|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
IP
|
$40.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: Aetna Commercial |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$31.65
|
| Rate for Payer: BCN Commercial |
$31.65
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cofinity Commercial |
$35.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$36.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.81
|
| Rate for Payer: PHP Commercial |
$34.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.04
|
| Rate for Payer: UHC Core |
$34.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.71
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
OP
|
$40.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: Aetna Commercial |
$34.81
|
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.80
|
| Rate for Payer: BCBS Complete |
$16.38
|
| Rate for Payer: BCBS MAPPO |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$31.84
|
| Rate for Payer: BCN Commercial |
$31.84
|
| Rate for Payer: BCN Medicare Advantage |
$10.24
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cofinity Commercial |
$35.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$36.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.81
|
| Rate for Payer: PACE Senior Care Partners |
$9.73
|
| Rate for Payer: PACE SWMI |
$10.24
|
| Rate for Payer: PHP Commercial |
$34.81
|
| Rate for Payer: PHP Medicare Advantage |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.63
|
| Rate for Payer: Priority Health Medicare |
$10.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.04
|
| Rate for Payer: UHC Core |
$34.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.24
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: VA VA |
$10.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.71
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.81 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna Medicare |
$310.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$373.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$373.44
|
| Rate for Payer: BCBS Complete |
$478.00
|
| Rate for Payer: BCBS MAPPO |
$298.75
|
| Rate for Payer: BCBS Trust/PPO |
$929.11
|
| Rate for Payer: BCN Commercial |
$929.11
|
| Rate for Payer: BCN Medicare Advantage |
$298.75
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,027.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.75
|
| Rate for Payer: Healthscope Commercial |
$1,075.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$313.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.75
|
| Rate for Payer: PACE Senior Care Partners |
$283.81
|
| Rate for Payer: PACE SWMI |
$298.75
|
| Rate for Payer: PHP Commercial |
$1,015.75
|
| Rate for Payer: PHP Medicare Advantage |
$298.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,039.65
|
| Rate for Payer: Priority Health Medicare |
$298.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$728.83
|
| Rate for Payer: Railroad Medicare Medicare |
$298.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,051.60
|
| Rate for Payer: UHC Core |
$997.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.75
|
| Rate for Payer: UHC Medicare Advantage |
$307.71
|
| Rate for Payer: VA VA |
$298.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.25
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.83 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: BCBS Trust/PPO |
$923.50
|
| Rate for Payer: BCN Commercial |
$923.50
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,027.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,075.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.75
|
| Rate for Payer: PHP Commercial |
$1,015.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,039.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$728.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,051.60
|
| Rate for Payer: UHC Core |
$997.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.25
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$143.21 |
| Rate for Payer: Aetna Commercial |
$135.25
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.72
|
| Rate for Payer: BCBS Complete |
$63.65
|
| Rate for Payer: BCBS MAPPO |
$39.78
|
| Rate for Payer: BCBS Trust/PPO |
$123.72
|
| Rate for Payer: BCN Commercial |
$123.72
|
| Rate for Payer: BCN Medicare Advantage |
$39.78
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$136.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.78
|
| Rate for Payer: Healthscope Commercial |
$143.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.25
|
| Rate for Payer: PACE Senior Care Partners |
$37.79
|
| Rate for Payer: PACE SWMI |
$39.78
|
| Rate for Payer: PHP Commercial |
$135.25
|
| Rate for Payer: PHP Medicare Advantage |
$39.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.43
|
| Rate for Payer: Priority Health Medicare |
$39.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.05
|
| Rate for Payer: Railroad Medicare Medicare |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.03
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.78
|
| Rate for Payer: UHC Medicare Advantage |
$40.97
|
| Rate for Payer: VA VA |
$39.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.34
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.05 |
| Max. Negotiated Rate |
$143.21 |
| Rate for Payer: Aetna Commercial |
$135.25
|
| Rate for Payer: BCBS Trust/PPO |
$122.97
|
| Rate for Payer: BCN Commercial |
$122.97
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$136.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$143.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.25
|
| Rate for Payer: PHP Commercial |
$135.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.03
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.34
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
IP
|
$330.88
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Aetna Commercial |
$281.25
|
| Rate for Payer: BCBS Trust/PPO |
$255.70
|
| Rate for Payer: BCN Commercial |
$255.70
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cofinity Commercial |
$284.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.70
|
| Rate for Payer: Healthscope Commercial |
$297.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.25
|
| Rate for Payer: PHP Commercial |
$281.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.17
|
| Rate for Payer: UHC Core |
$276.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.16
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
OP
|
$330.88
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Aetna Commercial |
$281.25
|
| Rate for Payer: Aetna Medicare |
$86.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.40
|
| Rate for Payer: BCBS Complete |
$132.35
|
| Rate for Payer: BCBS MAPPO |
$82.72
|
| Rate for Payer: BCBS Trust/PPO |
$257.26
|
| Rate for Payer: BCN Commercial |
$257.26
|
| Rate for Payer: BCN Medicare Advantage |
$82.72
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cofinity Commercial |
