|
HC BRACE TLSO PREFAB
|
Facility
|
IP
|
$2,957.53
|
|
|
Service Code
|
HCPCS L0464
|
| Hospital Charge Code |
27400037
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,803.80 |
| Max. Negotiated Rate |
$2,661.78 |
| Rate for Payer: Aetna Commercial |
$2,513.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,285.58
|
| Rate for Payer: BCN Commercial |
$2,285.58
|
| Rate for Payer: Cash Price |
$2,366.02
|
| Rate for Payer: Cofinity Commercial |
$2,543.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,366.02
|
| Rate for Payer: Healthscope Commercial |
$2,661.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,513.90
|
| Rate for Payer: PHP Commercial |
$2,513.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,573.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,803.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,602.63
|
| Rate for Payer: UHC Core |
$2,469.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,218.15
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
OP
|
$1,964.25
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$466.51 |
| Max. Negotiated Rate |
$1,767.82 |
| Rate for Payer: Aetna Commercial |
$1,669.61
|
| Rate for Payer: Aetna Medicare |
$510.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.83
|
| Rate for Payer: BCBS Complete |
$785.70
|
| Rate for Payer: BCBS MAPPO |
$491.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,527.20
|
| Rate for Payer: BCN Commercial |
$1,527.20
|
| Rate for Payer: BCN Medicare Advantage |
$491.06
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cofinity Commercial |
$1,689.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.06
|
| Rate for Payer: Healthscope Commercial |
$1,767.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,669.61
|
| Rate for Payer: PACE Senior Care Partners |
$466.51
|
| Rate for Payer: PACE SWMI |
$491.06
|
| Rate for Payer: PHP Commercial |
$1,669.61
|
| Rate for Payer: PHP Medicare Advantage |
$491.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.90
|
| Rate for Payer: Priority Health Medicare |
$491.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,198.00
|
| Rate for Payer: Railroad Medicare Medicare |
$491.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.54
|
| Rate for Payer: UHC Core |
$1,640.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$491.06
|
| Rate for Payer: UHC Medicare Advantage |
$505.79
|
| Rate for Payer: VA VA |
$491.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.19
|
|
|
HC BRACE TLSO PREFAB CUSTOM FIT
|
Facility
|
IP
|
$1,964.25
|
|
|
Service Code
|
HCPCS L0460
|
| Hospital Charge Code |
27400023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,198.00 |
| Max. Negotiated Rate |
$1,767.82 |
| Rate for Payer: Aetna Commercial |
$1,669.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.97
|
| Rate for Payer: BCN Commercial |
$1,517.97
|
| Rate for Payer: Cash Price |
$1,571.40
|
| Rate for Payer: Cofinity Commercial |
$1,689.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.40
|
| Rate for Payer: Healthscope Commercial |
$1,767.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,669.61
|
| Rate for Payer: PHP Commercial |
$1,669.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,198.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.54
|
| Rate for Payer: UHC Core |
$1,640.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.19
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$12.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.69
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$11.75
|
| Rate for Payer: BCBS Trust/PPO |
$36.54
|
| Rate for Payer: BCN Commercial |
$36.54
|
| Rate for Payer: BCN Medicare Advantage |
$11.75
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.75
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.16
|
| Rate for Payer: PACE SWMI |
$11.75
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.89
|
| Rate for Payer: Priority Health Medicare |
$11.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.36
|
| Rate for Payer: UHC Core |
$39.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.75
|
| Rate for Payer: UHC Medicare Advantage |
$12.10
|
| Rate for Payer: VA VA |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC BRACE UE FX RAD/ULNAR ORTHOSIS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS L3982
|
| Hospital Charge Code |
27400026
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.67 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$36.32
|
| Rate for Payer: BCN Commercial |
$36.32
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.95
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.36
|
| Rate for Payer: UHC Core |
$39.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$35.44
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.08
|
| Rate for Payer: BCBS Complete |
$14.18
|
| Rate for Payer: BCBS MAPPO |
$8.86
|
| Rate for Payer: BCBS Trust/PPO |
$27.55
|
| Rate for Payer: BCN Commercial |
$27.55
|
| Rate for Payer: BCN Medicare Advantage |
$8.86
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$30.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.86
|
| Rate for Payer: Healthscope Commercial |
$31.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.12
|
| Rate for Payer: PACE Senior Care Partners |
$8.42
|
| Rate for Payer: PACE SWMI |
$8.86
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: PHP Medicare Advantage |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.83
|
| Rate for Payer: Priority Health Medicare |
$8.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.19
|
| Rate for Payer: UHC Core |
$29.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.86
|
| Rate for Payer: UHC Medicare Advantage |
$9.13
|
| Rate for Payer: VA VA |
$8.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.58
|
|
|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
IP
|
$35.44
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$31.90 |
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: BCBS Trust/PPO |
$27.39
|
| Rate for Payer: BCN Commercial |
$27.39
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$30.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.35
|
| Rate for Payer: Healthscope Commercial |
$31.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.12
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.19
|
| Rate for Payer: UHC Core |
$29.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.58
