|
HC ARTHROGRAM SACROILIAC
|
Facility
|
IP
|
$956.46
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100585
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$665.70 |
| Max. Negotiated Rate |
$860.81 |
| Rate for Payer: Aetna Commercial |
$812.99
|
| Rate for Payer: BCBS Trust/PPO |
$789.94
|
| Rate for Payer: BCN Commercial |
$789.94
|
| Rate for Payer: Cash Price |
$765.17
|
| Rate for Payer: Cofinity Commercial |
$822.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.17
|
| Rate for Payer: Healthscope Commercial |
$860.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$717.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$812.99
|
| Rate for Payer: Nomi Health Commercial |
$784.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$717.35
|
| Rate for Payer: PHP Commercial |
$812.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$832.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$665.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.68
|
| Rate for Payer: UHC Core |
$798.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$717.35
|
|
|
HC ARTHROGRAM SACROILIAC
|
Facility
|
OP
|
$956.46
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100585
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.62 |
| Max. Negotiated Rate |
$860.81 |
| Rate for Payer: Aetna Commercial |
$812.99
|
| Rate for Payer: Aetna Medicare |
$248.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.89
|
| Rate for Payer: BCBS Complete |
$177.04
|
| Rate for Payer: BCBS MAPPO |
$239.12
|
| Rate for Payer: BCBS Trust/PPO |
$786.31
|
| Rate for Payer: BCN Commercial |
$786.31
|
| Rate for Payer: BCN Medicare Advantage |
$239.12
|
| Rate for Payer: Cash Price |
$765.17
|
| Rate for Payer: Cofinity Commercial |
$822.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.12
|
| Rate for Payer: Healthscope Commercial |
$860.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$717.35
|
| Rate for Payer: Mclaren Medicaid |
$168.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.07
|
| Rate for Payer: Meridian Medicaid |
$177.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$263.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$812.99
|
| Rate for Payer: Nomi Health Commercial |
$784.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$717.35
|
| Rate for Payer: PACE Senior Care Partners |
$227.16
|
| Rate for Payer: PACE SWMI |
$239.12
|
| Rate for Payer: PHP Commercial |
$812.99
|
| Rate for Payer: PHP Medicare Advantage |
$239.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$832.12
|
| Rate for Payer: Priority Health Medicare |
$241.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$665.70
|
| Rate for Payer: Railroad Medicare Medicare |
$239.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.68
|
| Rate for Payer: UHC Core |
$798.64
|
| Rate for Payer: UHC Exchange |
$239.12
|
| Rate for Payer: UHC Medicaid |
$168.62
|
| Rate for Payer: UHC Medicare Advantage |
$239.12
|
| Rate for Payer: UHCCP Medicaid |
$168.62
|
| Rate for Payer: VA VA |
$239.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$717.35
|
|
|
HC ARTHROGRAM SACROILIAC BIL
|
Facility
|
IP
|
$1,090.19
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.77 |
| Max. Negotiated Rate |
$981.17 |
| Rate for Payer: Aetna Commercial |
$926.66
|
| Rate for Payer: BCBS Trust/PPO |
$900.39
|
| Rate for Payer: BCN Commercial |
$900.39
|
| Rate for Payer: Cash Price |
$872.15
|
| Rate for Payer: Cofinity Commercial |
$937.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.15
|
| Rate for Payer: Healthscope Commercial |
$981.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$817.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$926.66
|
| Rate for Payer: Nomi Health Commercial |
$893.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$817.64
|
| Rate for Payer: PHP Commercial |
$926.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$948.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.37
|
| Rate for Payer: UHC Core |
$910.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$817.64
|
|
|
HC ARTHROGRAM SACROILIAC BIL
|
Facility
|
OP
|
$1,090.19
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$981.17 |
| Rate for Payer: Aetna Commercial |
$926.66
|
| Rate for Payer: Aetna Medicare |
$283.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$340.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$340.68
|
| Rate for Payer: BCBS Complete |
$201.79
|
| Rate for Payer: BCBS MAPPO |
$272.55
|
| Rate for Payer: BCBS Trust/PPO |
$896.25
|
| Rate for Payer: BCN Commercial |
$896.25
|
| Rate for Payer: BCN Medicare Advantage |
$272.55
|
| Rate for Payer: Cash Price |
$872.15
|
| Rate for Payer: Cofinity Commercial |
