payer: UHC Core |
$72.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.68
|
| Rate for Payer: UHC Exchange |
$21.68
|
| Rate for Payer: UHC Medicare Advantage |
$21.68
|
| Rate for Payer: UHCCP Medicaid |
$17.43
|
| Rate for Payer: VA VA |
$21.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.02
|
|
|
HC SUPPLEMENTAL NEWBORN SCRN
|
Facility
|
IP
|
$86.70
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.36 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: BCBS Trust/PPO |
$70.77
|
| Rate for Payer: BCN Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$69.36
|
| Rate for Payer: Cofinity Commercial |
$74.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.36
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Nomi Health Commercial |
$71.09
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health HMO/PPO |
$75.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.30
|
| Rate for Payer: UHC Core |
$72.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.02
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$118.97
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna Commercial |
$101.12
|
| Rate for Payer: Aetna Medicare |
$30.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.18
|
| Rate for Payer: BCBS Complete |
$47.59
|
| Rate for Payer: BCBS MAPPO |
$29.74
|
| Rate for Payer: BCBS Trust/PPO |
$97.81
|
| Rate for Payer: BCN Commercial |
$92.50
|
| Rate for Payer: BCN Medicare Advantage |
$29.74
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.74
|
| Rate for Payer: Healthscope Commercial |
$107.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.12
|
| Rate for Payer: Nomi Health Commercial |
$97.56
|
| Rate for Payer: PACE Senior Care Partners |
$28.26
|
| Rate for Payer: PACE SWMI |
$29.74
|
| Rate for Payer: PHP Commercial |
$101.12
|
| Rate for Payer: PHP Medicare Advantage |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.33
|
| Rate for Payer: Priority Health HMO/PPO |
$103.50
|
| Rate for Payer: Priority Health Medicare |
$30.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.71
|
| Rate for Payer: Railroad Medicare Medicare |
$29.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.69
|
| Rate for Payer: UHC Core |
$99.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.74
|
| Rate for Payer: UHC Exchange |
$29.74
|
| Rate for Payer: UHC Medicare Advantage |
$29.74
|
| Rate for Payer: VA VA |
$29.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.23
|
|
|
HC SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$118.97
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
27200072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna Commercial |
$101.12
|
| Rate for Payer: BCBS Trust/PPO |
$97.12
|
| Rate for Payer: BCN Commercial |
$91.94
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.18
|
| Rate for Payer: Healthscope Commercial |
$107.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.12
|
| Rate for Payer: Nomi Health Commercial |
$97.56
|
| Rate for Payer: PHP Commercial |
$101.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.33
|
| Rate for Payer: Priority Health HMO/PPO |
$103.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.69
|
| Rate for Payer: UHC Core |
$99.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.23
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna Commercial |
$63.50
|
| Rate for Payer: BCBS Trust/PPO |
$60.98
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.50
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: PHP Commercial |
$63.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.56
|
| Rate for Payer: Priority Health HMO/PPO |
$64.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.74
|
| Rate for Payer: UHC Core |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.02
|
|
|
HC SURGERY FROZEN EA ADDL
|
Facility
|
OP
|
$74.70
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
31000057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna Commercial |
$63.50
|
| Rate for Payer: Aetna Medicare |
$19.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.34
|
| Rate for Payer: BCBS Complete |
$29.88
|
| Rate for Payer: BCBS MAPPO |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$61.41
|
| Rate for Payer: BCCCP Commercial |
$51.41
|
| Rate for Payer: BCN Commercial |
$58.08
|
| Rate for Payer: BCN Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.50
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: PACE Senior Care Partners |
$17.74
|
| Rate for Payer: PACE SWMI |
$18.68
|
| Rate for Payer: PHP Commercial |
$63.50
|
| Rate for Payer: PHP Medicare Advantage |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.56
|
| Rate for Payer: Priority Health HMO/PPO |
$64.99
|
| Rate for Payer: Priority Health Medicare |
$18.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.74
|
| Rate for Payer: UHC Core |
$62.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.68
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.02
|
|
|
HC SURGICAL HAND
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$457.87 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: BCBS Trust/PPO |
$575.02
|
