|
HC IR GUIDE VISCERAL TISSUE AB
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
32000244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.51 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna Medicare |
$99.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.09
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS MAPPO |
$95.27
|
| Rate for Payer: BCBS Trust/PPO |
$296.30
|
| Rate for Payer: BCN Commercial |
$296.30
|
| Rate for Payer: BCN Medicare Advantage |
$95.27
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.27
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PACE Senior Care Partners |
$90.51
|
| Rate for Payer: PACE SWMI |
$95.27
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: PHP Medicare Advantage |
$95.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.55
|
| Rate for Payer: Priority Health Medicare |
$95.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.43
|
| Rate for Payer: Railroad Medicare Medicare |
$95.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.36
|
| Rate for Payer: UHC Core |
$318.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.27
|
| Rate for Payer: UHC Medicare Advantage |
$98.13
|
| Rate for Payer: VA VA |
$95.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
|
HC IR GUIDE VISCERAL TISSUE AB
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 76940
|
| Hospital Charge Code |
32000244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.43 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: BCBS Trust/PPO |
$294.51
|
| Rate for Payer: BCN Commercial |
$294.51
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.36
|
| Rate for Payer: UHC Core |
$318.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
|
HC IR GUIDEWIRE
|
Facility
|
OP
|
$43.86
|
|
| Hospital Charge Code |
27200306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$11.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.71
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: BCBS MAPPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$34.10
|
| Rate for Payer: BCN Commercial |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.96
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Senior Care Partners |
$10.42
|
| Rate for Payer: PACE SWMI |
$10.96
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.16
|
| Rate for Payer: Priority Health Medicare |
$10.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: Railroad Medicare Medicare |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.29
|
| Rate for Payer: VA VA |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC IR GUIDEWIRE
|
Facility
|
IP
|
$43.86
|
|
| Hospital Charge Code |
27200306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.90
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
OP
|
$476.47
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$123.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.90
|
| Rate for Payer: BCBS Complete |
$264.89
|
| Rate for Payer: BCBS MAPPO |
$119.12
|
| Rate for Payer: BCBS Trust/PPO |
$370.46
|
| Rate for Payer: BCN Commercial |
$370.46
|
| Rate for Payer: BCN Medicare Advantage |
$119.12
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.12
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.35
|
| Rate for Payer: Mclaren Medicaid |
$252.28
|
| Rate for Payer: Meridian Medicaid |
$264.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PACE Senior Care Partners |
$113.16
|
| Rate for Payer: PACE SWMI |
$119.12
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: PHP Medicare Advantage |
$119.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.53
|
| Rate for Payer: Priority Health Medicare |
$119.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.60
|
| Rate for Payer: Railroad Medicare Medicare |
$119.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.29
|
| Rate for Payer: UHC Core |
$397.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.12
|
| Rate for Payer: UHC Medicare Advantage |
$122.69
|
| Rate for Payer: VA VA |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.35
|
|
|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
IP
|
$476.47
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.60 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: BCBS Trust/PPO |
$368.22
|
| Rate for Payer: BCN Commercial |
$368.22
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.29
|
| Rate for Payer: UHC Core |
$397.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.35
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
IP
|
$809.50
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.71 |
| Max. Negotiated Rate |
$728.55 |
| Rate for Payer: Aetna Commercial |
$688.08
|
| Rate for Payer: BCBS Trust/PPO |
$625.58
|
| Rate for Payer: BCN Commercial |
$625.58
|
| Rate for Payer: Cash Price |
$647.60
|
| Rate for Payer: Cofinity Commercial |
$696.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.60
|
| Rate for Payer: Healthscope Commercial |
$728.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.08
|
| Rate for Payer: PHP Commercial |
$688.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.36
|
| Rate for Payer: UHC Core |
$675.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.12
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
OP
|
$809.50
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.26 |