$937.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.55
|
| Rate for Payer: Healthscope Commercial |
$981.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$817.64
|
| Rate for Payer: Mclaren Medicaid |
$192.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.17
|
| Rate for Payer: Meridian Medicaid |
$201.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$299.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$926.66
|
| Rate for Payer: Nomi Health Commercial |
$893.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$817.64
|
| Rate for Payer: PACE Senior Care Partners |
$258.92
|
| Rate for Payer: PACE SWMI |
$272.55
|
| Rate for Payer: PHP Commercial |
$926.66
|
| Rate for Payer: PHP Medicare Advantage |
$272.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$948.47
|
| Rate for Payer: Priority Health Medicare |
$275.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.77
|
| Rate for Payer: Railroad Medicare Medicare |
$272.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.37
|
| Rate for Payer: UHC Core |
$910.31
|
| Rate for Payer: UHC Exchange |
$272.55
|
| Rate for Payer: UHC Medicaid |
$192.20
|
| Rate for Payer: UHC Medicare Advantage |
$272.55
|
| Rate for Payer: UHCCP Medicaid |
$192.20
|
| Rate for Payer: VA VA |
$272.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$817.64
|
|
|
HC ARTHROTOMY W/EXP, DRAIN, REMOVAL FB METACARPOPHALANGEAL JT EACH
|
Facility
|
OP
|
$1,853.20
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
76100135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.72 |
| Max. Negotiated Rate |
$1,667.88 |
| Rate for Payer: Aetna Commercial |
$1,575.22
|
| Rate for Payer: Aetna Medicare |
$481.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$579.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$579.12
|
| Rate for Payer: BCBS Complete |
$343.03
|
| Rate for Payer: BCBS MAPPO |
$463.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.52
|
| Rate for Payer: BCN Commercial |
$1,523.52
|
| Rate for Payer: BCN Medicare Advantage |
$463.30
|
| Rate for Payer: Cash Price |
$1,482.56
|
| Rate for Payer: Cofinity Commercial |
$1,593.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.30
|
| Rate for Payer: Healthscope Commercial |
$1,667.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,389.90
|
| Rate for Payer: Mclaren Medicaid |
$326.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$486.46
|
| Rate for Payer: Meridian Medicaid |
$343.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$532.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$509.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.22
|
| Rate for Payer: Nomi Health Commercial |
$1,519.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,389.90
|
| Rate for Payer: PACE Senior Care Partners |
$440.13
|
| Rate for Payer: PACE SWMI |
$463.30
|
| Rate for Payer: PHP Commercial |
$1,575.22
|
| Rate for Payer: PHP Medicare Advantage |
$463.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,612.28
|
| Rate for Payer: Priority Health Medicare |
$467.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.83
|
| Rate for Payer: Railroad Medicare Medicare |
$463.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,630.82
|
| Rate for Payer: UHC Core |
$1,547.42
|
| Rate for Payer: UHC Exchange |
$463.30
|
| Rate for Payer: UHC Medicaid |
$326.72
|
| Rate for Payer: UHC Medicare Advantage |
$463.30
|
| Rate for Payer: UHCCP Medicaid |
$326.72
|
| Rate for Payer: VA VA |
$463.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,389.90
|
|
|
HC ARTHROTOMY W/EXP, DRAIN, REMOVAL FB METACARPOPHALANGEAL JT EACH
|
Facility
|
IP
|
$1,853.20
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
76100135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,289.83 |
| Max. Negotiated Rate |
$1,667.88 |
| Rate for Payer: Aetna Commercial |
$1,575.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,530.56
|
| Rate for Payer: BCN Commercial |
$1,530.56
|
| Rate for Payer: Cash Price |
$1,482.56
|
| Rate for Payer: Cofinity Commercial |
$1,593.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.56
|
| Rate for Payer: Healthscope Commercial |
$1,667.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,389.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.22
|
| Rate for Payer: Nomi Health Commercial |
$1,519.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,389.90
|
| Rate for Payer: PHP Commercial |
$1,575.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,612.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,630.82
|
| Rate for Payer: UHC Core |
$1,547.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,389.90
|
|
|
HC ARTHRT EXPL DRAIN RMV FOREIGN BODY FINGER JT
|
Facility
|
IP
|