$284.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$297.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.25
|
| Rate for Payer: PACE Senior Care Partners |
$78.58
|
| Rate for Payer: PACE SWMI |
$82.72
|
| Rate for Payer: PHP Commercial |
$281.25
|
| Rate for Payer: PHP Medicare Advantage |
$82.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.87
|
| Rate for Payer: Priority Health Medicare |
$82.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.80
|
| Rate for Payer: Railroad Medicare Medicare |
$82.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.17
|
| Rate for Payer: UHC Core |
$276.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.72
|
| Rate for Payer: UHC Medicare Advantage |
$85.20
|
| Rate for Payer: VA VA |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.16
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
OP
|
$475.65
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.97 |
| Max. Negotiated Rate |
$428.08 |
| Rate for Payer: Aetna Commercial |
$404.30
|
| Rate for Payer: Aetna Medicare |
$123.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.64
|
| Rate for Payer: BCBS Complete |
$190.26
|
| Rate for Payer: BCBS MAPPO |
$118.91
|
| Rate for Payer: BCBS Trust/PPO |
$369.82
|
| Rate for Payer: BCN Commercial |
$369.82
|
| Rate for Payer: BCN Medicare Advantage |
$118.91
|
| Rate for Payer: Cash Price |
$380.52
|
| Rate for Payer: Cofinity Commercial |
$409.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.91
|
| Rate for Payer: Healthscope Commercial |
$428.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.30
|
| Rate for Payer: PACE Senior Care Partners |
$112.97
|
| Rate for Payer: PACE SWMI |
$118.91
|
| Rate for Payer: PHP Commercial |
$404.30
|
| Rate for Payer: PHP Medicare Advantage |
$118.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.82
|
| Rate for Payer: Priority Health Medicare |
$118.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.10
|
| Rate for Payer: Railroad Medicare Medicare |
$118.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.57
|
| Rate for Payer: UHC Core |
$397.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.91
|
| Rate for Payer: UHC Medicare Advantage |
$122.48
|
| Rate for Payer: VA VA |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.74
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$475.65
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$428.08 |
| Rate for Payer: Aetna Commercial |
$404.30
|
| Rate for Payer: BCBS Trust/PPO |
$367.58
|
| Rate for Payer: BCN Commercial |
$367.58
|
| Rate for Payer: Cash Price |
$380.52
|
| Rate for Payer: Cofinity Commercial |
$409.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.52
|
| Rate for Payer: Healthscope Commercial |
$428.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.30
|
| Rate for Payer: PHP Commercial |
$404.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.57
|
| Rate for Payer: UHC Core |
$397.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.74
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$18.68
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$47.58
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$18.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$47.30
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,330.03
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$4,797.03 |
| Rate for Payer: Aetna Commercial |
$4,530.53
|
| Rate for Payer: Aetna Medicare |
$1,385.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,665.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,665.63
|
| Rate for Payer: BCBS Complete |
$2,132.01
|
| Rate for Payer: BCBS MAPPO |
$1,332.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,144.10
|
| Rate for Payer: BCN Commercial |
$4,144.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,332.51
|
| Rate for Payer: Cash Price |
$4,264.02
|
| Rate for Payer: Cofinity Commercial |
$4,583.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,264.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,332.51
|
| Rate for Payer: Healthscope Commercial |
$4,797.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,997.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,399.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,532.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,530.53
|
| Rate for Payer: PACE Senior Care Partners |
$1,265.88
|
| Rate for Payer: PACE SWMI |
$1,332.51
|
| Rate for Payer: PHP Commercial |
$4,530.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,332.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,731.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,637.13
|
| Rate for Payer: Priority Health Medicare |
$1,332.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,250.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,332.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,690.43
|
| Rate for Payer: UHC Core |
$4,450.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,332.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,372.48
|
| Rate for Payer: VA VA |
$1,332.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,997.52
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,330.03
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,250.79 |
| Max. Negotiated Rate |
$4,797.03 |
| Rate for Payer: Aetna Commercial |
$4,530.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,119.05
|
| Rate for Payer: BCN Commercial |
$4,119.05
|
| Rate for Payer: Cash Price |
$4,264.02
|
| Rate for Payer: Cofinity Commercial |
$4,583.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,264.02
|
| Rate for Payer: Healthscope Commercial |
$4,797.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,997.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,530.53
|
| Rate for Payer: PHP Commercial |
$4,530.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,731.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,637.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,250.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,690.43
|
| Rate for Payer: UHC Core |
$4,450.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,997.52
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,272.44
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$776.06 |
| Max. Negotiated Rate |
$1,145.20 |
| Rate for Payer: Aetna Commercial |
$1,081.57
|
| Rate for Payer: BCBS Trust/PPO |
$983.34
|
| Rate for Payer: BCN Commercial |
$983.34
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cofinity Commercial |
$1,094.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,017.95
|
| Rate for Payer: Healthscope Commercial |
$1,145.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,081.57
|
| Rate for Payer: PHP Commercial |
$1,081.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$776.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,119.75
|
| Rate for Payer: UHC Core |
$1,062.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.33
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,272.44
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$302.20 |