| Max. Negotiated Rate |
$728.55 |
| Rate for Payer: Aetna Commercial |
$688.08
|
| Rate for Payer: Aetna Medicare |
$210.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.97
|
| Rate for Payer: BCBS Complete |
$379.99
|
| Rate for Payer: BCBS MAPPO |
$202.38
|
| Rate for Payer: BCBS Trust/PPO |
$629.39
|
| Rate for Payer: BCN Commercial |
$629.39
|
| Rate for Payer: BCN Medicare Advantage |
$202.38
|
| Rate for Payer: Cash Price |
$647.60
|
| Rate for Payer: Cash Price |
$647.60
|
| Rate for Payer: Cofinity Commercial |
$696.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.38
|
| Rate for Payer: Healthscope Commercial |
$728.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.12
|
| Rate for Payer: Mclaren Medicaid |
$361.89
|
| Rate for Payer: Meridian Medicaid |
$379.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$212.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.08
|
| Rate for Payer: PACE Senior Care Partners |
$192.26
|
| Rate for Payer: PACE SWMI |
$202.38
|
| Rate for Payer: PHP Commercial |
$688.08
|
| Rate for Payer: PHP Medicare Advantage |
$202.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.26
|
| Rate for Payer: Priority Health Medicare |
$202.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.71
|
| Rate for Payer: Railroad Medicare Medicare |
$202.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.36
|
| Rate for Payer: UHC Core |
$675.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.38
|
| Rate for Payer: UHC Medicare Advantage |
$208.45
|
| Rate for Payer: VA VA |
$202.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.12
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
OP
|
$1,919.61
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.91 |
| Max. Negotiated Rate |
$1,727.65 |
| Rate for Payer: Aetna Commercial |
$1,631.67
|
| Rate for Payer: Aetna Medicare |
$499.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$599.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$599.88
|
| Rate for Payer: BCBS Complete |
$1,402.94
|
| Rate for Payer: BCBS MAPPO |
$479.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.50
|
| Rate for Payer: BCN Commercial |
$1,492.50
|
| Rate for Payer: BCN Medicare Advantage |
$479.90
|
| Rate for Payer: Cash Price |
$1,535.69
|
| Rate for Payer: Cash Price |
$1,535.69
|
| Rate for Payer: Cofinity Commercial |
$1,650.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.90
|
| Rate for Payer: Healthscope Commercial |
$1,727.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,439.71
|
| Rate for Payer: Mclaren Medicaid |
$1,336.13
|
| Rate for Payer: Meridian Medicaid |
$1,402.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$503.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$551.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,631.67
|
| Rate for Payer: PACE Senior Care Partners |
$455.91
|
| Rate for Payer: PACE SWMI |
$479.90
|
| Rate for Payer: PHP Commercial |
$1,631.67
|
| Rate for Payer: PHP Medicare Advantage |
$479.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,336.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,670.06
|
| Rate for Payer: Priority Health Medicare |
$479.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,170.77
|
| Rate for Payer: Railroad Medicare Medicare |
$479.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,689.26
|
| Rate for Payer: UHC Core |
$1,602.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.90
|
| Rate for Payer: UHC Medicare Advantage |
$494.30
|
| Rate for Payer: VA VA |
$479.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,439.71
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
IP
|
$1,919.61
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,170.77 |
| Max. Negotiated Rate |
$1,727.65 |
| Rate for Payer: Aetna Commercial |
$1,631.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,483.47
|
| Rate for Payer: BCN Commercial |
$1,483.47
|
| Rate for Payer: Cash Price |
$1,535.69
|
| Rate for Payer: Cofinity Commercial |
$1,650.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.69
|
| Rate for Payer: Healthscope Commercial |
$1,727.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,439.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,631.67
|
| Rate for Payer: PHP Commercial |
$1,631.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,670.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,170.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,689.26
|
| Rate for Payer: UHC Core |
$1,602.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,439.71
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
IP
|
$4,219.50
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,573.47 |
| Max. Negotiated Rate |
$3,797.55 |
| Rate for Payer: Aetna Commercial |
$3,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,260.83
|
| Rate for Payer: BCN Commercial |
$3,260.83
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cofinity Commercial |
$3,628.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,375.60
|
| Rate for Payer: Healthscope Commercial |
$3,797.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,164.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,586.58
|
| Rate for Payer: PHP Commercial |
$3,586.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,953.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,670.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,573.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,713.16
