|
HC IR DISKOGRAM CERVICAL THORACIC
|
Facility
|
OP
|
$2,507.98
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
32000057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$595.65 |
| Max. Negotiated Rate |
$2,257.18 |
| Rate for Payer: Aetna Commercial |
$2,131.78
|
| Rate for Payer: Aetna Medicare |
$652.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$783.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$783.74
|
| Rate for Payer: BCBS Complete |
$1,329.91
|
| Rate for Payer: BCBS MAPPO |
$627.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.95
|
| Rate for Payer: BCN Commercial |
$1,949.95
|
| Rate for Payer: BCN Medicare Advantage |
$627.00
|
| Rate for Payer: Cash Price |
$2,006.38
|
| Rate for Payer: Cash Price |
$2,006.38
|
| Rate for Payer: Cofinity Commercial |
$2,156.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.00
|
| Rate for Payer: Healthscope Commercial |
$2,257.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.98
|
| Rate for Payer: Mclaren Medicaid |
$1,266.58
|
| Rate for Payer: Meridian Medicaid |
$1,329.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$658.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,131.78
|
| Rate for Payer: PACE Senior Care Partners |
$595.65
|
| Rate for Payer: PACE SWMI |
$627.00
|
| Rate for Payer: PHP Commercial |
$2,131.78
|
| Rate for Payer: PHP Medicare Advantage |
$627.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,266.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,755.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,181.94
|
| Rate for Payer: Priority Health Medicare |
$627.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,529.62
|
| Rate for Payer: Railroad Medicare Medicare |
$627.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,207.02
|
| Rate for Payer: UHC Core |
$2,094.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$627.00
|
| Rate for Payer: UHC Medicare Advantage |
$645.80
|
| Rate for Payer: VA VA |
$627.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.98
|
|
|
HC IR DISKOGRAM LUMBAR ONLY
|
Facility
|
OP
|
$2,871.60
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$2,584.44 |
| Rate for Payer: Aetna Commercial |
$2,440.86
|
| Rate for Payer: Aetna Medicare |
$746.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$897.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$897.38
|
| Rate for Payer: BCBS Complete |
$1,329.91
|
| Rate for Payer: BCBS MAPPO |
$717.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.67
|
| Rate for Payer: BCN Commercial |
$2,232.67
|
| Rate for Payer: BCN Medicare Advantage |
$717.90
|
| Rate for Payer: Cash Price |
$2,297.28
|
| Rate for Payer: Cash Price |
$2,297.28
|
| Rate for Payer: Cofinity Commercial |
$2,469.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,297.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.90
|
| Rate for Payer: Healthscope Commercial |
$2,584.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,153.70
|
| Rate for Payer: Mclaren Medicaid |
$1,266.58
|
| Rate for Payer: Meridian Medicaid |
$1,329.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$753.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$825.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,440.86
|
| Rate for Payer: PACE Senior Care Partners |
$682.00
|
| Rate for Payer: PACE SWMI |
$717.90
|
| Rate for Payer: PHP Commercial |
$2,440.86
|
| Rate for Payer: PHP Medicare Advantage |
$717.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,266.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,010.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,498.29
|
| Rate for Payer: Priority Health Medicare |
$717.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,751.39
|
| Rate for Payer: Railroad Medicare Medicare |
$717.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,527.01
|
| Rate for Payer: UHC Core |
$2,397.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.90
|
| Rate for Payer: UHC Medicare Advantage |
$739.44
|
| Rate for Payer: VA VA |
$717.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,153.70
|
|
|
HC IR DISKOGRAM LUMBAR ONLY
|
Facility
|
IP
|
$2,871.60
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,751.39 |
| Max. Negotiated Rate |
$2,584.44 |
| Rate for Payer: Aetna Commercial |
$2,440.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,219.17
|
| Rate for Payer: BCN Commercial |
$2,219.17
|
| Rate for Payer: Cash Price |
$2,297.28
|
| Rate for Payer: Cofinity Commercial |
$2,469.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,297.28
|
| Rate for Payer: Healthscope Commercial |
$2,584.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,153.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,440.86
|
| Rate for Payer: PHP Commercial |
$2,440.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,010.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,498.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,751.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,527.01
