|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$553.44
|
| Rate for Payer: BCN Commercial |
$523.41
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Senior Care Partners |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Medicare |
$169.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC UNLISTED PROCEDURE FOREARM WRIST
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
76100410
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: BCBS Trust/PPO |
$549.53
|
| Rate for Payer: BCN Commercial |
$520.25
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC UNLISTED PROCEDURE FOREARM WRIST
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
76100410
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$553.44
|
| Rate for Payer: BCN Commercial |
$523.41
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Senior Care Partners |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Medicare |
$169.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: BCBS Trust/PPO |
$549.53
|
| Rate for Payer: BCN Commercial |
$520.25
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$553.44
|
| Rate for Payer: BCN Commercial |
$523.41
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Senior Care Partners |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Medicare |
$169.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: BCBS Trust/PPO |
$549.53
|
| Rate for Payer: BCN Commercial |
$520.25
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$553.44
|
| Rate for Payer: BCN Commercial |
$523.41
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Senior Care Partners |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Medicare |
$169.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$726.66
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.33 |
| Max. Negotiated Rate |
$653.99 |
| Rate for Payer: Aetna Commercial |
$617.66
|
| Rate for Payer: BCBS Trust/PPO |
$593.17
|
| Rate for Payer: BCN Commercial |
$561.56
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cofinity Commercial |
$624.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.33
|
| Rate for Payer: Healthscope Commercial |
$653.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$545.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.66
|
| Rate for Payer: Nomi Health Commercial |
$595.86
|
| Rate for Payer: PHP Commercial |
$617.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.33
|
| Rate for Payer: Priority Health HMO/PPO |
$632.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$639.46
|
| Rate for Payer: UHC Core |
$606.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$545.00
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$726.66
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.58 |
| Max. Negotiated Rate |
$653.99 |
| Rate for Payer: Aetna Commercial |
$617.66
|
| Rate for Payer: Aetna Medicare |
$188.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$227.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$227.08
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$181.66
|
| Rate for Payer: BCBS Trust/PPO |
$597.39
|
| Rate for Payer: BCN Commercial |
$564.98
|
| Rate for Payer: BCN Medicare Advantage |
$181.66
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cofinity Commercial |
$624.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.66
|
| Rate for Payer: Healthscope Commercial |
$653.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$545.00
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.75
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.66
|
| Rate for Payer: Nomi Health Commercial |
$595.86
|
| Rate for Payer: PACE Senior Care Partners |
$172.58
|
| Rate for Payer: PACE SWMI |
$181.66
|
| Rate for Payer: PHP Commercial |
$617.66
|
| Rate for Payer: PHP Medicare Advantage |
$181.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.33
|
| Rate for Payer: Priority Health HMO/PPO |
$632.19
|
| Rate for Payer: Priority Health Medicare |
$183.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.86
|
| Rate for Payer: Railroad Medicare Medicare |
$181.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$639.46
|
| Rate for Payer: UHC Core |
$606.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.66
|
| Rate for Payer: UHC Exchange |
$181.66
|
| Rate for Payer: UHC Medicare Advantage |
$181.66
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$181.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$545.00
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.46 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna Medicare |
$172.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.19
|
| Rate for Payer: BCBS Complete |
$172.73
|
| Rate for Payer: BCBS MAPPO |
$165.75
|
| Rate for Payer: BCBS Trust/PPO |
$545.05
|
| Rate for Payer: BCN Commercial |
$515.48
|
| Rate for Payer: BCN Medicare Advantage |
$165.75
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.75
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.25
|
| Rate for Payer: Mclaren Medicaid |
$164.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.04
|
| Rate for Payer: Meridian Medicaid |
$172.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$543.66
|
| Rate for Payer: PACE Senior Care Partners |
$157.46
|
| Rate for Payer: PACE SWMI |
$165.75
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: PHP Medicare Advantage |
$165.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: Priority Health HMO/PPO |
$576.81
|
| Rate for Payer: Priority Health Medicare |
$167.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.21
|
| Rate for Payer: Railroad Medicare Medicare |
$165.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.44
|
| Rate for Payer: UHC Core |