$4,178.93
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
76100373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,908.54 |
| Max. Negotiated Rate |
$3,761.04 |
| Rate for Payer: Aetna Commercial |
$3,552.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,451.38
|
| Rate for Payer: BCN Commercial |
$3,451.38
|
| Rate for Payer: Cash Price |
$3,343.14
|
| Rate for Payer: Cofinity Commercial |
$3,593.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,343.14
|
| Rate for Payer: Healthscope Commercial |
$3,761.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,134.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,552.09
|
| Rate for Payer: Nomi Health Commercial |
$3,426.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,134.20
|
| Rate for Payer: PHP Commercial |
$3,552.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,635.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,908.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,677.46
|
| Rate for Payer: UHC Core |
$3,489.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,134.20
|
|
|
HC ARTHRT EXPL DRAIN RMV FOREIGN BODY FINGER JT
|
Facility
|
OP
|
$4,178.93
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
76100373
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.75 |
| Max. Negotiated Rate |
$3,761.04 |
| Rate for Payer: Aetna Commercial |
$3,552.09
|
| Rate for Payer: Aetna Medicare |
$1,086.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,305.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,305.92
|
| Rate for Payer: BCBS Complete |
$773.52
|
| Rate for Payer: BCBS MAPPO |
$1,044.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,435.50
|
| Rate for Payer: BCN Commercial |
$3,435.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,044.73
|
| Rate for Payer: Cash Price |
$3,343.14
|
| Rate for Payer: Cofinity Commercial |
$3,593.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,343.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,044.73
|
| Rate for Payer: Healthscope Commercial |
$3,761.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,134.20
|
| Rate for Payer: Mclaren Medicaid |
$736.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,096.97
|
| Rate for Payer: Meridian Medicaid |
$773.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,201.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,149.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,552.09
|
| Rate for Payer: Nomi Health Commercial |
$3,426.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,134.20
|
| Rate for Payer: PACE Senior Care Partners |
$992.50
|
| Rate for Payer: PACE SWMI |
$1,044.73
|
| Rate for Payer: PHP Commercial |
$3,552.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,044.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,635.67
|
| Rate for Payer: Priority Health Medicare |
$1,055.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,908.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,044.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,677.46
|
| Rate for Payer: UHC Core |
$3,489.41
|
| Rate for Payer: UHC Exchange |
$1,044.73
|
| Rate for Payer: UHC Medicaid |
$736.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,044.73
|
| Rate for Payer: UHCCP Medicaid |
$736.75
|
| Rate for Payer: VA VA |
$1,044.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,134.20
|
|
|
HC ART IMG UNILAT LOWER EXTREMITY
|
Facility
|
IP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$654.69 |
| Max. Negotiated Rate |
$846.59 |
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: BCBS Trust/PPO |
$776.88
|
| Rate for Payer: BCN Commercial |
$776.88
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Commercial |
$808.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Healthscope Commercial |
$846.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.55
|
| Rate for Payer: Nomi Health Commercial |
$771.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| Rate for Payer: PHP Commercial |
$799.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$818.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.77
|
| Rate for Payer: UHC Core |
$785.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.49
|
|
|
HC ART IMG UNILAT LOWER EXTREMITY
|
Facility
|
OP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$846.59 |
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: Aetna Medicare |
$244.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.95
|
| Rate for Payer: BCBS Complete |
$174.11
|
| Rate for Payer: BCBS MAPPO |
$235.16
|
| Rate for Payer: BCBS Trust/PPO |
$773.31
|
| Rate for Payer: BCN Commercial |
$773.31
|
| Rate for Payer: BCN Medicare Advantage |
$235.16