|
| Rate for Payer: UHC Core |
$3,523.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,164.62
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
OP
|
$4,219.50
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,002.13 |
| Max. Negotiated Rate |
$3,797.55 |
| Rate for Payer: Aetna Commercial |
$3,586.58
|
| Rate for Payer: Aetna Medicare |
$1,097.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,318.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,318.59
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$1,054.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,280.66
|
| Rate for Payer: BCN Commercial |
$3,280.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,054.88
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cash Price |
$3,375.60
|
| Rate for Payer: Cofinity Commercial |
$3,628.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,375.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,054.88
|
| Rate for Payer: Healthscope Commercial |
$3,797.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,164.62
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,107.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,213.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,586.58
|
| Rate for Payer: PACE Senior Care Partners |
$1,002.13
|
| Rate for Payer: PACE SWMI |
$1,054.88
|
| Rate for Payer: PHP Commercial |
$3,586.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,054.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,953.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,670.96
|
| Rate for Payer: Priority Health Medicare |
$1,054.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,573.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,054.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,713.16
|
| Rate for Payer: UHC Core |
$3,523.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,054.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,086.52
|
| Rate for Payer: VA VA |
$1,054.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,164.62
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
IP
|
$3,402.31
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,075.07 |
| Max. Negotiated Rate |
$3,062.08 |
| Rate for Payer: Aetna Commercial |
$2,891.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,629.31
|
| Rate for Payer: BCN Commercial |
$2,629.31
|
| Rate for Payer: Cash Price |
$2,721.85
|
| Rate for Payer: Cofinity Commercial |
$2,925.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,721.85
|
| Rate for Payer: Healthscope Commercial |
$3,062.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,551.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,891.96
|
| Rate for Payer: PHP Commercial |
$2,891.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,381.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,960.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,075.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,994.03
|
| Rate for Payer: UHC Core |
$2,840.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,551.73
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
OP
|
$3,402.31
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$808.05 |
| Max. Negotiated Rate |
$3,062.08 |
| Rate for Payer: Aetna Commercial |
$2,891.96
|
| Rate for Payer: Aetna Medicare |
$884.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,063.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,063.22
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$850.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,645.30
|
| Rate for Payer: BCN Commercial |
$2,645.30
|
| Rate for Payer: BCN Medicare Advantage |
$850.58
|
| Rate for Payer: Cash Price |
$2,721.85
|
| Rate for Payer: Cash Price |
$2,721.85
|
| Rate for Payer: Cofinity Commercial |
$2,925.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,721.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$850.58
|
| Rate for Payer: Healthscope Commercial |
$3,062.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,551.73
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$893.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$978.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,891.96
|
| Rate for Payer: PACE Senior Care Partners |
$808.05
|
| Rate for Payer: PACE SWMI |
$850.58
|
| Rate for Payer: PHP Commercial |
$2,891.96
|
| Rate for Payer: PHP Medicare Advantage |
$850.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,381.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,960.01
|
| Rate for Payer: Priority Health Medicare |
$850.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,075.07
|
| Rate for Payer: Railroad Medicare Medicare |
$850.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,994.03
|
| Rate for Payer: UHC Core |
$2,840.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$850.58
|
| Rate for Payer: UHC Medicare Advantage |
$876.09
|
| Rate for Payer: VA VA |
$850.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,551.73
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
OP
|
$1,243.18
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.26 |
| Max. Negotiated Rate |
$1,118.86 |
| Rate for Payer: Aetna Commercial |
$1,056.70
|
| Rate for Payer: Aetna Medicare |
