|
HC BRACE UNIVERSAL COCKUP SPLINT
|
Facility
|
OP
|
$36.15
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400012
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.30
|
| Rate for Payer: BCBS Complete |
$14.46
|
| Rate for Payer: BCBS MAPPO |
$9.04
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.11
|
| Rate for Payer: BCN Medicare Advantage |
$9.04
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cofinity Commercial |
$31.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.04
|
| Rate for Payer: Healthscope Commercial |
$32.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.73
|
| Rate for Payer: Nomi Health Commercial |
$29.64
|
| Rate for Payer: PACE Senior Care Partners |
$8.59
|
| Rate for Payer: PACE SWMI |
$9.04
|
| Rate for Payer: PHP Commercial |
$30.73
|
| Rate for Payer: PHP Medicare Advantage |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.50
|
| Rate for Payer: Priority Health HMO/PPO |
$31.45
|
| Rate for Payer: Priority Health Medicare |
$9.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.22
|
| Rate for Payer: Railroad Medicare Medicare |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.81
|
| Rate for Payer: UHC Core |
$30.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.04
|
| Rate for Payer: UHC Exchange |
$9.04
|
| Rate for Payer: UHC Medicare Advantage |
$9.04
|
| Rate for Payer: VA VA |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.11
|
|
|
HC BRACE WAIST BELT
|
Facility
|
OP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Aetna Medicare |
$38.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.10
|
| Rate for Payer: BCBS Complete |
$59.01
|
| Rate for Payer: BCBS MAPPO |
$36.88
|
| Rate for Payer: BCBS Trust/PPO |
$121.28
|
| Rate for Payer: BCN Commercial |
$114.70
|
| Rate for Payer: BCN Medicare Advantage |
$36.88
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.88
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Nomi Health Commercial |
$120.97
|
| Rate for Payer: PACE Senior Care Partners |
$35.04
|
| Rate for Payer: PACE SWMI |
$36.88
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: PHP Medicare Advantage |
$36.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health HMO/PPO |
$128.34
|
| Rate for Payer: Priority Health Medicare |
$37.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.84
|
| Rate for Payer: Railroad Medicare Medicare |
$36.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.82
|
| Rate for Payer: UHC Core |
$123.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.88
|
| Rate for Payer: UHC Exchange |
$36.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.88
|
| Rate for Payer: VA VA |
$36.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
|
|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: BCBS Trust/PPO |
$120.42
|
| Rate for Payer: BCN Commercial |
$114.00
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Nomi Health Commercial |
$120.97
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health HMO/PPO |
$128.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.82
|
| Rate for Payer: UHC Core |
$123.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$305.25 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Medicare |
$88.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.99
|
| Rate for Payer: BCBS Complete |
$135.67
|
| Rate for Payer: BCBS MAPPO |
$84.79
|
| Rate for Payer: BCBS Trust/PPO |
$278.83
|
| Rate for Payer: BCN Commercial |
$263.70
|
| Rate for Payer: BCN Medicare Advantage |
$84.79
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$291.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.79
|
| Rate for Payer: Healthscope Commercial |
$305.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: Nomi Health Commercial |
$278.12
|
| Rate for Payer: PACE Senior Care Partners |
$80.55
|
| Rate for Payer: PACE SWMI |
$84.79
|
| Rate for Payer: PHP Commercial |
$288.29
|
| Rate for Payer: PHP Medicare Advantage |
$84.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health HMO/PPO |
$295.08
|
| Rate for Payer: Priority Health Medicare |
$85.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.24
|
| Rate for Payer: Railroad Medicare Medicare |
$84.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.47
|
| Rate for Payer: UHC Core |
$283.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.79
|
| Rate for Payer: UHC Exchange |
$84.79
|
| Rate for Payer: UHC Medicare Advantage |
$84.79
|
| Rate for Payer: VA VA |
$84.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.38
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$305.25 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: BCBS Trust/PPO |
$276.86
|
| Rate for Payer: BCN Commercial |
$262.11
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$291.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$305.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: Nomi Health Commercial |
$278.12
|
| Rate for Payer: PHP Commercial |
$288.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health HMO/PPO |
$295.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.47
|
| Rate for Payer: UHC Core |
$283.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.38
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.65 |
| Max. Negotiated Rate |
$434.48 |
| Rate for Payer: Aetna Commercial |
$410.34
|
| Rate for Payer: Aetna Medicare |
$125.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.86
|
| Rate for Payer: BCBS Complete |
$193.10
|
| Rate for Payer: BCBS MAPPO |
$120.69
|
| Rate for Payer: BCBS Trust/PPO |