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$144.63
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$130.17 |
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.20
|
| Rate for Payer: BCBS Complete |
$57.85
|
| Rate for Payer: BCBS MAPPO |
$36.16
|
| Rate for Payer: BCBS Trust/PPO |
$112.45
|
| Rate for Payer: BCN Commercial |
$112.45
|
| Rate for Payer: BCN Medicare Advantage |
$36.16
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$124.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.16
|
| Rate for Payer: Healthscope Commercial |
$130.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.94
|
| Rate for Payer: PACE Senior Care Partners |
$34.35
|
| Rate for Payer: PACE SWMI |
$36.16
|
| Rate for Payer: PHP Commercial |
$122.94
|
| Rate for Payer: PHP Medicare Advantage |
$36.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.83
|
| Rate for Payer: Priority Health Medicare |
$36.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.21
|
| Rate for Payer: Railroad Medicare Medicare |
$36.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.27
|
| Rate for Payer: UHC Core |
$120.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.16
|
| Rate for Payer: UHC Medicare Advantage |
$37.24
|
| Rate for Payer: VA VA |
$36.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.47
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$144.63
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.21 |
| Max. Negotiated Rate |
$130.17 |
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: BCBS Trust/PPO |
$111.77
|
| Rate for Payer: BCN Commercial |
$111.77
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cofinity Commercial |
$124.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.70
|
| Rate for Payer: Healthscope Commercial |
$130.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.94
|
| Rate for Payer: PHP Commercial |
$122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.27
|
| Rate for Payer: UHC Core |
$120.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.47
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$332.52
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$299.27 |
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: BCBS Trust/PPO |
$256.97
|
| Rate for Payer: BCN Commercial |
$256.97
|
| Rate for Payer: Cash Price |
$266.02
|
| Rate for Payer: Cofinity Commercial |
$285.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.02
|
| Rate for Payer: Healthscope Commercial |
$299.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.64
|
| Rate for Payer: PHP Commercial |
$282.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.62
|
| Rate for Payer: UHC Core |
$277.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.39
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$332.52
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.97 |
| Max. Negotiated Rate |
$299.27 |
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Aetna Medicare |
$86.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.91
|
| Rate for Payer: BCBS Complete |
$133.01
|
| Rate for Payer: BCBS MAPPO |
$83.13
|
| Rate for Payer: BCBS Trust/PPO |
$258.53
|
| Rate for Payer: BCN Commercial |
$258.53
|
| Rate for Payer: BCN Medicare Advantage |
$83.13
|
| Rate for Payer: Cash Price |
$266.02
|
| Rate for Payer: Cofinity Commercial |
$285.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.13
|
| Rate for Payer: Healthscope Commercial |
$299.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.64
|
| Rate for Payer: PACE Senior Care Partners |
$78.97
|
| Rate for Payer: PACE SWMI |
$83.13
|
| Rate for Payer: PHP Commercial |
$282.64
|
| Rate for Payer: PHP Medicare Advantage |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.29
|
| Rate for Payer: Priority Health Medicare |
$83.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.80
|
| Rate for Payer: Railroad Medicare Medicare |
$83.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.62
|
| Rate for Payer: UHC Core |
$277.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.13
|
| Rate for Payer: UHC Medicare Advantage |
$85.62
|
| Rate for Payer: VA VA |
$83.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.39
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$473.28
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$425.95 |
| Rate for Payer: Aetna Commercial |
$402.29
|
| Rate for Payer: Aetna Medicare |
$123.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.90
|
| Rate for Payer: BCBS Complete |
$189.31
|
| Rate for Payer: BCBS MAPPO |
$118.32
|
| Rate for Payer: BCBS Trust/PPO |
$367.98
|
| Rate for Payer: BCN Commercial |
$367.98
|
| Rate for Payer: BCN Medicare Advantage |
$118.32
|
| Rate for Payer: Cash Price |
$378.62
|
| Rate for Payer: Cofinity Commercial |
$407.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.32
|
| Rate for Payer: Healthscope Commercial |
$425.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.29
|
| Rate for Payer: PACE Senior Care Partners |
$112.40
|
| Rate for Payer: PACE SWMI |
$118.32
|
| Rate for Payer: PHP Commercial |
$402.29
|
| Rate for Payer: PHP Medicare Advantage |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.75
|
| Rate for Payer: Priority Health Medicare |
$118.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.65
|
| Rate for Payer: Railroad Medicare Medicare |
$118.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.49
|
| Rate for Payer: UHC Core |
$395.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.32
|
| Rate for Payer: UHC Medicare Advantage |
$121.87
|
| Rate for Payer: VA VA |
$118.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.96
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$473.28
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$288.65 |
| Max. Negotiated Rate |
$425.95 |
| Rate for Payer: Aetna Commercial |
$402.29
|
| Rate for Payer: BCBS Trust/PPO |
$365.75
|
| Rate for Payer: BCN Commercial |
$365.75
|
| Rate for Payer: Cash Price |
$378.62
|
| Rate for Payer: Cofinity Commercial |
$407.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.62
|
| Rate for Payer: Healthscope Commercial |
$425.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.29
|
| Rate for Payer: PHP Commercial |
$402.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.49
|
| Rate for Payer: UHC Core |
$395.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.96
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$132.19