$323.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$388.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$388.49
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$310.80
|
| Rate for Payer: BCBS Trust/PPO |
$966.57
|
| Rate for Payer: BCN Commercial |
$966.57
|
| Rate for Payer: BCN Medicare Advantage |
$310.80
|
| Rate for Payer: Cash Price |
$994.54
|
| Rate for Payer: Cash Price |
$994.54
|
| Rate for Payer: Cofinity Commercial |
$1,069.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.80
|
| Rate for Payer: Healthscope Commercial |
$1,118.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.38
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$326.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.70
|
| Rate for Payer: PACE Senior Care Partners |
$295.26
|
| Rate for Payer: PACE SWMI |
$310.80
|
| Rate for Payer: PHP Commercial |
$1,056.70
|
| Rate for Payer: PHP Medicare Advantage |
$310.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,081.57
|
| Rate for Payer: Priority Health Medicare |
$310.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.22
|
| Rate for Payer: Railroad Medicare Medicare |
$310.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,094.00
|
| Rate for Payer: UHC Core |
$1,038.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.80
|
| Rate for Payer: UHC Medicare Advantage |
$320.12
|
| Rate for Payer: VA VA |
$310.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.38
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
IP
|
$1,243.18
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.22 |
| Max. Negotiated Rate |
$1,118.86 |
| Rate for Payer: Aetna Commercial |
$1,056.70
|
| Rate for Payer: BCBS Trust/PPO |
$960.73
|
| Rate for Payer: BCN Commercial |
$960.73
|
| Rate for Payer: Cash Price |
$994.54
|
| Rate for Payer: Cofinity Commercial |
$1,069.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.54
|
| Rate for Payer: Healthscope Commercial |
$1,118.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.70
|
| Rate for Payer: PHP Commercial |
$1,056.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,081.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,094.00
|
| Rate for Payer: UHC Core |
$1,038.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.38
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
IP
|
$1,618.52
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$987.14 |
| Max. Negotiated Rate |
$1,456.67 |
| Rate for Payer: Aetna Commercial |
$1,375.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,250.79
|
| Rate for Payer: BCN Commercial |
$1,250.79
|
| Rate for Payer: Cash Price |
$1,294.82
|
| Rate for Payer: Cofinity Commercial |
$1,391.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.82
|
| Rate for Payer: Healthscope Commercial |
$1,456.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,213.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,375.74
|
| Rate for Payer: PHP Commercial |
$1,375.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$987.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,424.30
|
| Rate for Payer: UHC Core |
$1,351.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,213.89
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
OP
|
$1,618.52
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.40 |
| Max. Negotiated Rate |
$1,456.67 |
| Rate for Payer: Aetna Commercial |
$1,375.74
|
| Rate for Payer: Aetna Medicare |
$420.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$505.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$505.79
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$404.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.40
|
| Rate for Payer: BCN Commercial |
$1,258.40
|
| Rate for Payer: BCN Medicare Advantage |
$404.63
|
| Rate for Payer: Cash Price |
$1,294.82
|
| Rate for Payer: Cash Price |
$1,294.82
|
| Rate for Payer: Cofinity Commercial |
$1,391.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.63
|
| Rate for Payer: Healthscope Commercial |
$1,456.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,213.89
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$424.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,375.74
|
| Rate for Payer: PACE Senior Care Partners |
$384.40
|
| Rate for Payer: PACE SWMI |
$404.63
|
| Rate for Payer: PHP Commercial |
$1,375.74
|
| Rate for Payer: PHP Medicare Advantage |
$404.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.11
|
| Rate for Payer: Priority Health Medicare |
$404.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$987.14
|
| Rate for Payer: Railroad Medicare Medicare |
$404.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,424.30
|
| Rate for Payer: UHC Core |
$1,351.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.63
|
| Rate for Payer: UHC Medicare Advantage |
$416.77
|
| Rate for Payer: VA VA |
$404.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,213.89
|
|
|
HC IR INSERTION CATH TUNNELED INTRAPERI W FLUORO
|
Facility
|
OP
|
$4,750.87
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
36100219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,128.33 |
| Max. Negotiated Rate |
$4,275.78 |
| Rate for Payer: Aetna Commercial |
$4,038.24
|
| Rate for Payer: Aetna Medicare |
$1,235.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,484.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,484.65