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Commercial |
$808.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.16
|
| Rate for Payer: Healthscope Commercial |
$846.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.49
|
| Rate for Payer: Mclaren Medicaid |
$165.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.92
|
| Rate for Payer: Meridian Medicaid |
$174.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$258.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.55
|
| Rate for Payer: Nomi Health Commercial |
$771.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| Rate for Payer: PACE Senior Care Partners |
$223.40
|
| Rate for Payer: PACE SWMI |
$235.16
|
| Rate for Payer: PHP Commercial |
$799.55
|
| Rate for Payer: PHP Medicare Advantage |
$235.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$818.37
|
| Rate for Payer: Priority Health Medicare |
$237.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.69
|
| Rate for Payer: Railroad Medicare Medicare |
$235.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.77
|
| Rate for Payer: UHC Core |
$785.44
|
| Rate for Payer: UHC Exchange |
$235.16
|
| Rate for Payer: UHC Medicaid |
$165.84
|
| Rate for Payer: UHC Medicare Advantage |
$235.16
|
| Rate for Payer: UHCCP Medicaid |
$165.84
|
| Rate for Payer: VA VA |
$235.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.49
|
|
|
HC ART IMG UNILAT UPPER EXTREM
|
Facility
|
IP
|
$771.48
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
92100009
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$536.95 |
| Max. Negotiated Rate |
$694.33 |
| Rate for Payer: Aetna Commercial |
$655.76
|
| Rate for Payer: BCBS Trust/PPO |
$637.17
|
| Rate for Payer: BCN Commercial |
$637.17
|
| Rate for Payer: Cash Price |
$617.18
|
| Rate for Payer: Cofinity Commercial |
$663.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$617.18
|
| Rate for Payer: Healthscope Commercial |
$694.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.76
|
| Rate for Payer: Nomi Health Commercial |
$632.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.61
|
| Rate for Payer: PHP Commercial |
$655.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$671.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.90
|
| Rate for Payer: UHC Core |
$644.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.61
|
|
|
HC ART IMG UNILAT UPPER EXTREM
|
Facility
|
OP
|
$771.48
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
92100009
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$136.01 |
| Max. Negotiated Rate |
$694.33 |
| Rate for Payer: Aetna Commercial |
$655.76
|
| Rate for Payer: Aetna Medicare |
$200.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$241.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$241.09
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$192.87
|
| Rate for Payer: BCBS Trust/PPO |
$634.23
|
| Rate for Payer: BCN Commercial |
$634.23
|
| Rate for Payer: BCN Medicare Advantage |
$192.87
|
| Rate for Payer: Cash Price |
$617.18
|
| Rate for Payer: Cofinity Commercial |
$663.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$617.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.87
|
| Rate for Payer: Healthscope Commercial |
$694.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.61
|
| Rate for Payer: Mclaren Medicaid |
$136.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.51
|
| Rate for Payer: Meridian Medicaid |
$142.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$212.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.76
|
| Rate for Payer: Nomi Health Commercial |
$632.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.61
|
| Rate for Payer: PACE Senior Care Partners |
$183.23
|
| Rate for Payer: PACE SWMI |
$192.87
|
| Rate for Payer: PHP Commercial |
$655.76
|
| Rate for Payer: PHP Medicare Advantage |
$192.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$671.19
|
| Rate for Payer: Priority Health Medicare |
$194.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.95
|
| Rate for Payer: Railroad Medicare Medicare |
$192.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.90
|
| Rate for Payer: UHC Core |
$644.19
|
| Rate for Payer: UHC Exchange |
$192.87
|
| Rate for Payer: UHC Medicaid |
$136.01
|
| Rate for Payer: UHC Medicare Advantage |
$192.87
|
| Rate for Payer: UHCCP Medicaid |
$136.01
|
| Rate for Payer: VA VA |
$192.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.61
|
|
|
HC ART&VEN TRANSCATH THROMBOLYSIS
|
Facility
|
IP
|
$4,737.42
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
36100373
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,297.24 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$4,026.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,912.64