|
| Rate for Payer: UHC Core |
$2,397.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,153.70
|
|
|
HC IR EMBOLIZATION
|
Facility
|
OP
|
$3,430.91
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
32000210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$814.84 |
| Max. Negotiated Rate |
$3,087.82 |
| Rate for Payer: Aetna Commercial |
$2,916.27
|
| Rate for Payer: Aetna Medicare |
$892.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,072.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,072.16
|
| Rate for Payer: BCBS Complete |
$1,372.36
|
| Rate for Payer: BCBS MAPPO |
$857.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,667.53
|
| Rate for Payer: BCN Commercial |
$2,667.53
|
| Rate for Payer: BCN Medicare Advantage |
$857.73
|
| Rate for Payer: Cash Price |
$2,744.73
|
| Rate for Payer: Cofinity Commercial |
$2,950.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,744.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$857.73
|
| Rate for Payer: Healthscope Commercial |
$3,087.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,573.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$900.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$986.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,916.27
|
| Rate for Payer: PACE Senior Care Partners |
$814.84
|
| Rate for Payer: PACE SWMI |
$857.73
|
| Rate for Payer: PHP Commercial |
$2,916.27
|
| Rate for Payer: PHP Medicare Advantage |
$857.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,984.89
|
| Rate for Payer: Priority Health Medicare |
$857.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,092.51
|
| Rate for Payer: Railroad Medicare Medicare |
$857.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,019.20
|
| Rate for Payer: UHC Core |
$2,864.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$857.73
|
| Rate for Payer: UHC Medicare Advantage |
$883.46
|
| Rate for Payer: VA VA |
$857.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,573.18
|
|
|
HC IR EMBOLIZATION
|
Facility
|
IP
|
$3,430.91
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
32000210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,092.51 |
| Max. Negotiated Rate |
$3,087.82 |
| Rate for Payer: Aetna Commercial |
$2,916.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,651.41
|
| Rate for Payer: BCN Commercial |
$2,651.41
|
| Rate for Payer: Cash Price |
$2,744.73
|
| Rate for Payer: Cofinity Commercial |
$2,950.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,744.73
|
| Rate for Payer: Healthscope Commercial |
$3,087.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,573.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,916.27
|
| Rate for Payer: PHP Commercial |
$2,916.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,984.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,092.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,019.20
|
| Rate for Payer: UHC Core |
$2,864.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,573.18
|
|
|
HC IR ERCP
|
Facility
|
IP
|
$800.65
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$488.32 |
| Max. Negotiated Rate |
$720.58 |
| Rate for Payer: Aetna Commercial |
$680.55
|
| Rate for Payer: BCBS Trust/PPO |
$618.74
|
| Rate for Payer: BCN Commercial |
$618.74
|
| Rate for Payer: Cash Price |
$640.52
|
| Rate for Payer: Cofinity Commercial |
$688.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.52
|
| Rate for Payer: Healthscope Commercial |
$720.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.55
|
| Rate for Payer: PHP Commercial |
$680.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$696.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$704.57
|
| Rate for Payer: UHC Core |
$668.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.49
|
|
|
HC IR ERCP
|
Facility
|
OP
|
$800.65
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
32000155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.15 |
| Max. Negotiated Rate |
$720.58 |
| Rate for Payer: Aetna Commercial |
$680.55
|
| Rate for Payer: Aetna Medicare |
$208.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.20
|
| Rate for Payer: BCBS Complete |
$320.26
|
| Rate for Payer: BCBS MAPPO |
$200.16
|
| Rate for Payer: BCBS Trust/PPO |
$622.51
|
| Rate for Payer: BCN Commercial |
$622.51
|
| Rate for Payer: BCN Medicare Advantage |
$200.16
|
| Rate for Payer: Cash Price |
$640.52
|
| Rate for Payer: Cofinity Commercial |
$688.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.16
|
| Rate for Payer: Healthscope Commercial |
$720.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$210.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.55
|
| Rate for Payer: PACE Senior Care Partners |
$190.15
|
| Rate for Payer: PACE SWMI |
$200.16
|
| Rate for Payer: PHP Commercial |
$680.55
|
| Rate for Payer: PHP Medicare Advantage |
$200.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$696.57
