|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$733.86
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.58 |
| Max. Negotiated Rate |
$660.47 |
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: BCBS Trust/PPO |
$567.13
|
| Rate for Payer: BCN Commercial |
$567.13
|
| Rate for Payer: Cash Price |
$587.09
|
| Rate for Payer: Cofinity Commercial |
$631.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.09
|
| Rate for Payer: Healthscope Commercial |
$660.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.78
|
| Rate for Payer: PHP Commercial |
$623.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$638.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.80
|
| Rate for Payer: UHC Core |
$612.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.40
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$733.86
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.29 |
| Max. Negotiated Rate |
$660.47 |
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: Aetna Medicare |
$190.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.33
|
| Rate for Payer: BCBS Complete |
$293.54
|
| Rate for Payer: BCBS MAPPO |
$183.46
|
| Rate for Payer: BCBS Trust/PPO |
$570.58
|
| Rate for Payer: BCN Commercial |
$570.58
|
| Rate for Payer: BCN Medicare Advantage |
$183.46
|
| Rate for Payer: Cash Price |
$587.09
|
| Rate for Payer: Cofinity Commercial |
$631.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.46
|
| Rate for Payer: Healthscope Commercial |
$660.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$192.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.78
|
| Rate for Payer: PACE Senior Care Partners |
$174.29
|
| Rate for Payer: PACE SWMI |
$183.46
|
| Rate for Payer: PHP Commercial |
$623.78
|
| Rate for Payer: PHP Medicare Advantage |
$183.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$638.46
|
| Rate for Payer: Priority Health Medicare |
$183.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.58
|
| Rate for Payer: Railroad Medicare Medicare |
$183.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.80
|
| Rate for Payer: UHC Core |
$612.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.46
|
| Rate for Payer: UHC Medicare Advantage |
$188.97
|
| Rate for Payer: VA VA |
$183.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.40
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,887.28
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,151.05 |
| Max. Negotiated Rate |
$1,698.55 |
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.49
|
| Rate for Payer: BCN Commercial |
$1,458.49
|
| Rate for Payer: Cash Price |
$1,509.82
|
| Rate for Payer: Cofinity Commercial |
$1,623.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.82
|
| Rate for Payer: Healthscope Commercial |
$1,698.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,415.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.19
|
| Rate for Payer: PHP Commercial |
$1,604.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,641.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,151.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,660.81
|
| Rate for Payer: UHC Core |
$1,575.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,415.46
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,887.28
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$448.23 |
| Max. Negotiated Rate |
$1,698.55 |
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: Aetna Medicare |
$490.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$589.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$589.78
|
| Rate for Payer: BCBS Complete |
$754.91
|
| Rate for Payer: BCBS MAPPO |
$471.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.36
|
| Rate for Payer: BCN Commercial |
$1,467.36
|
| Rate for Payer: BCN Medicare Advantage |
$471.82
|
| Rate for Payer: Cash Price |
$1,509.82
|
| Rate for Payer: Cofinity Commercial |
$1,623.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.82
|
| Rate for Payer: Healthscope Commercial |
$1,698.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,415.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$495.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$542.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.19
|
| Rate for Payer: PACE Senior Care Partners |
$448.23
|
| Rate for Payer: PACE SWMI |
$471.82
|
| Rate for Payer: PHP Commercial |
$1,604.19
|
| Rate for Payer: PHP Medicare Advantage |
$471.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,641.93
|
| Rate for Payer: Priority Health Medicare |
$471.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,151.05
|
| Rate for Payer: Railroad Medicare Medicare |
$471.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,660.81
|
| Rate for Payer: UHC Core |
$1,575.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$471.82
|
| Rate for Payer: UHC Medicare Advantage |
$485.97
|
| Rate for Payer: VA VA |
$471.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,415.46
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$72.76 |
| Rate for Payer: Aetna Commercial |
$68.72
|
| Rate for Payer: Aetna Medicare |
$21.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.27
|
| Rate for Payer: BCBS Complete |
$32.34
|
| Rate for Payer: BCBS MAPPO |
$20.21
|
| Rate for Payer: BCBS Trust/PPO |
$62.86
|
| Rate for Payer: BCN Commercial |
$62.86
|
| Rate for Payer: BCN Medicare Advantage |
$20.21
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$72.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.72
|
| Rate for Payer: PACE Senior Care Partners |
$19.20
|
| Rate for Payer: PACE SWMI |
$20.21
|
| Rate for Payer: PHP Commercial |
$68.72
|
| Rate for Payer: PHP Medicare Advantage |
$20.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.34
|
| Rate for Payer: Priority Health Medicare |
$20.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.31
|
| Rate for Payer: Railroad Medicare Medicare |
