|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$781.02
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: Aetna Medicare |
$203.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$244.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$244.07
|
| Rate for Payer: BCBS Complete |
$144.57
|
| Rate for Payer: BCBS MAPPO |
$195.25
|
| Rate for Payer: BCBS Trust/PPO |
$642.08
|
| Rate for Payer: BCN Commercial |
$642.08
|
| Rate for Payer: BCN Medicare Advantage |
$195.25
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.25
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.76
|
| Rate for Payer: Mclaren Medicaid |
$137.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.02
|
| Rate for Payer: Meridian Medicaid |
$144.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PACE Senior Care Partners |
$185.49
|
| Rate for Payer: PACE SWMI |
$195.25
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: PHP Medicare Advantage |
$195.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$679.49
|
| Rate for Payer: Priority Health Medicare |
$197.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$543.59
|
| Rate for Payer: Railroad Medicare Medicare |
$195.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.30
|
| Rate for Payer: UHC Core |
$652.15
|
| Rate for Payer: UHC Exchange |
$195.25
|
| Rate for Payer: UHC Medicaid |
$137.69
|
| Rate for Payer: UHC Medicare Advantage |
$195.25
|
| Rate for Payer: UHCCP Medicaid |
$137.69
|
| Rate for Payer: VA VA |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.76
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$728.91
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.32 |
| Max. Negotiated Rate |
$656.02 |
| Rate for Payer: Aetna Commercial |
$619.57
|
| Rate for Payer: BCBS Trust/PPO |
$602.01
|
| Rate for Payer: BCN Commercial |
$602.01
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cofinity Commercial |
$626.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.13
|
| Rate for Payer: Healthscope Commercial |
$656.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.57
|
| Rate for Payer: Nomi Health Commercial |
$597.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.68
|
| Rate for Payer: PHP Commercial |
$619.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$634.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.44
|
| Rate for Payer: UHC Core |
$608.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.68
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$728.91
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.51 |
| Max. Negotiated Rate |
$656.02 |
| Rate for Payer: Aetna Commercial |
$619.57
|
| Rate for Payer: Aetna Medicare |
$189.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$227.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$227.78
|
| Rate for Payer: BCBS Complete |
$134.92
|
| Rate for Payer: BCBS MAPPO |
$182.23
|
| Rate for Payer: BCBS Trust/PPO |
$599.24
|
| Rate for Payer: BCN Commercial |
$599.24
|
| Rate for Payer: BCN Medicare Advantage |
$182.23
|
| Rate for Payer: Cash Price |
$583.13
|
| Rate for Payer: Cofinity Commercial |
$626.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.23
|
| Rate for Payer: Healthscope Commercial |
$656.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.68
|
| Rate for Payer: Mclaren Medicaid |
$128.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.34
|
| Rate for Payer: Meridian Medicaid |
$134.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.57
|
| Rate for Payer: Nomi Health Commercial |
$597.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.68
|
| Rate for Payer: PACE Senior Care Partners |
$173.12
|
| Rate for Payer: PACE SWMI |
$182.23
|
| Rate for Payer: PHP Commercial |
$619.57
|
| Rate for Payer: PHP Medicare Advantage |
$182.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$634.15
|
| Rate for Payer: Priority Health Medicare |
$184.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.32
|
| Rate for Payer: Railroad Medicare Medicare |
$182.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.44
|
| Rate for Payer: UHC Core |
$608.64
|
| Rate for Payer: UHC Exchange |
$182.23
|
| Rate for Payer: UHC Medicaid |
$128.51
|
| Rate for Payer: UHC Medicare Advantage |
$182.23
|
| Rate for Payer: UHCCP Medicaid |
$128.51
|
| Rate for Payer: VA VA |
$182.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.68
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$17.23
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna Medicare |
$4.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.38
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS MAPPO |
$4.31
|
| Rate for Payer: BCBS Trust/PPO |
$14.16
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: BCN Medicare Advantage |
$4.31
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.31
|
| Rate for Payer: Healthscope Commercial |
$15.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.92
|
| Rate for Payer: Mclaren Medicaid |
$3.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.52
|
| Rate for Payer: Meridian Medicaid |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$14.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.92
|
| Rate for Payer: PACE Senior Care Partners |
$4.09
|
| Rate for Payer: PACE SWMI |
$4.31
|