|
| Rate for Payer: Priority Health Medicare |
$200.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.32
|
| Rate for Payer: Railroad Medicare Medicare |
$200.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$704.57
|
| Rate for Payer: UHC Core |
$668.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.16
|
| Rate for Payer: UHC Medicare Advantage |
$206.17
|
| Rate for Payer: VA VA |
$200.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.49
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
OP
|
$616.61
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$554.95 |
| Rate for Payer: Aetna Commercial |
$524.12
|
| Rate for Payer: Aetna Medicare |
$160.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.69
|
| Rate for Payer: BCBS Complete |
$246.64
|
| Rate for Payer: BCBS MAPPO |
$154.15
|
| Rate for Payer: BCBS Trust/PPO |
$479.41
|
| Rate for Payer: BCN Commercial |
$479.41
|
| Rate for Payer: BCN Medicare Advantage |
$154.15
|
| Rate for Payer: Cash Price |
$493.29
|
| Rate for Payer: Cofinity Commercial |
$530.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.15
|
| Rate for Payer: Healthscope Commercial |
$554.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$524.12
|
| Rate for Payer: PACE Senior Care Partners |
$146.44
|
| Rate for Payer: PACE SWMI |
$154.15
|
| Rate for Payer: PHP Commercial |
$524.12
|
| Rate for Payer: PHP Medicare Advantage |
$154.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.45
|
| Rate for Payer: Priority Health Medicare |
$154.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.07
|
| Rate for Payer: Railroad Medicare Medicare |
$154.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.62
|
| Rate for Payer: UHC Core |
$514.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.15
|
| Rate for Payer: UHC Medicare Advantage |
$158.78
|
| Rate for Payer: VA VA |
$154.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.46
|
|
|
HC IR FIBRIN STRIPPING OF VAD
|
Facility
|
IP
|
$616.61
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$376.07 |
| Max. Negotiated Rate |
$554.95 |
| Rate for Payer: Aetna Commercial |
$524.12
|
| Rate for Payer: BCBS Trust/PPO |
$476.52
|
| Rate for Payer: BCN Commercial |
$476.52
|
| Rate for Payer: Cash Price |
$493.29
|
| Rate for Payer: Cofinity Commercial |
$530.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.29
|
| Rate for Payer: Healthscope Commercial |
$554.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$524.12
|
| Rate for Payer: PHP Commercial |
$524.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.62
|
| Rate for Payer: UHC Core |
$514.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.46
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
OP
|
$300.42
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: Aetna Medicare |
$78.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.88
|
| Rate for Payer: BCBS Complete |
$120.17
|
| Rate for Payer: BCBS MAPPO |
$75.10
|
| Rate for Payer: BCBS Trust/PPO |
$233.58
|
| Rate for Payer: BCN Commercial |
$233.58
|
| Rate for Payer: BCN Medicare Advantage |
$75.10
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.10
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PACE Senior Care Partners |
$71.35
|
| Rate for Payer: PACE SWMI |
$75.10
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: PHP Medicare Advantage |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.37
|
| Rate for Payer: Priority Health Medicare |
$75.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.23
|
| Rate for Payer: Railroad Medicare Medicare |
$75.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.37
|
| Rate for Payer: UHC Core |
$250.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.10
|
| Rate for Payer: UHC Medicare Advantage |
$77.36
|
| Rate for Payer: VA VA |
$75.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.32
|
|
|
HC IR FLUORO GUIDE CVA
|
Facility
|
IP
|
$300.42
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
32000245
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.23 |
| Max. Negotiated Rate |
$270.38 |
| Rate for Payer: Aetna Commercial |
$255.36
|
| Rate for Payer: BCBS Trust/PPO |
$232.16
|
| Rate for Payer: BCN Commercial |
$232.16
|
| Rate for Payer: Cash Price |
$240.34
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.34
|
| Rate for Payer: Healthscope Commercial |
$270.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.36
|
| Rate for Payer: PHP Commercial |
$255.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.37
|
| Rate for Payer: UHC Core |
$250.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.32
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
OP
|
$550.58
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.76 |
| Max. Negotiated Rate |
$495.52 |
| Rate for Payer: Aetna Commercial |
$467.99
|
| Rate for Payer: Aetna Medicare |
$143.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.06
|