$396.87
|
| Rate for Payer: BCN Commercial |
$375.34
|
| Rate for Payer: BCN Medicare Advantage |
$120.69
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$415.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.69
|
| Rate for Payer: Healthscope Commercial |
$434.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: PACE Senior Care Partners |
$114.65
|
| Rate for Payer: PACE SWMI |
$120.69
|
| Rate for Payer: PHP Commercial |
$410.34
|
| Rate for Payer: PHP Medicare Advantage |
$120.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health HMO/PPO |
$419.99
|
| Rate for Payer: Priority Health Medicare |
$121.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.44
|
| Rate for Payer: Railroad Medicare Medicare |
$120.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.82
|
| Rate for Payer: UHC Core |
$403.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.69
|
| Rate for Payer: UHC Exchange |
$120.69
|
| Rate for Payer: UHC Medicare Advantage |
$120.69
|
| Rate for Payer: VA VA |
$120.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.06
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.79 |
| Max. Negotiated Rate |
$434.48 |
| Rate for Payer: Aetna Commercial |
$410.34
|
| Rate for Payer: BCBS Trust/PPO |
$394.07
|
| Rate for Payer: BCN Commercial |
$373.07
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$415.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$434.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: PHP Commercial |
$410.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health HMO/PPO |
$419.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.82
|
| Rate for Payer: UHC Core |
$403.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.06
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.01 |
| Max. Negotiated Rate |
$2,083.86 |
| Rate for Payer: Aetna Commercial |
$1,968.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.06
|
| Rate for Payer: BCN Commercial |
$1,789.34
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$1,991.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,083.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,736.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: PHP Commercial |
$1,968.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,014.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,551.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,037.55
|
| Rate for Payer: UHC Core |
$1,933.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,736.55
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$549.91 |
| Max. Negotiated Rate |
$2,083.86 |
| Rate for Payer: Aetna Commercial |
$1,968.09
|
| Rate for Payer: Aetna Medicare |
$602.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.56
|
| Rate for Payer: BCBS Complete |
$926.16
|
| Rate for Payer: BCBS MAPPO |
$578.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,903.49
|
| Rate for Payer: BCN Commercial |
$1,800.22
|
| Rate for Payer: BCN Medicare Advantage |
$578.85
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$1,991.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.85
|
| Rate for Payer: Healthscope Commercial |
$2,083.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,736.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$607.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: PACE Senior Care Partners |
$549.91
|
| Rate for Payer: PACE SWMI |
$578.85
|
| Rate for Payer: PHP Commercial |
$1,968.09
|
| Rate for Payer: PHP Medicare Advantage |
$578.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,014.40
|
| Rate for Payer: Priority Health Medicare |
$584.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,551.32
|
| Rate for Payer: Railroad Medicare Medicare |
$578.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,037.55
|
| Rate for Payer: UHC Core |
$1,933.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$578.85
|
| Rate for Payer: UHC Exchange |
$578.85
|
| Rate for Payer: UHC Medicare Advantage |
$578.85
|
| Rate for Payer: VA VA |
$578.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,736.55
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Aetna Commercial |
$130.08
|
| Rate for Payer: Aetna Medicare |
$39.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.82
|
| Rate for Payer: BCBS Complete |
$61.22
|
| Rate for Payer: BCBS MAPPO |
$38.26
|
| Rate for Payer: BCBS Trust/PPO |
$125.81
|
| Rate for Payer: BCN Commercial |
$118.99
|
| Rate for Payer: BCN Medicare Advantage |
$38.26
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$131.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.26
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: Nomi Health Commercial |
$125.49
|
| Rate for Payer: PACE Senior Care Partners |
$36.35
|
| Rate for Payer: PACE SWMI |
$38.26
|
| Rate for Payer: PHP Commercial |
$130.08
|
| Rate for Payer: PHP Medicare Advantage |
$38.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: Priority Health HMO/PPO |
$133.14
|
| Rate for Payer: Priority Health Medicare |
$38.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.54
|
| Rate for Payer: Railroad Medicare Medicare |
$38.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.68
|
| Rate for Payer: UHC Core |
$127.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.26
|
| Rate for Payer: UHC Exchange |
$38.26
|
| Rate for Payer: UHC Medicare Advantage |
$38.26
|
| Rate for Payer: VA VA |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.78
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.48 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Aetna Commercial |