| Rate for Payer: PHP Commercial |
$14.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.16
|
| Rate for Payer: UHC Core |
$14.39
|
| Rate for Payer: UHC Exchange |
$4.31
|
| Rate for Payer: UHC Medicaid |
$3.04
|
| Rate for Payer: UHC Medicare Advantage |
$4.31
|
| Rate for Payer: UHCCP Medicaid |
$3.04
|
| Rate for Payer: VA VA |
$4.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.92
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$17.23
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$15.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$14.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.92
|
| Rate for Payer: PHP Commercial |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.16
|
| Rate for Payer: UHC Core |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.92
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$801.68
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.97 |
| Max. Negotiated Rate |
$721.51 |
| Rate for Payer: Aetna Commercial |
$681.43
|
| Rate for Payer: BCBS Trust/PPO |
$662.11
|
| Rate for Payer: BCN Commercial |
$662.11
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cofinity Commercial |
$689.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.34
|
| Rate for Payer: Healthscope Commercial |
$721.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.43
|
| Rate for Payer: Nomi Health Commercial |
$657.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.26
|
| Rate for Payer: PHP Commercial |
$681.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$697.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$557.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.48
|
| Rate for Payer: UHC Core |
$669.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.26
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
OP
|
$801.68
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$141.34 |
| Max. Negotiated Rate |
$721.51 |
| Rate for Payer: Aetna Commercial |
$681.43
|
| Rate for Payer: Aetna Medicare |
$208.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.53
|
| Rate for Payer: BCBS Complete |
$148.39
|
| Rate for Payer: BCBS MAPPO |
$200.42
|
| Rate for Payer: BCBS Trust/PPO |
$659.06
|
| Rate for Payer: BCN Commercial |
$659.06
|
| Rate for Payer: BCN Medicare Advantage |
$200.42
|
| Rate for Payer: Cash Price |
$641.34
|
| Rate for Payer: Cofinity Commercial |
$689.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.42
|
| Rate for Payer: Healthscope Commercial |
$721.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.26
|
| Rate for Payer: Mclaren Medicaid |
$141.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.44
|
| Rate for Payer: Meridian Medicaid |
$148.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.43
|
| Rate for Payer: Nomi Health Commercial |
$657.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.26
|
| Rate for Payer: PACE Senior Care Partners |
$190.40
|
| Rate for Payer: PACE SWMI |
$200.42
|
| Rate for Payer: PHP Commercial |
$681.43
|
| Rate for Payer: PHP Medicare Advantage |
$200.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$697.46
|
| Rate for Payer: Priority Health Medicare |
$202.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$557.97
|
| Rate for Payer: Railroad Medicare Medicare |
$200.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.48
|
| Rate for Payer: UHC Core |
$669.40
|
| Rate for Payer: UHC Exchange |
$200.42
|
| Rate for Payer: UHC Medicaid |
$141.34
|
| Rate for Payer: UHC Medicare Advantage |
$200.42
|
| Rate for Payer: UHCCP Medicaid |
$141.34
|
| Rate for Payer: VA VA |
$200.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.26
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.02 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: BCBS Trust/PPO |
$409.42
|
| Rate for Payer: BCN Commercial |
$409.42
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.23
|
| Rate for Payer: UHC Core |
$413.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.79
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna Medicare |
$128.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.91
|
| Rate for Payer: BCBS Complete |
$91.76
|
| Rate for Payer: BCBS MAPPO |
$123.93
|
| Rate for Payer: BCBS Trust/PPO |
$407.53
|
| Rate for Payer: BCN Commercial |
$407.53
|
| Rate for Payer: BCN Medicare Advantage |
$123.93
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.93
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.79
|
| Rate for Payer: Mclaren Medicaid |
$87.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.13
|
| Rate for Payer: Meridian Medicaid |
$91.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Senior Care Partners |
$117.73
|
| Rate for Payer: PACE SWMI |
$123.93
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: PHP Medicare Advantage |
$123.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.28
|
| Rate for Payer: Priority Health Medicare |
$125.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.02
|
| Rate for Payer: Railroad Medicare Medicare |
$123.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.23
|
| Rate for Payer: UHC Core |
$413.93
|
| Rate for Payer: UHC Exchange |
$123.93
|
| Rate for Payer: UHC Medicaid |
$87.40
|
| Rate for Payer: UHC Medicare Advantage |
$123.93
|
| Rate for Payer: UHCCP Medicaid |
$87.40
|