| Rate for Payer: BCBS Complete |
$220.23
|
| Rate for Payer: BCBS MAPPO |
$137.64
|
| Rate for Payer: BCBS Trust/PPO |
$428.08
|
| Rate for Payer: BCN Commercial |
$428.08
|
| Rate for Payer: BCN Medicare Advantage |
$137.64
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$473.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.64
|
| Rate for Payer: Healthscope Commercial |
$495.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PACE Senior Care Partners |
$130.76
|
| Rate for Payer: PACE SWMI |
$137.64
|
| Rate for Payer: PHP Commercial |
$467.99
|
| Rate for Payer: PHP Medicare Advantage |
$137.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.00
|
| Rate for Payer: Priority Health Medicare |
$137.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.80
|
| Rate for Payer: Railroad Medicare Medicare |
$137.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.51
|
| Rate for Payer: UHC Core |
$459.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.64
|
| Rate for Payer: UHC Medicare Advantage |
$141.77
|
| Rate for Payer: VA VA |
$137.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.94
|
|
|
HC IR FLUOROSCOPIC GUIDE SPINE
|
Facility
|
IP
|
$550.58
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
32000247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$335.80 |
| Max. Negotiated Rate |
$495.52 |
| Rate for Payer: Aetna Commercial |
$467.99
|
| Rate for Payer: BCBS Trust/PPO |
$425.49
|
| Rate for Payer: BCN Commercial |
$425.49
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$473.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$495.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PHP Commercial |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.51
|
| Rate for Payer: UHC Core |
$459.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.94
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
IP
|
$550.58
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$335.80 |
| Max. Negotiated Rate |
$495.52 |
| Rate for Payer: Aetna Commercial |
$467.99
|
| Rate for Payer: BCBS Trust/PPO |
$425.49
|
| Rate for Payer: BCN Commercial |
$425.49
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$473.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$495.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PHP Commercial |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.51
|
| Rate for Payer: UHC Core |
$459.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.94
|
|
|
HC IR FLUORO UP TO 1 HOUR DR TIME
|
Facility
|
OP
|
$550.58
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000231
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.76 |
| Max. Negotiated Rate |
$495.52 |
| Rate for Payer: Aetna Commercial |
$467.99
|
| Rate for Payer: Aetna Medicare |
$143.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.06
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$137.64
|
| Rate for Payer: BCBS Trust/PPO |
$428.08
|
| Rate for Payer: BCN Commercial |
$428.08
|
| Rate for Payer: BCN Medicare Advantage |
$137.64
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$473.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.64
|
| Rate for Payer: Healthscope Commercial |
$495.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.94
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PACE Senior Care Partners |
$130.76
|
| Rate for Payer: PACE SWMI |
$137.64
|
| Rate for Payer: PHP Commercial |
$467.99
|
| Rate for Payer: PHP Medicare Advantage |
$137.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.00
|
| Rate for Payer: Priority Health Medicare |
$137.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.80
|
| Rate for Payer: Railroad Medicare Medicare |
$137.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.51
|
| Rate for Payer: UHC Core |
$459.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.64
|
| Rate for Payer: UHC Medicare Advantage |
$141.77
|
| Rate for Payer: VA VA |
$137.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.94
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
OP
|
$956.25
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.11 |
| Max. Negotiated Rate |
$860.62 |
| Rate for Payer: Aetna Commercial |
$812.81
|
| Rate for Payer: Aetna Medicare |
$248.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.83
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$239.06
|
| Rate for Payer: BCBS Trust/PPO |
$743.48
|
| Rate for Payer: BCN Commercial |
$743.48
|
| Rate for Payer: BCN Medicare Advantage |
$239.06
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cofinity Commercial |
$822.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.06
|
| Rate for Payer: Healthscope Commercial |
$860.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$717.19
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.81
|
| Rate for Payer: PACE Senior Care Partners |
$227.11
|
| Rate for Payer: PACE SWMI |
$239.06
|
| Rate for Payer: PHP Commercial |
$812.81
|