$130.08
|
| Rate for Payer: BCBS Trust/PPO |
$124.93
|
| Rate for Payer: BCN Commercial |
$118.27
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$131.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: Nomi Health Commercial |
$125.49
|
| Rate for Payer: PHP Commercial |
$130.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: Priority Health HMO/PPO |
$133.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.68
|
| Rate for Payer: UHC Core |
$127.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.78
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$201.79 |
| Rate for Payer: Aetna Commercial |
$190.58
|
| Rate for Payer: Aetna Medicare |
$58.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.07
|
| Rate for Payer: BCBS Complete |
$26.12
|
| Rate for Payer: BCBS MAPPO |
$56.05
|
| Rate for Payer: BCBS Trust/PPO |
$184.32
|
| Rate for Payer: BCN Commercial |
$174.32
|
| Rate for Payer: BCN Medicare Advantage |
$56.05
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$192.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.05
|
| Rate for Payer: Healthscope Commercial |
$201.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.16
|
| Rate for Payer: Mclaren Medicaid |
$24.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.86
|
| Rate for Payer: Meridian Medicaid |
$26.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: PACE Senior Care Partners |
$53.25
|
| Rate for Payer: PACE SWMI |
$56.05
|
| Rate for Payer: PHP Commercial |
$190.58
|
| Rate for Payer: PHP Medicare Advantage |
$56.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health HMO/PPO |
$195.06
|
| Rate for Payer: Priority Health Medicare |
$56.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.22
|
| Rate for Payer: Railroad Medicare Medicare |
$56.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.30
|
| Rate for Payer: UHC Core |
$187.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.05
|
| Rate for Payer: UHC Exchange |
$56.05
|
| Rate for Payer: UHC Medicare Advantage |
$56.05
|
| Rate for Payer: UHCCP Medicaid |
$24.87
|
| Rate for Payer: VA VA |
$56.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.16
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$201.79 |
| Rate for Payer: Aetna Commercial |
$190.58
|
| Rate for Payer: BCBS Trust/PPO |
$183.02
|
| Rate for Payer: BCN Commercial |
$173.27
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$192.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Healthscope Commercial |
$201.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: PHP Commercial |
$190.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health HMO/PPO |
$195.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.30
|
| Rate for Payer: UHC Core |
$187.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.16
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.45 |
| Max. Negotiated Rate |
$1,608.16 |
| Rate for Payer: Aetna Commercial |
$1,518.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.61
|
| Rate for Payer: BCN Commercial |
$1,380.88
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,536.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Healthscope Commercial |
$1,608.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,340.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: Nomi Health Commercial |
$1,465.22
|
| Rate for Payer: PHP Commercial |
$1,518.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,554.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,197.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,572.43
|
| Rate for Payer: UHC Core |
$1,492.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,340.14
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$424.38 |
| Max. Negotiated Rate |
$1,608.16 |
| Rate for Payer: Aetna Commercial |
$1,518.82
|
| Rate for Payer: Aetna Medicare |
$464.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$558.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$558.39
|
| Rate for Payer: BCBS Complete |
$714.74
|
| Rate for Payer: BCBS MAPPO |
$446.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.97
|
| Rate for Payer: BCN Commercial |
$1,389.28
|
| Rate for Payer: BCN Medicare Advantage |
$446.71
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,536.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$446.71
|
| Rate for Payer: Healthscope Commercial |
$1,608.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,340.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$513.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: Nomi Health Commercial |
$1,465.22
|
| Rate for Payer: PACE Senior Care Partners |
$424.38
|
| Rate for Payer: PACE SWMI |
$446.71
|
| Rate for Payer: PHP Commercial |
$1,518.82
|
| Rate for Payer: PHP Medicare Advantage |
$446.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,554.56
|
| Rate for Payer: Priority Health Medicare |
$451.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,197.19
|
| Rate for Payer: Railroad Medicare Medicare |
$446.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,572.43
|
| Rate for Payer: UHC Core |
$1,492.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$446.71
|
| Rate for Payer: UHC Exchange |
$446.71
|
| Rate for Payer: UHC Medicare Advantage |
$446.71
|
| Rate for Payer: VA VA |
$446.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,340.14
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$524.38 |
| Max. Negotiated Rate |
$4,661.30 |
| Rate for Payer: Aetna Commercial |