|
| Rate for Payer: BCN Commercial |
$3,912.64
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cofinity Commercial |
$4,074.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,789.94
|
| Rate for Payer: Healthscope Commercial |
$4,263.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,553.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Nomi Health Commercial |
$3,884.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: PHP Commercial |
$4,026.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,121.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,297.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,168.93
|
| Rate for Payer: UHC Core |
$3,955.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,553.07
|
|
|
HC ART&VEN TRANSCATH THROMBOLYSIS
|
Facility
|
OP
|
$4,737.42
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
36100373
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$835.21 |
| Max. Negotiated Rate |
$4,263.68 |
| Rate for Payer: Aetna Commercial |
$4,026.81
|
| Rate for Payer: Aetna Medicare |
$1,231.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,480.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,480.44
|
| Rate for Payer: BCBS Complete |
$876.90
|
| Rate for Payer: BCBS MAPPO |
$1,184.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,894.63
|
| Rate for Payer: BCN Commercial |
$3,894.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.36
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cofinity Commercial |
$4,074.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,789.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.36
|
| Rate for Payer: Healthscope Commercial |
$4,263.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,553.07
|
| Rate for Payer: Mclaren Medicaid |
$835.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.57
|
| Rate for Payer: Meridian Medicaid |
$876.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,362.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,302.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Nomi Health Commercial |
$3,884.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: PACE Senior Care Partners |
$1,125.14
|
| Rate for Payer: PACE SWMI |
$1,184.36
|
| Rate for Payer: PHP Commercial |
$4,026.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,121.56
|
| Rate for Payer: Priority Health Medicare |
$1,196.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,297.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,184.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,168.93
|
| Rate for Payer: UHC Core |
$3,955.75
|
| Rate for Payer: UHC Exchange |
$1,184.36
|
| Rate for Payer: UHC Medicaid |
$835.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.36
|
| Rate for Payer: UHCCP Medicaid |
$835.21
|
| Rate for Payer: VA VA |
$1,184.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,553.07
|
|
|
HC ASCLERA 1%
|
Facility
|
OP
|
$33.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$30.51 |
| Rate for Payer: Aetna Commercial |
$28.82
|
| Rate for Payer: Aetna Medicare |
$8.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.59
|
| Rate for Payer: BCBS Complete |
$6.27
|
| Rate for Payer: BCBS MAPPO |
$8.47
|
| Rate for Payer: BCBS Trust/PPO |
$27.87
|
| Rate for Payer: BCN Commercial |
$27.87
|
| Rate for Payer: BCN Medicare Advantage |
$8.47
|
| Rate for Payer: Cash Price |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$29.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.47
|
| Rate for Payer: Healthscope Commercial |
$30.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.43
|
| Rate for Payer: Mclaren Medicaid |
$5.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.90
|
| Rate for Payer: Meridian Medicaid |
$6.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.82
|
| Rate for Payer: Nomi Health Commercial |
$27.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.43
|
| Rate for Payer: PACE Senior Care Partners |
$8.05
|
| Rate for Payer: PACE SWMI |
$8.47
|
| Rate for Payer: PHP Commercial |
$28.82
|
| Rate for Payer: PHP Medicare Advantage |
$8.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.49
|
| Rate for Payer: Priority Health Medicare |
$8.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$8.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.83
|
| Rate for Payer: UHC Core |
$28.31
|
| Rate for Payer: UHC Exchange |
$8.47
|
| Rate for Payer: UHC Medicaid |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$8.47
|
| Rate for Payer: UHCCP Medicaid |
$5.98
|
| Rate for Payer: VA VA |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.43
|
|
|
HC ASCLERA 1%
|
Facility
|
IP
|
$33.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$30.51 |