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna Commercial |
$112.36
|
| Rate for Payer: Aetna Medicare |
$34.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.31
|
| Rate for Payer: BCBS Complete |
$52.88
|
| Rate for Payer: BCBS MAPPO |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$102.78
|
| Rate for Payer: BCN Commercial |
$102.78
|
| Rate for Payer: BCN Medicare Advantage |
$33.05
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cofinity Commercial |
$113.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.05
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.36
|
| Rate for Payer: PACE Senior Care Partners |
$31.40
|
| Rate for Payer: PACE SWMI |
$33.05
|
| Rate for Payer: PHP Commercial |
$112.36
|
| Rate for Payer: PHP Medicare Advantage |
$33.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.01
|
| Rate for Payer: Priority Health Medicare |
$33.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.62
|
| Rate for Payer: Railroad Medicare Medicare |
$33.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.33
|
| Rate for Payer: UHC Core |
$110.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.05
|
| Rate for Payer: UHC Medicare Advantage |
$34.04
|
| Rate for Payer: VA VA |
$33.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.14
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$132.19
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.62 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna Commercial |
$112.36
|
| Rate for Payer: BCBS Trust/PPO |
$102.16
|
| Rate for Payer: BCN Commercial |
$102.16
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cofinity Commercial |
$113.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.75
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.36
|
| Rate for Payer: PHP Commercial |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.33
|
| Rate for Payer: UHC Core |
$110.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.14
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$219.81
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$197.83 |
| Rate for Payer: Aetna Commercial |
$186.84
|
| Rate for Payer: Aetna Medicare |
$57.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.69
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS MAPPO |
$54.95
|
| Rate for Payer: BCBS Trust/PPO |
$170.90
|
| Rate for Payer: BCN Commercial |
$170.90
|
| Rate for Payer: BCN Medicare Advantage |
$54.95
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cofinity Commercial |
$189.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.95
|
| Rate for Payer: Healthscope Commercial |
$197.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.86
|
| Rate for Payer: Mclaren Medicaid |
$24.07
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.84
|
| Rate for Payer: PACE Senior Care Partners |
$52.20
|
| Rate for Payer: PACE SWMI |
$54.95
|
| Rate for Payer: PHP Commercial |
$186.84
|
| Rate for Payer: PHP Medicare Advantage |
$54.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.23
|
| Rate for Payer: Priority Health Medicare |
$54.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.06
|
| Rate for Payer: Railroad Medicare Medicare |
$54.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.43
|
| Rate for Payer: UHC Core |
$183.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.95
|
| Rate for Payer: UHC Medicare Advantage |
$56.60
|
| Rate for Payer: VA VA |
$54.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.86
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$219.81
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$197.83 |
| Rate for Payer: Aetna Commercial |
$186.84
|
| Rate for Payer: BCBS Trust/PPO |
$169.87
|
| Rate for Payer: BCN Commercial |
$169.87
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cofinity Commercial |
$189.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.85
|
| Rate for Payer: Healthscope Commercial |
$197.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.84
|
| Rate for Payer: PHP Commercial |
$186.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.43
|
| Rate for Payer: UHC Core |
$183.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.86
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,751.81
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.05 |
| Max. Negotiated Rate |
$1,576.63 |
| Rate for Payer: Aetna Commercial |
$1,489.04
|
| Rate for Payer: Aetna Medicare |
$455.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$547.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$547.44
|
| Rate for Payer: BCBS Complete |
$700.72
|
| Rate for Payer: BCBS MAPPO |
$437.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.03
|
| Rate for Payer: BCN Commercial |
$1,362.03
|
| Rate for Payer: BCN Medicare Advantage |
$437.95
|
| Rate for Payer: Cash Price |
$1,401.45
|
| Rate for Payer: Cofinity Commercial |
$1,506.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.95
|
| Rate for Payer: Healthscope Commercial |
$1,576.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,313.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$459.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$503.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,489.04
|
| Rate for Payer: PACE Senior Care Partners |
$416.05
|
| Rate for Payer: PACE SWMI |
$437.95
|
| Rate for Payer: PHP Commercial |
$1,489.04
|
| Rate for Payer: PHP Medicare Advantage |
$437.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,524.07
|
| Rate for Payer: Priority Health Medicare |
$437.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,068.43
|
| Rate for Payer: Railroad Medicare Medicare |
$437.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,541.59
|
| Rate for Payer: UHC Core |
$1,462.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.95
|
| Rate for Payer: UHC Medicare Advantage |
$451.09
|
| Rate for Payer: VA VA |
$437.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,313.86
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,751.81
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,068.43 |
| Max. Negotiated Rate |
$1,576.63 |
| Rate for Payer: Aetna Commercial |
$1,489.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.80
|
| Rate for Payer: BCN Commercial |
$1,353.80
|
| Rate for Payer: Cash Price |
$1,401.45
|
| Rate for Payer: Cofinity Commercial |
$1,506.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.45
|
| Rate for Payer: Healthscope Commercial |