$4,402.34
|
| Rate for Payer: Aetna Medicare |
$1,346.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,618.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,618.51
|
| Rate for Payer: BCBS Complete |
$2,071.69
|
| Rate for Payer: BCBS MAPPO |
$1,294.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,257.84
|
| Rate for Payer: BCCCP Commercial |
$524.38
|
| Rate for Payer: BCN Commercial |
$4,026.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,294.80
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$4,454.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,294.80
|
| Rate for Payer: Healthscope Commercial |
$4,661.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,884.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,359.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,489.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: Nomi Health Commercial |
$4,246.96
|
| Rate for Payer: PACE Senior Care Partners |
$1,230.06
|
| Rate for Payer: PACE SWMI |
$1,294.80
|
| Rate for Payer: PHP Commercial |
$4,402.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,294.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: Priority Health HMO/PPO |
$4,505.92
|
| Rate for Payer: Priority Health Medicare |
$1,307.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,470.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,294.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,557.71
|
| Rate for Payer: UHC Core |
$4,324.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,294.80
|
| Rate for Payer: UHC Exchange |
$1,294.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,294.80
|
| Rate for Payer: VA VA |
$1,294.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,884.42
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.49 |
| Max. Negotiated Rate |
$4,661.30 |
| Rate for Payer: Aetna Commercial |
$4,402.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,227.80
|
| Rate for Payer: BCN Commercial |
$4,002.50
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$4,454.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Healthscope Commercial |
$4,661.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,884.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: Nomi Health Commercial |
$4,246.96
|
| Rate for Payer: PHP Commercial |
$4,402.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: Priority Health HMO/PPO |
$4,505.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,470.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,557.71
|
| Rate for Payer: UHC Core |
$4,324.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,884.42
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
IP
|
$3,670.34
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,385.72 |
| Max. Negotiated Rate |
$3,303.31 |
| Rate for Payer: Aetna Commercial |
$3,119.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,996.10
|
| Rate for Payer: BCN Commercial |
$2,836.44
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cofinity Commercial |
$3,156.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,936.27
|
| Rate for Payer: Healthscope Commercial |
$3,303.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,752.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,119.79
|
| Rate for Payer: Nomi Health Commercial |
$3,009.68
|
| Rate for Payer: PHP Commercial |
$3,119.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,385.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,193.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,459.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,229.90
|
| Rate for Payer: UHC Core |
$3,064.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,752.76
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
OP
|
$3,670.34
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.68 |
| Max. Negotiated Rate |
$3,303.31 |
| Rate for Payer: Aetna Commercial |
$3,119.79
|
| Rate for Payer: Aetna Medicare |
$954.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,146.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,146.98
|
| Rate for Payer: BCBS Complete |
$1,468.14
|
| Rate for Payer: BCBS MAPPO |
$917.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,017.39
|
| Rate for Payer: BCCCP Commercial |
$344.68
|
| Rate for Payer: BCN Commercial |
$2,853.69
|
| Rate for Payer: BCN Medicare Advantage |
$917.58
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cofinity Commercial |
$3,156.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,936.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.58
|
| Rate for Payer: Healthscope Commercial |
$3,303.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,752.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$963.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,055.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,119.79
|
| Rate for Payer: Nomi Health Commercial |
$3,009.68
|
| Rate for Payer: PACE Senior Care Partners |
$871.71
|
| Rate for Payer: PACE SWMI |
$917.58
|
| Rate for Payer: PHP Commercial |
$3,119.79
|
| Rate for Payer: PHP Medicare Advantage |
$917.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,385.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,193.20
|
| Rate for Payer: Priority Health Medicare |
$926.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,459.13
|
| Rate for Payer: Railroad Medicare Medicare |
$917.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,229.90
|
| Rate for Payer: UHC Core |
$3,064.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$917.58