| Rate for Payer: VA VA |
$123.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.79
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$694.03
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$483.04 |
| Max. Negotiated Rate |
$624.63 |
| Rate for Payer: Aetna Commercial |
$589.93
|
| Rate for Payer: BCBS Trust/PPO |
$573.20
|
| Rate for Payer: BCN Commercial |
$573.20
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cofinity Commercial |
$596.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.22
|
| Rate for Payer: Healthscope Commercial |
$624.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.93
|
| Rate for Payer: Nomi Health Commercial |
$569.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.52
|
| Rate for Payer: PHP Commercial |
$589.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$603.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$483.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$610.75
|
| Rate for Payer: UHC Core |
$579.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.52
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$694.03
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$624.63 |
| Rate for Payer: Aetna Commercial |
$589.93
|
| Rate for Payer: Aetna Medicare |
$180.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.88
|
| Rate for Payer: BCBS Complete |
$128.46
|
| Rate for Payer: BCBS MAPPO |
$173.51
|
| Rate for Payer: BCBS Trust/PPO |
$570.56
|
| Rate for Payer: BCN Commercial |
$570.56
|
| Rate for Payer: BCN Medicare Advantage |
$173.51
|
| Rate for Payer: Cash Price |
$555.22
|
| Rate for Payer: Cofinity Commercial |
$596.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.51
|
| Rate for Payer: Healthscope Commercial |
$624.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.52
|
| Rate for Payer: Mclaren Medicaid |
$122.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.18
|
| Rate for Payer: Meridian Medicaid |
$128.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$190.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.93
|
| Rate for Payer: Nomi Health Commercial |
$569.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$520.52
|
| Rate for Payer: PACE Senior Care Partners |
$164.83
|
| Rate for Payer: PACE SWMI |
$173.51
|
| Rate for Payer: PHP Commercial |
$589.93
|
| Rate for Payer: PHP Medicare Advantage |
$173.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$603.81
|
| Rate for Payer: Priority Health Medicare |
$175.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$483.04
|
| Rate for Payer: Railroad Medicare Medicare |
$173.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$610.75
|
| Rate for Payer: UHC Core |
$579.52
|
| Rate for Payer: UHC Exchange |
$173.51
|
| Rate for Payer: UHC Medicaid |
$122.36
|
| Rate for Payer: UHC Medicare Advantage |
$173.51
|
| Rate for Payer: UHCCP Medicaid |
$122.36
|
| Rate for Payer: VA VA |
$173.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.52
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.03 |
| Max. Negotiated Rate |
$152.63 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: BCBS Trust/PPO |
$140.06
|
| Rate for Payer: BCN Commercial |
$140.06
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Commercial |
$145.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Healthscope Commercial |
$152.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$139.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PHP Commercial |
$144.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.24
|
| Rate for Payer: UHC Core |
$141.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.19
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$152.63 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: Aetna Medicare |
$44.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.00
|
| Rate for Payer: BCBS Complete |
$31.39
|
| Rate for Payer: BCBS MAPPO |
$42.40
|
| Rate for Payer: BCBS Trust/PPO |
$139.42
|
| Rate for Payer: BCN Commercial |
$139.42
|
| Rate for Payer: BCN Medicare Advantage |
$42.40
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Commercial |
$145.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$152.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.19
|
| Rate for Payer: Mclaren Medicaid |
$29.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.52
|
| Rate for Payer: Meridian Medicaid |
$31.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$139.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PACE Senior Care Partners |
$40.28
|
| Rate for Payer: PACE SWMI |
$42.40
|
| Rate for Payer: PHP Commercial |
$144.15
|
| Rate for Payer: PHP Medicare Advantage |
$42.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.54
|
| Rate for Payer: Priority Health Medicare |
$42.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.03
|
| Rate for Payer: Railroad Medicare Medicare |
$42.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.24
|
| Rate for Payer: UHC Core |
$141.61
|
| Rate for Payer: UHC Exchange |
$42.40
|
| Rate for Payer: UHC Medicaid |
$29.90
|
| Rate for Payer: UHC Medicare Advantage |
$42.40
|
| Rate for Payer: UHCCP Medicaid |
$29.90
|
| Rate for Payer: VA VA |
$42.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.19
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$151.69 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: BCBS Trust/PPO |