| Rate for Payer: Aetna Commercial |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$28.00
|
| Rate for Payer: BCN Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$29.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.12
|
| Rate for Payer: Healthscope Commercial |
$30.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.82
|
| Rate for Payer: Nomi Health Commercial |
$27.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.43
|
| Rate for Payer: PHP Commercial |
$28.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.83
|
| Rate for Payer: UHC Core |
$28.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.43
|
|
|
HC ASCLERA O.5%
|
Facility
|
IP
|
$29.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$26.59 |
| Rate for Payer: Aetna Commercial |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$24.41
|
| Rate for Payer: BCN Commercial |
$24.41
|
| Rate for Payer: Cash Price |
$23.64
|
| Rate for Payer: Cofinity Commercial |
$25.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$26.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.12
|
| Rate for Payer: Nomi Health Commercial |
$24.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.16
|
| Rate for Payer: PHP Commercial |
$25.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.00
|
| Rate for Payer: UHC Core |
$24.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.16
|
|
|
HC ASCLERA O.5%
|
Facility
|
OP
|
$29.55
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$26.59 |
| Rate for Payer: Aetna Commercial |
$25.12
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.23
|
| Rate for Payer: BCBS Complete |
$5.47
|
| Rate for Payer: BCBS MAPPO |
$7.39
|
| Rate for Payer: BCBS Trust/PPO |
$24.29
|
| Rate for Payer: BCN Commercial |
$24.29
|
| Rate for Payer: BCN Medicare Advantage |
$7.39
|
| Rate for Payer: Cash Price |
$23.64
|
| Rate for Payer: Cofinity Commercial |
$25.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.39
|
| Rate for Payer: Healthscope Commercial |
$26.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.16
|
| Rate for Payer: Mclaren Medicaid |
$5.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.76
|
| Rate for Payer: Meridian Medicaid |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.12
|
| Rate for Payer: Nomi Health Commercial |
$24.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.16
|
| Rate for Payer: PACE Senior Care Partners |
$7.02
|
| Rate for Payer: PACE SWMI |
$7.39
|
| Rate for Payer: PHP Commercial |
$25.12
|
| Rate for Payer: PHP Medicare Advantage |
$7.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.71
|
| Rate for Payer: Priority Health Medicare |
$7.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.00
|
| Rate for Payer: UHC Core |
$24.67
|
| Rate for Payer: UHC Exchange |
$7.39
|
| Rate for Payer: UHC Medicaid |
$5.21
|
| Rate for Payer: UHC Medicare Advantage |
$7.39
|
| Rate for Payer: UHCCP Medicaid |
$5.21
|
| Rate for Payer: VA VA |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.16
|
|
|
HC ASMT VERTEBRAL FX VIA DXA
|
Facility
|
IP
|
$199.57
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
32000302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$179.61 |
| Rate for Payer: Aetna Commercial |
$169.63
|
| Rate for Payer: BCBS Trust/PPO |
$164.82
|
| Rate for Payer: BCN Commercial |
$164.82
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$179.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.63
|
| Rate for Payer: Nomi Health Commercial |
$163.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.68
|
| Rate for Payer: PHP Commercial |
$169.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.62
|
| Rate for Payer: UHC Core |
$166.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
HC ASMT VERTEBRAL FX VIA DXA
|
Facility
|
OP
|
$199.57
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
32000302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.18 |
| Max. Negotiated Rate |
$179.61 |
| Rate for Payer: Aetna Commercial |
$169.63
|
| Rate for Payer: Aetna Medicare |
$51.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.37
|
| Rate for Payer: BCBS Complete |
$36.94
|
| Rate for Payer: BCBS MAPPO |
$49.89
|
| Rate for Payer: BCBS Trust/PPO |
$164.07
|
| Rate for Payer: BCN Commercial |
$164.07
|
| Rate for Payer: BCN Medicare Advantage |
$49.89
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.89
|
| Rate for Payer: Healthscope Commercial |
$179.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Mclaren Medicaid |
$35.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.39
|
| Rate for Payer: Meridian Medicaid |
$36.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.63
|
| Rate for Payer: Nomi Health Commercial |
