|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: BCBS Trust/PPO |
$274.32
|
| Rate for Payer: BCN Commercial |
$259.70
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
HC TX TARSAL BONE FX, EXCEPT TALUS/CALCANEUS; W/O MANIP
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.81 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$87.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.02
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$84.01
|
| Rate for Payer: BCBS Trust/PPO |
$276.27
|
| Rate for Payer: BCN Commercial |
$261.28
|
| Rate for Payer: BCN Medicare Advantage |
$84.01
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.01
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.21
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: PACE Senior Care Partners |
$79.81
|
| Rate for Payer: PACE SWMI |
$84.01
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Medicare |
$84.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.15
|
| Rate for Payer: Railroad Medicare Medicare |
$84.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.01
|
| Rate for Payer: UHC Exchange |
$84.01
|
| Rate for Payer: UHC Medicare Advantage |
$84.01
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$84.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
OP
|
$4,285.00
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,017.69 |
| Max. Negotiated Rate |
$3,856.50 |
| Rate for Payer: Aetna Commercial |
$3,642.25
|
| Rate for Payer: Aetna Medicare |
$1,114.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,339.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,339.06
|
| Rate for Payer: BCBS Complete |
$1,124.59
|
| Rate for Payer: BCBS MAPPO |
$1,071.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,522.70
|
| Rate for Payer: BCN Commercial |
$3,331.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.25
|
| Rate for Payer: Cash Price |
$3,428.00
|
| Rate for Payer: Cash Price |
$3,428.00
|
| Rate for Payer: Cofinity Commercial |
$3,685.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,428.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.25
|
| Rate for Payer: Healthscope Commercial |
$3,856.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,213.75
|
| Rate for Payer: Mclaren Medicaid |
$1,070.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.81
|
| Rate for Payer: Meridian Medicaid |
$1,124.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,231.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.25
|
| Rate for Payer: Nomi Health Commercial |
$3,513.70
|
| Rate for Payer: PACE Senior Care Partners |
$1,017.69
|
| Rate for Payer: PACE SWMI |
$1,071.25
|
| Rate for Payer: PHP Commercial |
$3,642.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.25
|
| Rate for Payer: Priority Health HMO/PPO |
$3,727.95
|
| Rate for Payer: Priority Health Medicare |
$1,081.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,870.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,071.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,770.80
|
| Rate for Payer: UHC Core |
$3,577.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.25
|
| Rate for Payer: UHC Exchange |
$1,071.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.25
|
| Rate for Payer: UHCCP Medicaid |
$1,070.97
|
| Rate for Payer: VA VA |
$1,071.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,213.75
|
|
|
HC TYMPANIC MEMBRANE REPAIR W/WO PREP OF PERF W/WO PATCH
|
Facility
|
IP
|
$4,285.00
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
76100523
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,785.25 |
| Max. Negotiated Rate |
$3,856.50 |
| Rate for Payer: Aetna Commercial |
$3,642.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,497.85
|
| Rate for Payer: BCN Commercial |
$3,311.45
|
| Rate for Payer: Cash Price |
$3,428.00
|
| Rate for Payer: Cofinity Commercial |
$3,685.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,428.00
|
| Rate for Payer: Healthscope Commercial |
$3,856.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.25
|
| Rate for Payer: Nomi Health Commercial |
$3,513.70
|
| Rate for Payer: PHP Commercial |
$3,642.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.25
|
| Rate for Payer: Priority Health HMO/PPO |
$3,727.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,870.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,770.80
|
| Rate for Payer: UHC Core |
$3,577.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,213.75
|
|
|
HC TYMPANOMETRY
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: BCBS Trust/PPO |
$23.78
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC TYMPANOMETRY
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
47100008
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Mclaren Medicaid |
$28.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.65
|
| Rate for Payer: Meridian Medicaid |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Medicare |
$7.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$7.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$28.38
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$148.92
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.37 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna Medicare |
$38.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.54
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$37.23
|
| Rate for Payer: BCBS Trust/PPO |
$122.43
|
| Rate for Payer: BCN Commercial |
$115.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.23
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.23
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.69
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.09
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PACE Senior Care Partners |
$35.37
|
| Rate for Payer: PACE SWMI |
$37.23
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: PHP Medicare Advantage |
$37.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO |
$129.56
|
| Rate for Payer: Priority Health Medicare |
$37.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.78
|
| Rate for Payer: Railroad Medicare Medicare |
$37.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.05
|
| Rate for Payer: UHC Core |
$124.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.23
|
| Rate for Payer: UHC Exchange |
$37.23
|
| Rate for Payer: UHC Medicare Advantage |
$37.23
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$37.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.69
|
|
|
HC TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$148.92
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: BCBS Trust/PPO |
$121.56
|
| Rate for Payer: BCN Commercial |
$115.09
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO |
$129.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.05
|
| Rate for Payer: UHC Core |
$124.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.69
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
OP
|
$1,342.32
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.80 |
| Max. Negotiated Rate |
$1,208.09 |
| Rate for Payer: Aetna Commercial |
$1,140.97
|
| Rate for Payer: Aetna Medicare |