$139.20
|
| Rate for Payer: BCN Commercial |
$139.20
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$138.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.41
|
| Rate for Payer: PHP Commercial |
$143.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.32
|
| Rate for Payer: UHC Core |
$140.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.41
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$168.54
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$151.69 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Medicare |
$43.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.67
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$42.13
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$138.56
|
| Rate for Payer: BCN Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.13
|
| Rate for Payer: Healthscope Commercial |
$151.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.41
|
| Rate for Payer: Mclaren Medicaid |
$29.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.24
|
| Rate for Payer: Meridian Medicaid |
$31.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.26
|
| Rate for Payer: Nomi Health Commercial |
$138.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.41
|
| Rate for Payer: PACE Senior Care Partners |
$40.03
|
| Rate for Payer: PACE SWMI |
$42.13
|
| Rate for Payer: PHP Commercial |
$143.26
|
| Rate for Payer: PHP Medicare Advantage |
$42.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.63
|
| Rate for Payer: Priority Health Medicare |
$42.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.30
|
| Rate for Payer: Railroad Medicare Medicare |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.32
|
| Rate for Payer: UHC Core |
$140.73
|
| Rate for Payer: UHC Exchange |
$42.13
|
| Rate for Payer: UHC Medicaid |
$29.71
|
| Rate for Payer: UHC Medicare Advantage |
$42.13
|
| Rate for Payer: UHCCP Medicaid |
$29.71
|
| Rate for Payer: VA VA |
$42.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.41
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$520.60
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$362.34 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: BCBS Trust/PPO |
$429.96
|
| Rate for Payer: BCN Commercial |
$429.96
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.13
|
| Rate for Payer: UHC Core |
$434.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.45
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$520.60
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.78 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna Medicare |
$135.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.69
|
| Rate for Payer: BCBS Complete |
$96.36
|
| Rate for Payer: BCBS MAPPO |
$130.15
|
| Rate for Payer: BCBS Trust/PPO |
$427.99
|
| Rate for Payer: BCN Commercial |
$427.99
|
| Rate for Payer: BCN Medicare Advantage |
$130.15
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.15
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.45
|
| Rate for Payer: Mclaren Medicaid |
$91.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.66
|
| Rate for Payer: Meridian Medicaid |
$96.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PACE Senior Care Partners |
$123.64
|
| Rate for Payer: PACE SWMI |
$130.15
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: PHP Medicare Advantage |
$130.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.92
|
| Rate for Payer: Priority Health Medicare |
$131.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.34
|
| Rate for Payer: Railroad Medicare Medicare |
$130.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.13
|
| Rate for Payer: UHC Core |
$434.70
|
| Rate for Payer: UHC Exchange |
$130.15
|
| Rate for Payer: UHC Medicaid |
$91.78
|
| Rate for Payer: UHC Medicare Advantage |
$130.15
|
| Rate for Payer: UHCCP Medicaid |
$91.78
|
| Rate for Payer: VA VA |
$130.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.45
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$8,219.16
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,449.04 |
| Max. Negotiated Rate |
$7,397.24 |
| Rate for Payer: Aetna Commercial |
$6,986.29
|
| Rate for Payer: Aetna Medicare |
$2,136.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,568.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,568.49
|
| Rate for Payer: BCBS Complete |
$1,521.37
|
| Rate for Payer: BCBS MAPPO |
$2,054.79
|
| Rate for Payer: BCBS Trust/PPO |
$6,756.97
|
| Rate for Payer: BCN Commercial |
$6,756.97
|
| Rate for Payer: BCN Medicare Advantage |
$2,054.79
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Commercial |
$7,068.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,054.79
|
| Rate for Payer: Healthscope Commercial |
$7,397.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,164.37
|
| Rate for Payer: Mclaren Medicaid |
$1,449.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,157.53
|
| Rate for Payer: Meridian Medicaid |
$1,521.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,363.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,260.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Nomi Health Commercial |
$6,739.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: PACE Senior Care Partners |
$1,952.05