| Rate for Payer: PHP Medicare Advantage |
$239.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$831.94
|
| Rate for Payer: Priority Health Medicare |
$239.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$583.22
|
| Rate for Payer: Railroad Medicare Medicare |
$239.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.50
|
| Rate for Payer: UHC Core |
$798.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.06
|
| Rate for Payer: UHC Medicare Advantage |
$246.23
|
| Rate for Payer: VA VA |
$239.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$717.19
|
|
|
HC IR GENICULAR NERVE BRANCHES ANESTHETIC/STEROID INJ
|
Facility
|
IP
|
$956.25
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
36100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$583.22 |
| Max. Negotiated Rate |
$860.62 |
| Rate for Payer: Aetna Commercial |
$812.81
|
| Rate for Payer: BCBS Trust/PPO |
$738.99
|
| Rate for Payer: BCN Commercial |
$738.99
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cofinity Commercial |
$822.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.00
|
| Rate for Payer: Healthscope Commercial |
$860.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$717.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.81
|
| Rate for Payer: PHP Commercial |
$812.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$831.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$583.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.50
|
| Rate for Payer: UHC Core |
$798.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$717.19
|
|
|
HC IR GI BILI DUCT DIL W WO STENT
|
Facility
|
IP
|
$1,477.35
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
32000157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$901.04 |
| Max. Negotiated Rate |
$1,329.62 |
| Rate for Payer: Aetna Commercial |
$1,255.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,141.70
|
| Rate for Payer: BCN Commercial |
$1,141.70
|
| Rate for Payer: Cash Price |
$1,181.88
|
| Rate for Payer: Cofinity Commercial |
$1,270.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.88
|
| Rate for Payer: Healthscope Commercial |
$1,329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,255.75
|
| Rate for Payer: PHP Commercial |
$1,255.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,285.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,300.07
|
| Rate for Payer: UHC Core |
$1,233.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.01
|
|
|
HC IR GI BILI DUCT DIL W WO STENT
|
Facility
|
OP
|
$1,477.35
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
32000157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$350.87 |
| Max. Negotiated Rate |
$1,329.62 |
| Rate for Payer: Aetna Commercial |
$1,255.75
|
| Rate for Payer: Aetna Medicare |
$384.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$461.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$461.67
|
| Rate for Payer: BCBS Complete |
$590.94
|
| Rate for Payer: BCBS MAPPO |
$369.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.64
|
| Rate for Payer: BCN Commercial |
$1,148.64
|
| Rate for Payer: BCN Medicare Advantage |
$369.34
|
| Rate for Payer: Cash Price |
$1,181.88
|
| Rate for Payer: Cofinity Commercial |
$1,270.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.34
|
| Rate for Payer: Healthscope Commercial |
$1,329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$387.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,255.75
|
| Rate for Payer: PACE Senior Care Partners |
$350.87
|
| Rate for Payer: PACE SWMI |
$369.34
|
| Rate for Payer: PHP Commercial |
$1,255.75
|
| Rate for Payer: PHP Medicare Advantage |
$369.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,285.29
|
| Rate for Payer: Priority Health Medicare |
$369.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.04
|
| Rate for Payer: Railroad Medicare Medicare |
$369.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,300.07
|
| Rate for Payer: UHC Core |
$1,233.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.34
|
| Rate for Payer: UHC Medicare Advantage |
$380.42
|
| Rate for Payer: VA VA |
$369.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.01
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
IP
|
$2,162.34
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,318.81 |
| Max. Negotiated Rate |
$1,946.11 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.06
|
| Rate for Payer: BCN Commercial |
$1,671.06
|
| Rate for Payer: Cash Price |
$1,729.87
|
| Rate for Payer: Cofinity Commercial |
$1,859.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.87
|
| Rate for Payer: Healthscope Commercial |
$1,946.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,621.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.99
|
| Rate for Payer: PHP Commercial |
$1,837.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,881.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,902.86
|
| Rate for Payer: UHC Core |