$553.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.75
|
| Rate for Payer: UHC Exchange |
$165.75
|
| Rate for Payer: UHC Medicare Advantage |
$165.75
|
| Rate for Payer: UHCCP Medicaid |
$164.50
|
| Rate for Payer: VA VA |
$165.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.25
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.95 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: BCBS Trust/PPO |
$541.21
|
| Rate for Payer: BCN Commercial |
$512.37
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$543.66
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: Priority Health HMO/PPO |
$576.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.44
|
| Rate for Payer: UHC Core |
$553.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.25
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,904.37
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,887.84 |
| Max. Negotiated Rate |
$2,613.93 |
| Rate for Payer: Aetna Commercial |
$2,468.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,370.84
|
| Rate for Payer: BCN Commercial |
$2,244.50
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cofinity Commercial |
$2,497.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,323.50
|
| Rate for Payer: Healthscope Commercial |
$2,613.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,178.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,468.71
|
| Rate for Payer: Nomi Health Commercial |
$2,381.58
|
| Rate for Payer: PHP Commercial |
$2,468.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,887.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,526.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,945.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,555.85
|
| Rate for Payer: UHC Core |
$2,425.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,178.28
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,904.37
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$2,613.93 |
| Rate for Payer: Aetna Commercial |
$2,468.71
|
| Rate for Payer: Aetna Medicare |
$755.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$907.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$907.62
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$726.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,387.68
|
| Rate for Payer: BCN Commercial |
$2,258.15
|
| Rate for Payer: BCN Medicare Advantage |
$726.09
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cofinity Commercial |
$2,497.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,323.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$726.09
|
| Rate for Payer: Healthscope Commercial |
$2,613.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,178.28
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$762.40
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,468.71
|
| Rate for Payer: Nomi Health Commercial |
$2,381.58
|
| Rate for Payer: PACE Senior Care Partners |
$689.79
|
| Rate for Payer: PACE SWMI |
$726.09
|
| Rate for Payer: PHP Commercial |
$2,468.71
|
| Rate for Payer: PHP Medicare Advantage |
$726.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,887.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,526.80
|
| Rate for Payer: Priority Health Medicare |
$733.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,945.93
|
| Rate for Payer: Railroad Medicare Medicare |
$726.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,555.85
|
| Rate for Payer: UHC Core |
$2,425.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$726.09
|
| Rate for Payer: UHC Exchange |
$726.09
|
| Rate for Payer: UHC Medicare Advantage |
$726.09
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$726.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,178.28
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$456.97
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.53 |
| Max. Negotiated Rate |
$411.27 |
| Rate for Payer: Aetna Commercial |
$388.42
|
| Rate for Payer: Aetna Medicare |
$118.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.80
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$114.24
|
| Rate for Payer: BCBS Trust/PPO |
$375.68
|
| Rate for Payer: BCN Commercial |
$355.29
|
| Rate for Payer: BCN Medicare Advantage |
$114.24
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cofinity Commercial |
$392.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.24
|
| Rate for Payer: Healthscope Commercial |
$411.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.73
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.95
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.72
|
| Rate for Payer: PACE Senior Care Partners |
$108.53
|
| Rate for Payer: PACE SWMI |
$114.24
|
| Rate for Payer: PHP Commercial |
$388.42
|
| Rate for Payer: PHP Medicare Advantage |
$114.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.03
|
| Rate for Payer: Priority Health HMO/PPO |
$397.56
|
| Rate for Payer: Priority Health Medicare |
$115.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.17
|
| Rate for Payer: Railroad Medicare Medicare |
$114.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.13
|
| Rate for Payer: UHC Core |
$381.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.24
|
| Rate for Payer: UHC Exchange |
$114.24
|
| Rate for Payer: UHC Medicare Advantage |
$114.24
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$114.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.73
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$456.97
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.03 |
| Max. Negotiated Rate |
$411.27 |
| Rate for Payer: Aetna Commercial |
$388.42
|
| Rate for Payer: BCBS Trust/PPO |
$373.02
|
| Rate for Payer: BCN Commercial |
$353.15