|
| Rate for Payer: PACE SWMI |
$2,054.79
|
| Rate for Payer: PHP Commercial |
$6,986.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,054.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,449.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,150.67
|
| Rate for Payer: Priority Health Medicare |
$2,075.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,720.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,054.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,232.86
|
| Rate for Payer: UHC Core |
$6,863.00
|
| Rate for Payer: UHC Exchange |
$2,054.79
|
| Rate for Payer: UHC Medicaid |
$1,449.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,054.79
|
| Rate for Payer: UHCCP Medicaid |
$1,449.04
|
| Rate for Payer: VA VA |
$2,054.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,164.37
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$8,219.16
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,720.54 |
| Max. Negotiated Rate |
$7,397.24 |
| Rate for Payer: Aetna Commercial |
$6,986.29
|
| Rate for Payer: BCBS Trust/PPO |
$6,788.20
|
| Rate for Payer: BCN Commercial |
$6,788.20
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Commercial |
$7,068.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Healthscope Commercial |
$7,397.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,164.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Nomi Health Commercial |
$6,739.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: PHP Commercial |
$6,986.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,150.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,720.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,232.86
|
| Rate for Payer: UHC Core |
$6,863.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,164.37
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$11.55
|
| Rate for Payer: BCBS MAPPO |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$51.32
|
| Rate for Payer: BCN Medicare Advantage |
$15.61
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$11.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.61
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Exchange |
$15.61
|
| Rate for Payer: UHC Medicaid |
$11.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.61
|
| Rate for Payer: UHCCP Medicaid |
$11.00
|
| Rate for Payer: VA VA |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$494.19
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$343.96 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: BCBS Trust/PPO |
$408.15
|
| Rate for Payer: BCN Commercial |
$408.15
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$405.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$429.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.89
|
| Rate for Payer: UHC Core |
$412.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.64
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$87.13 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna Medicare |
$128.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.43
|
| Rate for Payer: BCBS Complete |
$91.47
|
| Rate for Payer: BCBS MAPPO |
$123.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.27
|
| Rate for Payer: BCN Commercial |
$406.27
|
| Rate for Payer: BCN Medicare Advantage |
$123.55
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.55
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.64
|
| Rate for Payer: Mclaren Medicaid |
$87.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.72
|
| Rate for Payer: Meridian Medicaid |
$91.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$405.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PACE Senior Care Partners |
$117.37
|
| Rate for Payer: PACE SWMI |
$123.55
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: PHP Medicare Advantage |
$123.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$429.95
|
| Rate for Payer: Priority Health Medicare |
$124.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.96
|
| Rate for Payer: Railroad Medicare Medicare |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.89
|
| Rate for Payer: UHC Core |
$412.65
|
| Rate for Payer: UHC Exchange |
$123.55
|
| Rate for Payer: UHC Medicaid |
$87.13
|
| Rate for Payer: UHC Medicare Advantage |
$123.55
|
| Rate for Payer: UHCCP Medicaid |
$87.13
|
| Rate for Payer: VA VA |
$123.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.64
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$52.96
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$235.21
|
| Rate for Payer: BCN Commercial |
$235.21
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Mclaren Medicaid |
$50.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: Meridian Medicaid |
$52.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$72.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.13
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: UHC Exchange |
$71.53
|
| Rate for Payer: UHC Medicaid |
$50.44
|
| Rate for Payer: UHC Medicare Advantage |
$71.53
|
| Rate for Payer: UHCCP Medicaid |
$50.44
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$199.13 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: BCBS Trust/PPO |
$236.30
|
| Rate for Payer: BCN Commercial |
$236.30
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