| Rate for Payer: BCN Commercial |
$544.38
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.87
|
| Rate for Payer: Priority Health HMO/PPO |
$612.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$471.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.89
|
| Rate for Payer: UHC Core |
$588.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.32
|
|
|
HC SURGICAL HAND
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna Medicare |
$183.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.13
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: BCBS MAPPO |
$176.10
|
| Rate for Payer: BCBS Trust/PPO |
$579.10
|
| Rate for Payer: BCN Commercial |
$547.69
|
| Rate for Payer: BCN Medicare Advantage |
$176.10
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.10
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: PACE Senior Care Partners |
$167.30
|
| Rate for Payer: PACE SWMI |
$176.10
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: PHP Medicare Advantage |
$176.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.87
|
| Rate for Payer: Priority Health HMO/PPO |
$612.85
|
| Rate for Payer: Priority Health Medicare |
$177.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$471.96
|
| Rate for Payer: Railroad Medicare Medicare |
$176.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.89
|
| Rate for Payer: UHC Core |
$588.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.10
|
| Rate for Payer: UHC Exchange |
$176.10
|
| Rate for Payer: UHC Medicare Advantage |
$176.10
|
| Rate for Payer: VA VA |
$176.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.32
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
IP
|
$86.43
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: BCBS Trust/PPO |
$70.55
|
| Rate for Payer: BCN Commercial |
$66.79
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: Nomi Health Commercial |
$70.87
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health HMO/PPO |
$75.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.06
|
| Rate for Payer: UHC Core |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.82
|
|
|
HC SURG SUPPLY MISC
|
Facility
|
OP
|
$86.43
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
62300132
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: Aetna Medicare |
$22.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.01
|
| Rate for Payer: BCBS Complete |
$34.57
|
| Rate for Payer: BCBS MAPPO |
$21.61
|
| Rate for Payer: BCBS Trust/PPO |
$71.05
|
| Rate for Payer: BCN Commercial |
$67.20
|
| Rate for Payer: BCN Medicare Advantage |
$21.61
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.61
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: Nomi Health Commercial |
$70.87
|
| Rate for Payer: PACE Senior Care Partners |
$20.53
|
| Rate for Payer: PACE SWMI |
$21.61
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: PHP Medicare Advantage |
$21.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health HMO/PPO |
$75.19
|
| Rate for Payer: Priority Health Medicare |
$21.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.91
|
| Rate for Payer: Railroad Medicare Medicare |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.06
|
| Rate for Payer: UHC Core |
$72.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.61
|
| Rate for Payer: UHC Exchange |
$21.61
|
| Rate for Payer: UHC Medicare Advantage |
$21.61
|
| Rate for Payer: VA VA |
$21.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.82
|
|
|
HC SUSCEPTIBILITY DISK
|
Facility
|
OP
|
$58.65
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
30600098
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$49.85
|
| Rate for Payer: Aetna Medicare |
$15.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.33
|
| Rate for Payer: BCBS Complete |
$5.68
|
| Rate for Payer: BCBS MAPPO |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$48.22
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: BCN Medicare Advantage |
$14.66
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$50.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$52.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.99
|
| Rate for Payer: Mclaren Medicaid |
$5.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.40
|
| Rate for Payer: Meridian Medicaid |
$5.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: Nomi Health Commercial |
$48.09
|
| Rate for Payer: PACE Senior Care Partners |
$13.93
|
| Rate for Payer: PACE SWMI |
$14.66
|
| Rate for Payer: PHP Commercial |
$49.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: Priority Health HMO/PPO |
$51.03
|
| Rate for Payer: Priority Health Medicare |
$14.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.30
|
| Rate for Payer: Railroad Medicare Medicare |
$14.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.61
|
| Rate for Payer: UHC Core |
$48.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.66
|
| Rate for Payer: UHC Exchange |
$14.66
|
| Rate for Payer: UHC Medicare Advantage |
$14.66
|
| Rate for Payer: UHCCP Medicaid |
$5.41
|
| Rate for Payer: VA VA |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.99
|
|