$349.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$419.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$419.48
|
| Rate for Payer: BCBS Complete |
$386.62
|
| Rate for Payer: BCBS MAPPO |
$335.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.52
|
| Rate for Payer: BCN Commercial |
$1,043.65
|
| Rate for Payer: BCN Medicare Advantage |
$335.58
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,154.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.58
|
| Rate for Payer: Healthscope Commercial |
$1,208.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.74
|
| Rate for Payer: Mclaren Medicaid |
$368.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.36
|
| Rate for Payer: Meridian Medicaid |
$386.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: PACE Senior Care Partners |
$318.80
|
| Rate for Payer: PACE SWMI |
$335.58
|
| Rate for Payer: PHP Commercial |
$1,140.97
|
| Rate for Payer: PHP Medicare Advantage |
$335.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,167.82
|
| Rate for Payer: Priority Health Medicare |
$338.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$899.35
|
| Rate for Payer: Railroad Medicare Medicare |
$335.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.24
|
| Rate for Payer: UHC Core |
$1,120.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.58
|
| Rate for Payer: UHC Exchange |
$335.58
|
| Rate for Payer: UHC Medicare Advantage |
$335.58
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$335.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.74
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
IP
|
$1,342.32
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.51 |
| Max. Negotiated Rate |
$1,208.09 |
| Rate for Payer: Aetna Commercial |
$1,140.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,095.74
|
| Rate for Payer: BCN Commercial |
$1,037.34
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,154.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Healthscope Commercial |
$1,208.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: PHP Commercial |
$1,140.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,167.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$899.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.24
|
| Rate for Payer: UHC Core |
$1,120.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.74
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$22.27
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$20.04 |
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.31
|
| Rate for Payer: BCN Commercial |
$17.31
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: PACE Senior Care Partners |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.92
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.60
|
| Rate for Payer: UHC Core |
$18.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$2.16
|
| Rate for Payer: VA VA |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$22.27
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$20.04 |
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.60
|
| Rate for Payer: UHC Core |
$18.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$37.85
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna Commercial |
$32.17
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.83
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$9.46
|
| Rate for Payer: BCBS Trust/PPO |
$31.12
|
| Rate for Payer: BCN Commercial |
$29.43
|
| Rate for Payer: BCN Medicare Advantage |
$9.46
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$32.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.46
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.39
|
| Rate for Payer: Mclaren Medicaid |
$7.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.94
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: PACE Senior Care Partners |
$8.99
|
| Rate for Payer: PACE SWMI |
$9.46
|
| Rate for Payer: PHP Commercial |
$32.17
|
| Rate for Payer: PHP Medicare Advantage |
$9.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: Priority Health HMO/PPO |
$32.93
|
| Rate for Payer: Priority Health Medicare |
$9.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.36
|
| Rate for Payer: Railroad Medicare Medicare |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.31
|
| Rate for Payer: UHC Core |
$31.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Medicare Advantage |
$9.46
|
| Rate for Payer: UHCCP Medicaid |
$7.06
|
| Rate for Payer: VA VA |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.39
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$37.85
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna Commercial |
$32.17
|
| Rate for Payer: BCBS Trust/PPO |
$30.90
|
| Rate for Payer: BCN Commercial |
$29.25
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$32.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.28
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.17
|
| Rate for Payer: Nomi Health Commercial |
$31.04
|
| Rate for Payer: PHP Commercial |
$32.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: Priority Health HMO/PPO |
$32.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.31
|
| Rate for Payer: UHC Core |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.39
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,805.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,823.25 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Aetna Commercial |
$2,384.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,289.72
|
| Rate for Payer: BCN Commercial |
$2,167.70
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$2,412.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,244.00
|
| Rate for Payer: Healthscope Commercial |
$2,524.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,103.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,384.25
|
| Rate for Payer: Nomi Health Commercial |
$2,300.10
|
| Rate for Payer: PHP Commercial |
$2,384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,440.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,879.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,468.40
|
| Rate for Payer: UHC Core |
$2,342.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,103.75
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,805.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.19 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Aetna Commercial |
$2,384.25
|
| Rate for Payer: Aetna Medicare |
$729.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$876.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$876.56
|
| Rate for Payer: BCBS Complete |
$1,122.00
|
| Rate for Payer: BCBS MAPPO |
$701.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,305.99
|
| Rate for Payer: BCN Commercial |
$2,180.89
|
| Rate for Payer: BCN Medicare Advantage |
$701.25
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$2,412.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,244.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.25
|
| Rate for Payer: Healthscope Commercial |