| Max. Negotiated Rate |
$1,145.20 |
| Rate for Payer: Aetna Commercial |
$1,081.57
|
| Rate for Payer: Aetna Medicare |
$330.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$397.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$397.64
|
| Rate for Payer: BCBS Complete |
$508.98
|
| Rate for Payer: BCBS MAPPO |
$318.11
|
| Rate for Payer: BCBS Trust/PPO |
$989.32
|
| Rate for Payer: BCN Commercial |
$989.32
|
| Rate for Payer: BCN Medicare Advantage |
$318.11
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cofinity Commercial |
$1,094.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,017.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.11
|
| Rate for Payer: Healthscope Commercial |
$1,145.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$334.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,081.57
|
| Rate for Payer: PACE Senior Care Partners |
$302.20
|
| Rate for Payer: PACE SWMI |
$318.11
|
| Rate for Payer: PHP Commercial |
$1,081.57
|
| Rate for Payer: PHP Medicare Advantage |
$318.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.02
|
| Rate for Payer: Priority Health Medicare |
$318.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$776.06
|
| Rate for Payer: Railroad Medicare Medicare |
$318.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,119.75
|
| Rate for Payer: UHC Core |
$1,062.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.11
|
| Rate for Payer: UHC Medicare Advantage |
$327.65
|
| Rate for Payer: VA VA |
$318.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.33
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$183.40
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$165.06 |
| Rate for Payer: Aetna Commercial |
$155.89
|
| Rate for Payer: Aetna Medicare |
$47.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.31
|
| Rate for Payer: BCBS Complete |
$73.36
|
| Rate for Payer: BCBS MAPPO |
$45.85
|
| Rate for Payer: BCBS Trust/PPO |
$142.59
|
| Rate for Payer: BCN Commercial |
$142.59
|
| Rate for Payer: BCN Medicare Advantage |
$45.85
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cofinity Commercial |
$157.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.85
|
| Rate for Payer: Healthscope Commercial |
$165.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.89
|
| Rate for Payer: PACE Senior Care Partners |
$43.56
|
| Rate for Payer: PACE SWMI |
$45.85
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: PHP Medicare Advantage |
$45.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.56
|
| Rate for Payer: Priority Health Medicare |
$45.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.86
|
| Rate for Payer: Railroad Medicare Medicare |
$45.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.39
|
| Rate for Payer: UHC Core |
$153.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.85
|
| Rate for Payer: UHC Medicare Advantage |
$47.23
|
| Rate for Payer: VA VA |
$45.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.55
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$183.40
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$165.06 |
| Rate for Payer: Aetna Commercial |
$155.89
|
| Rate for Payer: BCBS Trust/PPO |
$141.73
|
| Rate for Payer: BCN Commercial |
$141.73
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cofinity Commercial |
$157.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.72
|
| Rate for Payer: Healthscope Commercial |
$165.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.89
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.39
|
| Rate for Payer: UHC Core |
$153.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.55
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
OP
|
$350.37
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.21 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$91.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.49
|
| Rate for Payer: BCBS Complete |
$140.15
|
| Rate for Payer: BCBS MAPPO |
$87.59
|
| Rate for Payer: BCBS Trust/PPO |
$272.41
|
| Rate for Payer: BCN Commercial |
$272.41
|
| Rate for Payer: BCN Medicare Advantage |
$87.59
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.59
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PACE Senior Care Partners |
$83.21
|
| Rate for Payer: PACE SWMI |
$87.59
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: PHP Medicare Advantage |
$87.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Medicare |
$87.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: Railroad Medicare Medicare |
$87.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.59
|
| Rate for Payer: UHC Medicare Advantage |
$90.22
|
| Rate for Payer: VA VA |
$87.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
IP
|
$350.37
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.69 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: BCBS Trust/PPO |
$270.77
|
| Rate for Payer: BCN Commercial |
$270.77
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
OP
|
$15.06
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$3.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.71
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS MAPPO |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: BCN Medicare Advantage |
$3.76
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$3.58
|
| Rate for Payer: PACE SWMI |
$3.76
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.10
|
| Rate for Payer: Priority Health Medicare |
$3.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.76
|
| Rate for Payer: UHC Medicare Advantage |
$3.88
|
| Rate for Payer: VA VA |
$3.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
IP
|
$15.06
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: BCBS Trust/PPO |
$81.45
|
| Rate for Payer: BCN Commercial |
$81.45
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$27.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.94
|
| Rate for Payer: BCBS Complete |
$10.60
|
| Rate for Payer: BCBS MAPPO |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$81.95
|
| Rate for Payer: BCN Commercial |
$81.95
|
| Rate for Payer: BCN Medicare Advantage |
$26.35
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.35
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Mclaren Medicaid |
$10.10
|
| Rate for Payer: Meridian Medicaid |
$10.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Senior Care Partners |
$25.03
|
| Rate for Payer: PACE SWMI |
$26.35
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$26.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Medicare |
$26.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: Railroad Medicare Medicare |
$26.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.35
|
| Rate for Payer: UHC Medicare Advantage |
$27.14
|
| Rate for Payer: VA VA |
$26.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$80.89
|
| Rate for Payer: BCN Commercial |
$80.89
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.45
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$26.79
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