$1,576.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,313.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,489.04
|
| Rate for Payer: PHP Commercial |
$1,489.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,524.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,068.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,541.59
|
| Rate for Payer: UHC Core |
$1,462.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,313.86
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
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 BRAZIL NUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
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 BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,077.67
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$613.86 |
| Max. Negotiated Rate |
$4,569.90 |
| Rate for Payer: Aetna Commercial |
$4,316.02
|
| Rate for Payer: Aetna Medicare |
$1,320.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,586.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,586.77
|
| Rate for Payer: BCBS Complete |
$2,031.07
|
| Rate for Payer: BCBS MAPPO |
$1,269.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,947.89
|
| Rate for Payer: BCCCP Commercial |
$613.86
|
| Rate for Payer: BCN Commercial |
$3,947.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,269.42
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cofinity Commercial |
$4,366.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,062.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,269.42
|
| Rate for Payer: Healthscope Commercial |
$4,569.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,808.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,332.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,459.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,316.02
|
| Rate for Payer: PACE Senior Care Partners |
$1,205.95
|
| Rate for Payer: PACE SWMI |
$1,269.42
|
| Rate for Payer: PHP Commercial |
$4,316.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,269.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,554.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,417.57
|
| Rate for Payer: Priority Health Medicare |
$1,269.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,096.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,269.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,468.35
|
| Rate for Payer: UHC Core |
$4,239.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,269.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,307.50
|
| Rate for Payer: VA VA |
$1,269.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,808.25
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,077.67
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,096.87 |
| Max. Negotiated Rate |
$4,569.90 |
| Rate for Payer: Aetna Commercial |
$4,316.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,924.02
|
| Rate for Payer: BCN Commercial |
$3,924.02
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cofinity Commercial |
$4,366.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,062.14
|
| Rate for Payer: Healthscope Commercial |
$4,569.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,808.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,316.02
|
| Rate for Payer: PHP Commercial |
$4,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,554.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,417.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,096.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,468.35
|
| Rate for Payer: UHC Core |
$4,239.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,808.25
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
IP
|
$3,598.37
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,194.65 |
| Max. Negotiated Rate |
$3,238.53 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,780.82
|
| Rate for Payer: BCN Commercial |
$2,780.82
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cofinity Commercial |
$3,094.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,878.70
|
| Rate for Payer: Healthscope Commercial |
$3,238.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,698.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,058.61
|
| Rate for Payer: PHP Commercial |
$3,058.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,130.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,194.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,166.57
|
| Rate for Payer: UHC Core |
$3,004.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,698.78
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
OP
|
$3,598.37
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.24 |
| Max. Negotiated Rate |
$3,238.53 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: Aetna Medicare |
$935.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,124.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,124.49
|
| Rate for Payer: BCBS Complete |
$1,439.35
|
| Rate for Payer: BCBS MAPPO |
$899.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,797.73
|
| Rate for Payer: BCCCP Commercial |
$400.24
|
| Rate for Payer: BCN Commercial |
$2,797.73
|
| Rate for Payer: BCN Medicare Advantage |
$899.59
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cofinity Commercial |
$3,094.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,878.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.59
|
| Rate for Payer: Healthscope Commercial |
$3,238.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,698.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$944.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,034.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,058.61
|
| Rate for Payer: PACE Senior Care Partners |
$854.61
|
| Rate for Payer: PACE SWMI |
$899.59
|
| Rate for Payer: PHP Commercial |
$3,058.61
|
| Rate for Payer: PHP Medicare Advantage |
$899.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,130.58
|
| Rate for Payer: Priority Health Medicare |
$899.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,194.65
|
| Rate for Payer: Railroad Medicare Medicare |
$899.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,166.57
|
| Rate for Payer: UHC Core |
$3,004.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.59
|
| Rate for Payer: UHC Medicare Advantage |
$926.58
|
| Rate for Payer: VA VA |
$899.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,698.78
|
|