$2,524.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,103.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$736.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$806.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,384.25
|
| Rate for Payer: Nomi Health Commercial |
$2,300.10
|
| Rate for Payer: PACE Senior Care Partners |
$666.19
|
| Rate for Payer: PACE SWMI |
$701.25
|
| Rate for Payer: PHP Commercial |
$2,384.25
|
| Rate for Payer: PHP Medicare Advantage |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,440.35
|
| Rate for Payer: Priority Health Medicare |
$708.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,879.35
|
| Rate for Payer: Railroad Medicare Medicare |
$701.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,468.40
|
| Rate for Payer: UHC Core |
$2,342.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$701.25
|
| Rate for Payer: UHC Exchange |
$701.25
|
| Rate for Payer: UHC Medicare Advantage |
$701.25
|
| Rate for Payer: VA VA |
$701.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,103.75
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| 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 |
$1.71
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$16.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.30
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.91
|
| Rate for Payer: Mclaren Medicaid |
$1.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$1.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PACE Senior Care Partners |
$5.04
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO |
$18.46
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.67
|
| Rate for Payer: UHC Core |
$17.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.30
|
| Rate for Payer: UHC Exchange |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.30
|
| Rate for Payer: UHCCP Medicaid |
$1.63
|
| Rate for Payer: VA VA |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.91
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$17.32
|
| Rate for Payer: BCN Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO |
$18.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.67
|
| Rate for Payer: UHC Core |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.91
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.90
|
| Rate for Payer: BCBS Complete |
$2.64
|
| Rate for Payer: BCBS MAPPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.12
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Mclaren Medicaid |
$2.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.28
|
| Rate for Payer: Meridian Medicaid |
$2.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PACE Senior Care Partners |
$2.96
|
| Rate for Payer: PACE SWMI |
$3.12
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: PHP Medicare Advantage |
$3.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Medicare |
$3.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.12
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.12
|
| Rate for Payer: UHCCP Medicaid |
$2.52
|
| Rate for Payer: VA VA |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.19
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.08
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.78
|
| Rate for Payer: BCN Commercial |
$30.06
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Mclaren Medicaid |
$2.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.15
|
| Rate for Payer: Meridian Medicaid |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Senior Care Partners |
$9.18
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Medicare |
$9.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.90
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.66
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UHC Medicare Advantage |
$9.66
|
| Rate for Payer: UHCCP Medicaid |
$2.21
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$21.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.33
|
| Rate for Payer: BCBS Complete |
$33.71
|
| Rate for Payer: BCBS MAPPO |
$21.07
|
| Rate for Payer: BCBS Trust/PPO |
$69.28
|
| Rate for Payer: BCN Commercial |
$65.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.07
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.07
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: PACE Senior Care Partners |
$20.01
|
| Rate for Payer: PACE SWMI |
$21.07
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: PHP Medicare Advantage |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO |
$73.31
|
| Rate for Payer: Priority Health Medicare |
$21.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: Railroad Medicare Medicare |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.07
|
| Rate for Payer: UHC Exchange |
$21.07
|
| Rate for Payer: UHC Medicare Advantage |
$21.07
|
| Rate for Payer: VA VA |
$21.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: BCBS Trust/PPO |
$68.79
|
| Rate for Payer: BCN Commercial |
$65.12
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO |
$73.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
OP
|
$9,635.14
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,288.35 |
| Max. Negotiated Rate |
$8,671.63 |
| Rate for Payer: Aetna Commercial |
$8,189.87
|
| Rate for Payer: Aetna Medicare |
$2,505.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,010.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,010.98
|
| Rate for Payer: BCBS Complete |
$5,614.14
|
| Rate for Payer: BCBS MAPPO |
$2,408.78
|
| Rate for Payer: BCBS Trust/PPO |
$7,921.05
|
| Rate for Payer: BCN Commercial |
$7,491.32
|
| Rate for Payer: BCN Medicare Advantage |
$2,408.78
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cofinity Commercial |
$8,286.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,708.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,408.78
|
| Rate for Payer: Healthscope Commercial |
$8,671.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,226.35
|
| Rate for Payer: Mclaren Medicaid |
$5,346.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,529.22
|
| Rate for Payer: Meridian Medicaid |
$5,614.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,770.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,189.87
|
| Rate for Payer: Nomi Health Commercial |
$7,900.81
|
| Rate for Payer: PACE Senior Care Partners |
$2,288.35
|
| Rate for Payer: PACE SWMI |
$2,408.78
|
| Rate for Payer: PHP Commercial |
$8,189.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,408.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,346.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,262.84
|
| Rate for Payer: Priority Health HMO/PPO |
$8,382.57
|
| Rate for Payer: Priority Health Medicare |
$2,432.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,455.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,408.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,478.92
|
| Rate for Payer: UHC Core |
$8,045.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,408.78
|
| Rate for Payer: UHC Exchange |
$2,408.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,408.78
|
| Rate for Payer: UHCCP Medicaid |
$5,346.45
|
| Rate for Payer: VA VA |
$2,408.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,226.35
|
|