$1,805.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,621.76
|
|
|
HC IR GI INJ PREV PLACE GI TUBE FL
|
Facility
|
OP
|
$2,162.34
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
36100194
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$513.56 |
| Max. Negotiated Rate |
$1,946.11 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: Aetna Medicare |
$562.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$675.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$675.73
|
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: BCBS MAPPO |
$540.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.22
|
| Rate for Payer: BCN Commercial |
$1,681.22
|
| Rate for Payer: BCN Medicare Advantage |
$540.58
|
| Rate for Payer: Cash Price |
$1,729.87
|
| Rate for Payer: Cash Price |
$1,729.87
|
| Rate for Payer: Cofinity Commercial |
$1,859.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.58
|
| Rate for Payer: Healthscope Commercial |
$1,946.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,621.76
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$567.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$621.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.99
|
| Rate for Payer: PACE Senior Care Partners |
$513.56
|
| Rate for Payer: PACE SWMI |
$540.58
|
| Rate for Payer: PHP Commercial |
$1,837.99
|
| Rate for Payer: PHP Medicare Advantage |
$540.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,881.24
|
| Rate for Payer: Priority Health Medicare |
$540.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.81
|
| Rate for Payer: Railroad Medicare Medicare |
$540.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,902.86
|
| Rate for Payer: UHC Core |
$1,805.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.58
|
| Rate for Payer: UHC Medicare Advantage |
$556.80
|
| Rate for Payer: VA VA |
$540.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,621.76
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna Medicare |
$86.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.27
|
| Rate for Payer: BCBS Complete |
$133.47
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$259.43
|
| Rate for Payer: BCN Commercial |
$259.43
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Medicare |
$83.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.42
|
| Rate for Payer: UHC Medicare Advantage |
$85.92
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC IR GI LONG TUBE PLACEMENT GUIDANCE
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.51 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: BCBS Trust/PPO |
$257.86
|
| Rate for Payer: BCN Commercial |
$257.86
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
OP
|
$256.22
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$230.60 |
| Rate for Payer: Aetna Commercial |
$217.79
|
| Rate for Payer: Aetna Medicare |
$66.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.07
|
| Rate for Payer: BCBS Complete |
$102.49
|
| Rate for Payer: BCBS MAPPO |
$64.06
|
| Rate for Payer: BCBS Trust/PPO |
$199.21
|
| Rate for Payer: BCCCP Commercial |
$59.82
|
| Rate for Payer: BCN Commercial |
$199.21
|
| Rate for Payer: BCN Medicare Advantage |
$64.06
|
| Rate for Payer: Cash Price |
$204.98
|
| Rate for Payer: Cash Price |
$204.98
|
| Rate for Payer: Cofinity Commercial |
$220.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.06
|
| Rate for Payer: Healthscope Commercial |
$230.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.79
|
| Rate for Payer: PACE Senior Care Partners |
$60.85
|
| Rate for Payer: PACE SWMI |
$64.06
|
| Rate for Payer: PHP Commercial |
$217.79
|
| Rate for Payer: PHP Medicare Advantage |
$64.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.91
|
| Rate for Payer: Priority Health Medicare |
$64.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.27
|
| Rate for Payer: Railroad Medicare Medicare |
$64.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.47
|
| Rate for Payer: UHC Core |
$213.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.06
|
| Rate for Payer: UHC Medicare Advantage |
$65.98
|
| Rate for Payer: VA VA |
$64.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.16
|
|
|
HC IR GUIDE FNA DIAGNOSTIC ASPIRA
|
Facility
|
IP
|
$256.22
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$156.27 |
| Max. Negotiated Rate |
$230.60 |
| Rate for Payer: Aetna Commercial |
$217.79
|
| Rate for Payer: BCBS Trust/PPO |
$198.01
|
| Rate for Payer: BCN Commercial |
$198.01
|
| Rate for Payer: Cash Price |
$204.98
|
| Rate for Payer: Cofinity Commercial |
$220.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.98
|
| Rate for Payer: Healthscope Commercial |
$230.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.79
|
| Rate for Payer: PHP Commercial |
$217.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.47
|
| Rate for Payer: UHC Core |
$213.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.16
|
|