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cofinity Commercial |
$392.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.58
|
| Rate for Payer: Healthscope Commercial |
$411.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.72
|
| Rate for Payer: PHP Commercial |
$388.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.03
|
| Rate for Payer: Priority Health HMO/PPO |
$397.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.13
|
| Rate for Payer: UHC Core |
$381.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.73
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$367.26
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$330.53 |
| Rate for Payer: Aetna Commercial |
$312.17
|
| Rate for Payer: Aetna Medicare |
$95.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.77
|
| Rate for Payer: BCBS Complete |
$117.37
|
| Rate for Payer: BCBS MAPPO |
$91.82
|
| Rate for Payer: BCBS Trust/PPO |
$301.92
|
| Rate for Payer: BCN Commercial |
$285.54
|
| Rate for Payer: BCN Medicare Advantage |
$91.82
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.82
|
| Rate for Payer: Healthscope Commercial |
$330.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.44
|
| Rate for Payer: Mclaren Medicaid |
$111.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.41
|
| Rate for Payer: Meridian Medicaid |
$117.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.17
|
| Rate for Payer: Nomi Health Commercial |
$301.15
|
| Rate for Payer: PACE Senior Care Partners |
$87.22
|
| Rate for Payer: PACE SWMI |
$91.82
|
| Rate for Payer: PHP Commercial |
$312.17
|
| Rate for Payer: PHP Medicare Advantage |
$91.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.72
|
| Rate for Payer: Priority Health HMO/PPO |
$319.52
|
| Rate for Payer: Priority Health Medicare |
$92.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.06
|
| Rate for Payer: Railroad Medicare Medicare |
$91.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.19
|
| Rate for Payer: UHC Core |
$306.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.82
|
| Rate for Payer: UHC Exchange |
$91.82
|
| Rate for Payer: UHC Medicare Advantage |
$91.82
|
| Rate for Payer: UHCCP Medicaid |
$111.78
|
| Rate for Payer: VA VA |
$91.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.44
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$367.26
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.72 |
| Max. Negotiated Rate |
$330.53 |
| Rate for Payer: Aetna Commercial |
$312.17
|
| Rate for Payer: BCBS Trust/PPO |
$299.79
|
| Rate for Payer: BCN Commercial |
$283.82
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.81
|
| Rate for Payer: Healthscope Commercial |
$330.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.17
|
| Rate for Payer: Nomi Health Commercial |
$301.15
|
| Rate for Payer: PHP Commercial |
$312.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.72
|
| Rate for Payer: Priority Health HMO/PPO |
$319.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.19
|
| Rate for Payer: UHC Core |
$306.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.44
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$9,022.12
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,142.75 |
| Max. Negotiated Rate |
$8,119.91 |
| Rate for Payer: Aetna Commercial |
$7,668.80
|
| Rate for Payer: Aetna Medicare |
$2,345.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,819.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,819.41
|
| Rate for Payer: BCBS Complete |
$7,784.62
|
| Rate for Payer: BCBS MAPPO |
$2,255.53
|
| Rate for Payer: BCBS Trust/PPO |
$7,417.08
|
| Rate for Payer: BCN Commercial |
$7,014.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,255.53
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cofinity Commercial |
$7,759.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,217.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,255.53
|
| Rate for Payer: Healthscope Commercial |
$8,119.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,766.59
|
| Rate for Payer: Mclaren Medicaid |
$7,413.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,368.31
|
| Rate for Payer: Meridian Medicaid |
$7,784.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,593.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,668.80
|
| Rate for Payer: Nomi Health Commercial |
$7,398.14
|
| Rate for Payer: PACE Senior Care Partners |
$2,142.75
|
| Rate for Payer: PACE SWMI |
$2,255.53
|
| Rate for Payer: PHP Commercial |
$7,668.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,255.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,413.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,864.38
|
| Rate for Payer: Priority Health HMO/PPO |
$7,849.24
|
| Rate for Payer: Priority Health Medicare |
$2,278.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,044.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,255.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,939.47
|
| Rate for Payer: UHC Core |
$7,533.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,255.53
|
| Rate for Payer: UHC Exchange |
$2,255.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,255.53
|
| Rate for Payer: UHCCP Medicaid |
$7,413.44
|
| Rate for Payer: VA VA |
$2,255.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,766.59
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$9,022.12
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,864.38 |
| Max. Negotiated Rate |
$8,119.91 |
| Rate for Payer: Aetna Commercial |
$7,668.80
|
| Rate for Payer: BCBS Trust/PPO |
$7,364.76
|
| Rate for Payer: BCN Commercial |
$6,972.29
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cofinity Commercial |