|
| Rate for Payer: BCBS Complete |
$2,382.99
|
| Rate for Payer: BCBS MAPPO |
$1,187.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,693.80
|
| Rate for Payer: BCN Commercial |
$3,693.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.72
|
| Rate for Payer: Cash Price |
$3,800.70
|
| Rate for Payer: Cash Price |
$3,800.70
|
| Rate for Payer: Cofinity Commercial |
$4,085.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,800.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.72
|
| Rate for Payer: Healthscope Commercial |
$4,275.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.15
|
| Rate for Payer: Mclaren Medicaid |
$2,269.51
|
| Rate for Payer: Meridian Medicaid |
$2,382.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,247.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,365.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,038.24
|
| Rate for Payer: PACE Senior Care Partners |
$1,128.33
|
| Rate for Payer: PACE SWMI |
$1,187.72
|
| Rate for Payer: PHP Commercial |
$4,038.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,269.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,325.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,133.26
|
| Rate for Payer: Priority Health Medicare |
$1,187.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,897.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,187.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,180.77
|
| Rate for Payer: UHC Core |
$3,966.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,223.35
|
| Rate for Payer: VA VA |
$1,187.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.15
|
|
|
HC IR INSERTION CATH TUNNELED INTRAPERI W FLUORO
|
Facility
|
IP
|
$4,750.87
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
36100219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,897.56 |
| Max. Negotiated Rate |
$4,275.78 |
| Rate for Payer: Aetna Commercial |
$4,038.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,671.47
|
| Rate for Payer: BCN Commercial |
$3,671.47
|
| Rate for Payer: Cash Price |
$3,800.70
|
| Rate for Payer: Cofinity Commercial |
$4,085.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,800.70
|
| Rate for Payer: Healthscope Commercial |
$4,275.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,038.24
|
| Rate for Payer: PHP Commercial |
$4,038.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,325.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,133.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,897.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,180.77
|
| Rate for Payer: UHC Core |
$3,966.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.15
|
|
|
HC IR INSERTION CHEST PORT ABOVE 5 YRS AGE
|
Facility
|
OP
|
$4,765.57
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36100125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,131.82 |
| Max. Negotiated Rate |
$4,289.01 |
| Rate for Payer: Aetna Commercial |
$4,050.73
|
| Rate for Payer: Aetna Medicare |
$1,239.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,489.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,489.24
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$1,191.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,705.23
|
| Rate for Payer: BCN Commercial |
$3,705.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.39
|
| Rate for Payer: Cash Price |
$3,812.46
|
| Rate for Payer: Cash Price |
$3,812.46
|
| Rate for Payer: Cofinity Commercial |
$4,098.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,812.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.39
|
| Rate for Payer: Healthscope Commercial |
$4,289.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,574.18
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,250.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,370.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,050.73
|
| Rate for Payer: PACE Senior Care Partners |
$1,131.82
|
| Rate for Payer: PACE SWMI |
$1,191.39
|
| Rate for Payer: PHP Commercial |
$4,050.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,335.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,146.05
|
| Rate for Payer: Priority Health Medicare |
$1,191.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,906.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,191.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,193.70
|
| Rate for Payer: UHC Core |
$3,979.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,227.13
|
| Rate for Payer: VA VA |
$1,191.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,574.18
|
|
|
HC IR INSERTION CHEST PORT ABOVE 5 YRS AGE
|
Facility
|
IP
|
$4,765.57
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36100125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,906.52 |
| Max. Negotiated Rate |
$4,289.01 |
| Rate for Payer: Aetna Commercial |
$4,050.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,682.83
|
| Rate for Payer: BCN Commercial |
$3,682.83
|
| Rate for Payer: Cash Price |
$3,812.46
|
| Rate for Payer: Cofinity Commercial |
$4,098.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,812.46
|
| Rate for Payer: Healthscope Commercial |
$4,289.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,574.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,050.73
|
| Rate for Payer: PHP Commercial |