$20.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.15
|
| Rate for Payer: UHC Core |
$67.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.21
|
| Rate for Payer: UHC Medicare Advantage |
$20.82
|
| Rate for Payer: VA VA |
$20.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.64
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.31 |
| Max. Negotiated Rate |
$72.76 |
| Rate for Payer: Aetna Commercial |
$68.72
|
| Rate for Payer: BCBS Trust/PPO |
$62.48
|
| Rate for Payer: BCN Commercial |
$62.48
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.68
|
| Rate for Payer: Healthscope Commercial |
$72.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.72
|
| Rate for Payer: PHP Commercial |
$68.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.15
|
| Rate for Payer: UHC Core |
$67.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.64
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
OP
|
$244.19
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: Aetna Medicare |
$63.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.31
|
| Rate for Payer: BCBS Complete |
$97.68
|
| Rate for Payer: BCBS MAPPO |
$61.05
|
| Rate for Payer: BCBS Trust/PPO |
$189.86
|
| Rate for Payer: BCN Commercial |
$189.86
|
| Rate for Payer: BCN Medicare Advantage |
$61.05
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.05
|
| Rate for Payer: Healthscope Commercial |
$219.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.56
|
| Rate for Payer: PACE Senior Care Partners |
$58.00
|
| Rate for Payer: PACE SWMI |
$61.05
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: PHP Medicare Advantage |
$61.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.45
|
| Rate for Payer: Priority Health Medicare |
$61.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.93
|
| Rate for Payer: Railroad Medicare Medicare |
$61.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.89
|
| Rate for Payer: UHC Core |
$203.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.05
|
| Rate for Payer: UHC Medicare Advantage |
$62.88
|
| Rate for Payer: VA VA |
$61.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.14
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
IP
|
$244.19
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: BCBS Trust/PPO |
$188.71
|
| Rate for Payer: BCN Commercial |
$188.71
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$219.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.56
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.89
|
| Rate for Payer: UHC Core |
$203.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.14
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 3
|
Facility
|
OP
|
$412.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.04 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: Aetna Medicare |
$107.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.99
|
| Rate for Payer: BCBS Complete |
$165.11
|
| Rate for Payer: BCBS MAPPO |
$103.20
|
| Rate for Payer: BCBS Trust/PPO |
$320.94
|
| Rate for Payer: BCN Commercial |
$320.94
|
| Rate for Payer: BCN Medicare Advantage |
$103.20
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.20
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PACE Senior Care Partners |
$98.04
|
| Rate for Payer: PACE SWMI |
$103.20
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: PHP Medicare Advantage |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.12
|
| Rate for Payer: Priority Health Medicare |
$103.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.75
|
| Rate for Payer: Railroad Medicare Medicare |
$103.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.25
|
| Rate for Payer: UHC Core |
$344.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.20
|
| Rate for Payer: UHC Medicare Advantage |
$106.29
|
| Rate for Payer: VA VA |
$103.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 3
|
Facility
|
IP
|
$412.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.75 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: BCBS Trust/PPO |
$319.00
|
| Rate for Payer: BCN Commercial |
$319.00
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.25
|
| Rate for Payer: UHC Core |
$344.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 4
|
Facility
|
OP
|
$576.58
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.94 |
| Max. Negotiated Rate |
$518.92 |
| Rate for Payer: Aetna Commercial |
$490.09
|
| Rate for Payer: Aetna Medicare |
$149.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.18
|
| Rate for Payer: BCBS Complete |
$230.63
|
| Rate for Payer: BCBS MAPPO |
$144.14
|
| Rate for Payer: BCBS Trust/PPO |
$448.29
|
| Rate for Payer: BCN Commercial |
$448.29
|
| Rate for Payer: BCN Medicare Advantage |
$144.14
|
| Rate for Payer: Cash Price |
$461.26
|
| Rate for Payer: Cofinity Commercial |
$495.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.14
|
| Rate for Payer: Healthscope Commercial |
$518.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.09
|
| Rate for Payer: PACE Senior Care Partners |
$136.94
|
| Rate for Payer: PACE SWMI |
$144.14
|
| Rate for Payer: PHP Commercial |
$490.09
|
| Rate for Payer: PHP Medicare Advantage |
$144.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.62
|
| Rate for Payer: Priority Health Medicare |
$144.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.66
|
| Rate for Payer: Railroad Medicare Medicare |
$144.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.39
|
| Rate for Payer: UHC Core |
$481.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.14
|
| Rate for Payer: UHC Medicare Advantage |
$148.47
|
| Rate for Payer: VA VA |
$144.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.44
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 4
|
Facility
|
IP
|
$576.58
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.66 |
| Max. Negotiated Rate |
$518.92 |
| Rate for Payer: Aetna Commercial |
$490.09
|
| Rate for Payer: BCBS Trust/PPO |
$445.58
|
| Rate for Payer: BCN Commercial |