|
| Rate for Payer: UHC Exchange |
$917.58
|
| Rate for Payer: UHC Medicare Advantage |
$917.58
|
| Rate for Payer: VA VA |
$917.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,752.76
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
IP
|
$4,045.90
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,629.84 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,302.67
|
| Rate for Payer: BCN Commercial |
$3,126.67
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,034.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.02
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health HMO/PPO |
$3,519.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,710.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,560.39
|
| Rate for Payer: UHC Core |
$3,378.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,034.42
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
OP
|
$4,045.90
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.10 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.02
|
| Rate for Payer: Aetna Medicare |
$1,051.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,264.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,264.34
|
| Rate for Payer: BCBS Complete |
$1,618.36
|
| Rate for Payer: BCBS MAPPO |
$1,011.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,326.13
|
| Rate for Payer: BCCCP Commercial |
$338.10
|
| Rate for Payer: BCN Commercial |
$3,145.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,011.48
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,011.48
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,034.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,062.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.02
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: PACE Senior Care Partners |
$960.90
|
| Rate for Payer: PACE SWMI |
$1,011.48
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,011.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health HMO/PPO |
$3,519.93
|
| Rate for Payer: Priority Health Medicare |
$1,021.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,710.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,011.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,560.39
|
| Rate for Payer: UHC Core |
$3,378.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,011.48
|
| Rate for Payer: UHC Exchange |
$1,011.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,011.48
|
| Rate for Payer: VA VA |
$1,011.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,034.42
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
IP
|
$3,096.85
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,012.95 |
| Max. Negotiated Rate |
$2,787.16 |
| Rate for Payer: Aetna Commercial |
$2,632.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,527.96
|
| Rate for Payer: BCN Commercial |
$2,393.25
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cofinity Commercial |
$2,663.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,477.48
|
| Rate for Payer: Healthscope Commercial |
$2,787.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,322.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,632.32
|
| Rate for Payer: Nomi Health Commercial |
$2,539.42
|
| Rate for Payer: PHP Commercial |
$2,632.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,694.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,074.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,725.23
|
| Rate for Payer: UHC Core |
$2,585.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,322.64
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
OP
|
$3,096.85
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$685.36 |
| Max. Negotiated Rate |
$2,787.16 |
| Rate for Payer: Aetna Commercial |
$2,632.32
|
| Rate for Payer: Aetna Medicare |
$805.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.77
|
| Rate for Payer: BCBS Complete |
$1,205.21
|
| Rate for Payer: BCBS MAPPO |
$774.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,545.92
|
| Rate for Payer: BCCCP Commercial |
$685.36
|
| Rate for Payer: BCN Commercial |
$2,407.80
|
| Rate for Payer: BCN Medicare Advantage |
$774.21
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cofinity Commercial |
$2,663.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,477.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.21
|
| Rate for Payer: Healthscope Commercial |
$2,787.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,322.64
|
| Rate for Payer: Mclaren Medicaid |
$1,147.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.92
|
| Rate for Payer: Meridian Medicaid |
$1,205.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,632.32
|
| Rate for Payer: Nomi Health Commercial |
$2,539.42
|
| Rate for Payer: PACE Senior Care Partners |
$735.50
|
| Rate for Payer: PACE SWMI |
$774.21
|
| Rate for Payer: PHP Commercial |
$2,632.32
|
| Rate for Payer: PHP Medicare Advantage |
$774.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,694.26
|
| Rate for Payer: Priority Health Medicare |
$781.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,074.89
|
| Rate for Payer: Railroad Medicare Medicare |
$774.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,725.23
|
| Rate for Payer: UHC Core |
$2,585.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.21
|
| Rate for Payer: UHC Exchange |
$774.21
|
| Rate for Payer: UHC Medicare Advantage |
$774.21
|
| Rate for Payer: UHCCP Medicaid |
$1,147.75
|
| Rate for Payer: VA VA |
$774.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,322.64
|
|