$4,050.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,335.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,146.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,906.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,193.70
|
| Rate for Payer: UHC Core |
$3,979.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,574.18
|
|
|
HC IR INSERTION CHEST PORT LESS THAN 5 YRS AGE
|
Facility
|
OP
|
$4,484.14
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
36100124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,064.98 |
| Max. Negotiated Rate |
$4,035.73 |
| Rate for Payer: Aetna Commercial |
$3,811.52
|
| Rate for Payer: Aetna Medicare |
$1,165.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,401.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,401.29
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$1,121.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.42
|
| Rate for Payer: BCN Commercial |
$3,486.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,121.04
|
| Rate for Payer: Cash Price |
$3,587.31
|
| Rate for Payer: Cash Price |
$3,587.31
|
| Rate for Payer: Cofinity Commercial |
$3,856.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,587.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,121.04
|
| Rate for Payer: Healthscope Commercial |
$4,035.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,363.10
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,177.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,289.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,811.52
|
| Rate for Payer: PACE Senior Care Partners |
$1,064.98
|
| Rate for Payer: PACE SWMI |
$1,121.04
|
| Rate for Payer: PHP Commercial |
$3,811.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,121.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,138.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,901.20
|
| Rate for Payer: Priority Health Medicare |
$1,121.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,734.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,121.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,946.04
|
| Rate for Payer: UHC Core |
$3,744.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,121.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,154.67
|
| Rate for Payer: VA VA |
$1,121.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,363.10
|
|
|
HC IR INSERTION CHEST PORT LESS THAN 5 YRS AGE
|
Facility
|
IP
|
$4,484.14
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
36100124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,734.88 |
| Max. Negotiated Rate |
$4,035.73 |
| Rate for Payer: Aetna Commercial |
$3,811.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,465.34
|
| Rate for Payer: BCN Commercial |
$3,465.34
|
| Rate for Payer: Cash Price |
$3,587.31
|
| Rate for Payer: Cofinity Commercial |
$3,856.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,587.31
|
| Rate for Payer: Healthscope Commercial |
$4,035.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,363.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,811.52
|
| Rate for Payer: PHP Commercial |
$3,811.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,138.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,901.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,734.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,946.04
|
| Rate for Payer: UHC Core |
$3,744.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,363.10
|
|
|
HC IR INSERT TUNNEL PERI CATH W PORT
|
Facility
|
OP
|
$4,770.51
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
36100366
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$4,293.46 |
| Rate for Payer: Aetna Commercial |
$4,054.93
|
| Rate for Payer: Aetna Medicare |
$1,240.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.78
|
| Rate for Payer: BCBS Complete |
$3,785.15
|
| Rate for Payer: BCBS MAPPO |
$1,192.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.07
|
| Rate for Payer: BCN Commercial |
$3,709.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.63
|
| Rate for Payer: Cash Price |
$3,816.41
|
| Rate for Payer: Cash Price |
$3,816.41
|
| Rate for Payer: Cofinity Commercial |
$4,102.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,816.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.63
|
| Rate for Payer: Healthscope Commercial |
$4,293.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,577.88
|
| Rate for Payer: Mclaren Medicaid |
$3,604.90
|
| Rate for Payer: Meridian Medicaid |
$3,785.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,252.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,054.93
|
| Rate for Payer: PACE Senior Care Partners |
$1,133.00
|
| Rate for Payer: PACE SWMI |
$1,192.63
|
| Rate for Payer: PHP Commercial |
$4,054.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,604.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,339.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,150.34
|
| Rate for Payer: Priority Health Medicare |
$1,192.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,909.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,198.05
|
| Rate for Payer: UHC Core |
$3,983.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,228.41
|
| Rate for Payer: VA VA |
$1,192.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,577.88
|
|