$445.58
|
| Rate for Payer: Cash Price |
$461.26
|
| Rate for Payer: Cofinity Commercial |
$495.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.26
|
| Rate for Payer: Healthscope Commercial |
$518.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.09
|
| Rate for Payer: PHP Commercial |
$490.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.39
|
| Rate for Payer: UHC Core |
$481.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.44
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 5
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.02 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Aetna Commercial |
$576.30
|
| Rate for Payer: Aetna Medicare |
$176.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.88
|
| Rate for Payer: BCBS Complete |
$271.20
|
| Rate for Payer: BCBS MAPPO |
$169.50
|
| Rate for Payer: BCBS Trust/PPO |
$527.14
|
| Rate for Payer: BCN Commercial |
$527.14
|
| Rate for Payer: BCN Medicare Advantage |
$169.50
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$583.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.50
|
| Rate for Payer: Healthscope Commercial |
$610.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.30
|
| Rate for Payer: PACE Senior Care Partners |
$161.02
|
| Rate for Payer: PACE SWMI |
$169.50
|
| Rate for Payer: PHP Commercial |
$576.30
|
| Rate for Payer: PHP Medicare Advantage |
$169.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Medicare |
$169.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.51
|
| Rate for Payer: Railroad Medicare Medicare |
$169.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.64
|
| Rate for Payer: UHC Core |
$566.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.50
|
| Rate for Payer: UHC Medicare Advantage |
$174.58
|
| Rate for Payer: VA VA |
$169.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.50
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 5
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.51 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Aetna Commercial |
$576.30
|
| Rate for Payer: BCBS Trust/PPO |
$523.96
|
| Rate for Payer: BCN Commercial |
$523.96
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$583.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.40
|
| Rate for Payer: Healthscope Commercial |
$610.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.30
|
| Rate for Payer: PHP Commercial |
$576.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.64
|
| Rate for Payer: UHC Core |
$566.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.50
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 6
|
Facility
|
OP
|
$869.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.48 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Aetna Commercial |
$738.99
|
| Rate for Payer: Aetna Medicare |
$226.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.69
|
| Rate for Payer: BCBS Complete |
$347.76
|
| Rate for Payer: BCBS MAPPO |
$217.35
|
| Rate for Payer: BCBS Trust/PPO |
$675.96
|
| Rate for Payer: BCN Commercial |
$675.96
|
| Rate for Payer: BCN Medicare Advantage |
$217.35
|
| Rate for Payer: Cash Price |
$695.52
|
| Rate for Payer: Cofinity Commercial |
$747.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.35
|
| Rate for Payer: Healthscope Commercial |
$782.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.99
|
| Rate for Payer: PACE Senior Care Partners |
$206.48
|
| Rate for Payer: PACE SWMI |
$217.35
|
| Rate for Payer: PHP Commercial |
$738.99
|
| Rate for Payer: PHP Medicare Advantage |
$217.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$756.38
|
| Rate for Payer: Priority Health Medicare |
$217.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.25
|
| Rate for Payer: Railroad Medicare Medicare |
$217.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.07
|
| Rate for Payer: UHC Core |
$725.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.35
|
| Rate for Payer: UHC Medicare Advantage |
$223.87
|
| Rate for Payer: VA VA |
$217.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.05
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 6
|
Facility
|
IP
|
$869.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.25 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Aetna Commercial |
$738.99
|
| Rate for Payer: BCBS Trust/PPO |
$671.87
|
| Rate for Payer: BCN Commercial |
$671.87
|
| Rate for Payer: Cash Price |
$695.52
|
| Rate for Payer: Cofinity Commercial |
$747.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.52
|
| Rate for Payer: Healthscope Commercial |
$782.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.99
|
| Rate for Payer: PHP Commercial |
$738.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$756.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.07
|
| Rate for Payer: UHC Core |
$725.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.05
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,126.70
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$742.59 |
| Max. Negotiated Rate |
$2,814.03 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Medicare |
$812.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$977.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$977.09
|
| Rate for Payer: BCBS Complete |
$1,250.68
|
| Rate for Payer: BCBS MAPPO |
$781.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,431.01
|
| Rate for Payer: BCN Commercial |
$2,431.01
|
| Rate for Payer: BCN Medicare Advantage |
$781.68
|
| Rate for Payer: Cash Price |
$2,501.36
|
| Rate for Payer: Cofinity Commercial |
$2,688.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,501.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.68
|
| Rate for Payer: Healthscope Commercial |
$2,814.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,345.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$820.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,657.70
|
| Rate for Payer: PACE Senior Care Partners |