$163.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.68
|
| Rate for Payer: PACE Senior Care Partners |
$47.40
|
| Rate for Payer: PACE SWMI |
$49.89
|
| Rate for Payer: PHP Commercial |
$169.63
|
| Rate for Payer: PHP Medicare Advantage |
$49.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.63
|
| Rate for Payer: Priority Health Medicare |
$50.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.90
|
| Rate for Payer: Railroad Medicare Medicare |
$49.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.62
|
| Rate for Payer: UHC Core |
$166.64
|
| Rate for Payer: UHC Exchange |
$49.89
|
| Rate for Payer: UHC Medicaid |
$35.18
|
| Rate for Payer: UHC Medicare Advantage |
$49.89
|
| Rate for Payer: UHCCP Medicaid |
$35.18
|
| Rate for Payer: VA VA |
$49.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
HC ASP AND OR INJ RENAL CYST OR PELVIS
|
Facility
|
IP
|
$1,296.72
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
36100242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$902.52 |
| Max. Negotiated Rate |
$1,167.05 |
| Rate for Payer: Aetna Commercial |
$1,102.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.96
|
| Rate for Payer: BCN Commercial |
$1,070.96
|
| Rate for Payer: Cash Price |
$1,037.38
|
| Rate for Payer: Cofinity Commercial |
$1,115.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,037.38
|
| Rate for Payer: Healthscope Commercial |
$1,167.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$972.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,102.21
|
| Rate for Payer: Nomi Health Commercial |
$1,063.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$972.54
|
| Rate for Payer: PHP Commercial |
$1,102.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,128.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$902.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,141.11
|
| Rate for Payer: UHC Core |
$1,082.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$972.54
|
|
|
HC ASP AND OR INJ RENAL CYST OR PELVIS
|
Facility
|
OP
|
$1,296.72
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
36100242
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.61 |
| Max. Negotiated Rate |
$1,167.05 |
| Rate for Payer: Aetna Commercial |
$1,102.21
|
| Rate for Payer: Aetna Medicare |
$337.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.23
|
| Rate for Payer: BCBS Complete |
$240.02
|
| Rate for Payer: BCBS MAPPO |
$324.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.03
|
| Rate for Payer: BCN Commercial |
$1,066.03
|
| Rate for Payer: BCN Medicare Advantage |
$324.18
|
| Rate for Payer: Cash Price |
$1,037.38
|
| Rate for Payer: Cofinity Commercial |
$1,115.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,037.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.18
|
| Rate for Payer: Healthscope Commercial |
$1,167.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$972.54
|
| Rate for Payer: Mclaren Medicaid |
$228.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.39
|
| Rate for Payer: Meridian Medicaid |
$240.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$356.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,102.21
|
| Rate for Payer: Nomi Health Commercial |
$1,063.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$972.54
|
| Rate for Payer: PACE Senior Care Partners |
$307.97
|
| Rate for Payer: PACE SWMI |
$324.18
|
| Rate for Payer: PHP Commercial |
$1,102.21
|
| Rate for Payer: PHP Medicare Advantage |
$324.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,128.15
|
| Rate for Payer: Priority Health Medicare |
$327.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$902.52
|
| Rate for Payer: Railroad Medicare Medicare |
$324.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,141.11
|
| Rate for Payer: UHC Core |
$1,082.76
|
| Rate for Payer: UHC Exchange |
$324.18
|
| Rate for Payer: UHC Medicaid |
$228.61
|
| Rate for Payer: UHC Medicare Advantage |
$324.18
|
| Rate for Payer: UHCCP Medicaid |
$228.61
|
| Rate for Payer: VA VA |
$324.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$972.54
|
|
|
HC ASPERGILLIS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200028
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ASPERGILLIS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200028
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ASPERGILLUS ANTIBODIES
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200221
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: BCBS Trust/PPO |
$39.44
|
| Rate for Payer: BCN Commercial |
$39.44
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.03
|
| Rate for Payer: UHC Core |
$39.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.82
|
|