$7,759.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,217.70
|
| Rate for Payer: Healthscope Commercial |
$8,119.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,766.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,668.80
|
| Rate for Payer: Nomi Health Commercial |
$7,398.14
|
| Rate for Payer: PHP Commercial |
$7,668.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,864.38
|
| Rate for Payer: Priority Health HMO/PPO |
$7,849.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,044.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,939.47
|
| Rate for Payer: UHC Core |
$7,533.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,766.59
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
OP
|
$4,647.80
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,103.85 |
| Max. Negotiated Rate |
$7,784.62 |
| Rate for Payer: Aetna Commercial |
$3,950.63
|
| Rate for Payer: Aetna Medicare |
$1,208.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,452.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,452.44
|
| Rate for Payer: BCBS Complete |
$7,784.62
|
| Rate for Payer: BCBS MAPPO |
$1,161.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,820.96
|
| Rate for Payer: BCN Commercial |
$3,613.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.95
|
| Rate for Payer: Cash Price |
$3,718.24
|
| Rate for Payer: Cash Price |
$3,718.24
|
| Rate for Payer: Cofinity Commercial |
$3,997.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,718.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.95
|
| Rate for Payer: Healthscope Commercial |
$4,183.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,485.85
|
| Rate for Payer: Mclaren Medicaid |
$7,413.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,220.05
|
| Rate for Payer: Meridian Medicaid |
$7,784.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,336.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,950.63
|
| Rate for Payer: Nomi Health Commercial |
$3,811.20
|
| Rate for Payer: PACE Senior Care Partners |
$1,103.85
|
| Rate for Payer: PACE SWMI |
$1,161.95
|
| Rate for Payer: PHP Commercial |
$3,950.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,413.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,021.07
|
| Rate for Payer: Priority Health HMO/PPO |
$4,043.59
|
| Rate for Payer: Priority Health Medicare |
$1,173.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,114.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,161.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,090.06
|
| Rate for Payer: UHC Core |
$3,880.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,161.95
|
| Rate for Payer: UHC Exchange |
$1,161.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,161.95
|
| Rate for Payer: UHCCP Medicaid |
$7,413.44
|
| Rate for Payer: VA VA |
$1,161.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,485.85
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
IP
|
$4,647.80
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,021.07 |
| Max. Negotiated Rate |
$4,183.02 |
| Rate for Payer: Aetna Commercial |
$3,950.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,794.00
|
| Rate for Payer: BCN Commercial |
$3,591.82
|
| Rate for Payer: Cash Price |
$3,718.24
|
| Rate for Payer: Cofinity Commercial |
$3,997.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,718.24
|
| Rate for Payer: Healthscope Commercial |
$4,183.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,485.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,950.63
|
| Rate for Payer: Nomi Health Commercial |
$3,811.20
|
| Rate for Payer: PHP Commercial |
$3,950.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,021.07
|
| Rate for Payer: Priority Health HMO/PPO |
$4,043.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,114.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,090.06
|
| Rate for Payer: UHC Core |
$3,880.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,485.85
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$2.86
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$10.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.32
|
| Rate for Payer: BCBS Complete |
$4.22
|
| Rate for Payer: BCBS MAPPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: BCN Medicare Advantage |
$9.86
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.86
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.57
|
| Rate for Payer: Mclaren Medicaid |
$4.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.35
|
| Rate for Payer: Meridian Medicaid |
$4.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: PACE Senior Care Partners |
$9.36
|
| Rate for Payer: PACE SWMI |
$9.86
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$9.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.63
|
| Rate for Payer: Priority Health HMO/PPO |
$34.30
|
| Rate for Payer: Priority Health Medicare |
$9.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.42
|
| Rate for Payer: Railroad Medicare Medicare |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.70
|
| Rate for Payer: UHC Core |
$32.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.86
|
| Rate for Payer: UHC Exchange |
$9.86
|
| Rate for Payer: UHC Medicare Advantage |
$9.86
|
| Rate for Payer: UHCCP Medicaid |
$4.02
|
| Rate for Payer: VA VA |
$9.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.57
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$32.19
|
| Rate for Payer: BCN Commercial |
$30.47
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.63
|
| Rate for Payer: Priority Health HMO/PPO |
$34.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.70
|
| Rate for Payer: UHC Core |
$32.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.57
|
|