$742.59
|
| Rate for Payer: PACE SWMI |
$781.68
|
| Rate for Payer: PHP Commercial |
$2,657.70
|
| Rate for Payer: PHP Medicare Advantage |
$781.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,720.23
|
| Rate for Payer: Priority Health Medicare |
$781.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,906.97
|
| Rate for Payer: Railroad Medicare Medicare |
$781.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,751.50
|
| Rate for Payer: UHC Core |
$2,610.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.68
|
| Rate for Payer: UHC Medicare Advantage |
$805.13
|
| Rate for Payer: VA VA |
$781.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,345.02
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,126.70
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,906.97 |
| Max. Negotiated Rate |
$2,814.03 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,416.31
|
| Rate for Payer: BCN Commercial |
$2,416.31
|
| Rate for Payer: Cash Price |
$2,501.36
|
| Rate for Payer: Cofinity Commercial |
$2,688.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,501.36
|
| Rate for Payer: Healthscope Commercial |
$2,814.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,345.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,657.70
|
| Rate for Payer: PHP Commercial |
$2,657.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,720.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,906.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,751.50
|
| Rate for Payer: UHC Core |
$2,610.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,345.02
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.42
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Commercial |
$10.37
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.81
|
| Rate for Payer: UHC Core |
$11.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.06
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.42
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: Aetna Medicare |
$3.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.19
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS MAPPO |
$3.36
|
| Rate for Payer: BCBS Trust/PPO |
$10.43
|
| Rate for Payer: BCN Commercial |
$10.43
|
| Rate for Payer: BCN Medicare Advantage |
$3.36
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.36
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: PACE Senior Care Partners |
$3.19
|
| Rate for Payer: PACE SWMI |
$3.36
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: PHP Medicare Advantage |
$3.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.68
|
| Rate for Payer: Priority Health Medicare |
$3.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.81
|
| Rate for Payer: UHC Core |
$11.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.36
|
| Rate for Payer: UHC Medicare Advantage |
$3.46
|
| Rate for Payer: VA VA |
$3.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.06
|
|
|
HC BANDING
|
Facility
|
IP
|
$946.71
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$577.40 |
| Max. Negotiated Rate |
$852.04 |
| Rate for Payer: Aetna Commercial |
$804.70
|
| Rate for Payer: BCBS Trust/PPO |
$731.62
|
| Rate for Payer: BCN Commercial |
$731.62
|
| Rate for Payer: Cash Price |
$757.37
|
| Rate for Payer: Cofinity Commercial |
$814.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.37
|
| Rate for Payer: Healthscope Commercial |
$852.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$804.70
|
| Rate for Payer: PHP Commercial |
$804.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$823.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$577.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$833.10
|
| Rate for Payer: UHC Core |
$790.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.03
|
|
|
HC BANDING
|
Facility
|
OP
|
$946.71
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.84 |
| Max. Negotiated Rate |
$852.04 |
| Rate for Payer: Aetna Commercial |
$804.70
|
| Rate for Payer: Aetna Medicare |
$246.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.85
|
| Rate for Payer: BCBS Complete |
$378.68
|
| Rate for Payer: BCBS MAPPO |
$236.68
|
| Rate for Payer: BCBS Trust/PPO |
$736.07
|
| Rate for Payer: BCN Commercial |
$736.07
|
| Rate for Payer: BCN Medicare Advantage |
$236.68
|
| Rate for Payer: Cash Price |
$757.37
|
| Rate for Payer: Cofinity Commercial |
$814.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.68
|
| Rate for Payer: Healthscope Commercial |
$852.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$248.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$804.70
|
| Rate for Payer: PACE Senior Care Partners |
$224.84
|
| Rate for Payer: PACE SWMI |
$236.68
|
| Rate for Payer: PHP Commercial |
$804.70
|
| Rate for Payer: PHP Medicare Advantage |
$236.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$823.64
|
| Rate for Payer: Priority Health Medicare |
$236.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$577.40
|
| Rate for Payer: Railroad Medicare Medicare |
$236.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$833.10
|
| Rate for Payer: UHC Core |
$790.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.68
|
| Rate for Payer: UHC Medicare Advantage |
$243.78
|
| Rate for Payer: VA VA |
$236.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.03
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.81
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCBS Trust/PPO |
$74.17
|
| Rate for Payer: BCN Commercial |
$74.17
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Senior Care Partners |
$22.66
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.00
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: Railroad Medicare Medicare |
$23.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.95
|
| Rate for Payer: UHC Core |
$79.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$24.57
|
| Rate for Payer: VA VA |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
