|
HC NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.24
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC NEISSERIA GONORRHOEAE AMP DNA
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
30600163
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$17.07
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC NEISSERIA MENINGITITIS
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600275
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC NEONATAL VENT INIT DAY
|
Facility
|
OP
|
$1,538.29
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$365.34 |
| Max. Negotiated Rate |
$1,384.46 |
| Rate for Payer: Aetna Commercial |
$1,307.55
|
| Rate for Payer: Aetna Medicare |
$399.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.72
|
| Rate for Payer: BCBS Complete |
$431.64
|
| Rate for Payer: BCBS MAPPO |
$384.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.02
|
| Rate for Payer: BCN Commercial |
$1,196.02
|
| Rate for Payer: BCN Medicare Advantage |
$384.57
|
| Rate for Payer: Cash Price |
$1,230.63
|
| Rate for Payer: Cash Price |
$1,230.63
|
| Rate for Payer: Cofinity Commercial |
$1,322.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.57
|
| Rate for Payer: Healthscope Commercial |
$1,384.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.72
|
| Rate for Payer: Mclaren Medicaid |
$411.09
|
| Rate for Payer: Meridian Medicaid |
$431.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$403.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$442.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.55
|
| Rate for Payer: PACE Senior Care Partners |
$365.34
|
| Rate for Payer: PACE SWMI |
$384.57
|
| Rate for Payer: PHP Commercial |
$1,307.55
|
| Rate for Payer: PHP Medicare Advantage |
$384.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,338.31
|
| Rate for Payer: Priority Health Medicare |
$384.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$938.20
|
| Rate for Payer: Railroad Medicare Medicare |
$384.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,353.70
|
| Rate for Payer: UHC Core |
$1,284.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.57
|
| Rate for Payer: UHC Medicare Advantage |
$396.11
|
| Rate for Payer: VA VA |
$384.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.72
|
|
|
HC NEONATAL VENT INIT DAY
|
Facility
|
IP
|
$1,538.29
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$938.20 |
| Max. Negotiated Rate |
$1,384.46 |
| Rate for Payer: Aetna Commercial |
$1,307.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.79
|
| Rate for Payer: BCN Commercial |
$1,188.79
|
| Rate for Payer: Cash Price |
$1,230.63
|
| Rate for Payer: Cofinity Commercial |
$1,322.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.63
|
| Rate for Payer: Healthscope Commercial |
$1,384.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.55
|
| Rate for Payer: PHP Commercial |
$1,307.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,338.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$938.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,353.70
|
| Rate for Payer: UHC Core |
$1,284.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.72
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
IP
|
$1,173.97
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$716.00 |
| Max. Negotiated Rate |
$1,056.57 |
| Rate for Payer: Aetna Commercial |
$997.87
|
| Rate for Payer: BCBS Trust/PPO |
$907.24
|
| Rate for Payer: BCN Commercial |
$907.24
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cofinity Commercial |
$1,009.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.18
|
| Rate for Payer: Healthscope Commercial |
$1,056.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.87
|
| Rate for Payer: PHP Commercial |
$997.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$716.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.09
|
| Rate for Payer: UHC Core |
$980.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.48
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
OP
|
$1,173.97
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$278.82 |
| Max. Negotiated Rate |
$1,056.57 |
| Rate for Payer: Aetna Commercial |
$997.87
|
| Rate for Payer: Aetna Medicare |
$305.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$366.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$366.87
|
| Rate for Payer: BCBS Complete |
$431.64
|
| Rate for Payer: BCBS MAPPO |
$293.49
|
| Rate for Payer: BCBS Trust/PPO |
$912.76
|
| Rate for Payer: BCN Commercial |
$912.76
|
| Rate for Payer: BCN Medicare Advantage |
$293.49
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cofinity Commercial |
$1,009.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$939.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.49
|
| Rate for Payer: Healthscope Commercial |
$1,056.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$880.48
|
| Rate for Payer: Mclaren Medicaid |
$411.09
|
| Rate for Payer: Meridian Medicaid |
$431.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$308.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.87
|
| Rate for Payer: PACE Senior Care Partners |
$278.82
|
| Rate for Payer: PACE SWMI |
$293.49
|
| Rate for Payer: PHP Commercial |
$997.87
|
| Rate for Payer: PHP Medicare Advantage |
$293.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.35
|
| Rate for Payer: Priority Health Medicare |
$293.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$716.00
|
| Rate for Payer: Railroad Medicare Medicare |
$293.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.09
|
| Rate for Payer: UHC Core |
$980.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.49
|
| Rate for Payer: UHC Medicare Advantage |
$302.30
|
| Rate for Payer: VA VA |
$293.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$880.48
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
IP
|
$1,180.78
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.16 |
| Max. Negotiated Rate |
$1,062.70 |
| Rate for Payer: Aetna Commercial |
$1,003.66
|
| Rate for Payer: BCBS Trust/PPO |
$912.51
|
| Rate for Payer: BCN Commercial |
$912.51
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,015.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Healthscope Commercial |
$1,062.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PHP Commercial |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$720.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.09
|
| Rate for Payer: UHC Core |
$985.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.58
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
OP
|
$1,180.78
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.44 |
| Max. Negotiated Rate |
$1,062.70 |
| Rate for Payer: Aetna Commercial |
$1,003.66
|
| Rate for Payer: Aetna Medicare |
$307.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.99
|
| Rate for Payer: BCBS Complete |
$470.52
|
| Rate for Payer: BCBS MAPPO |
$295.20
|
| Rate for Payer: BCBS Trust/PPO |
$918.06
|
| Rate for Payer: BCN Commercial |
$918.06
|
| Rate for Payer: BCN Medicare Advantage |
$295.20
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,015.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.20
|
| Rate for Payer: Healthscope Commercial |
$1,062.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.58
|
| Rate for Payer: Mclaren Medicaid |
$448.11
|
| Rate for Payer: Meridian Medicaid |
$470.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$309.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PACE Senior Care Partners |
$280.44
|
| Rate for Payer: PACE SWMI |
$295.20
|
| Rate for Payer: PHP Commercial |
$1,003.66
|
| Rate for Payer: PHP Medicare Advantage |
$295.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.28
|
| Rate for Payer: Priority Health Medicare |
$295.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$720.16
|
| Rate for Payer: Railroad Medicare Medicare |
$295.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.09
|
| Rate for Payer: UHC Core |
$985.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.20
|
| Rate for Payer: UHC Medicare Advantage |
$304.05
|
| Rate for Payer: VA VA |
$295.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.58
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
IP
|
$1,180.78
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.16 |
| Max. Negotiated Rate |
$1,062.70 |
| Rate for Payer: Aetna Commercial |
$1,003.66
|
| Rate for Payer: BCBS Trust/PPO |
$912.51
|
| Rate for Payer: BCN Commercial |
$912.51
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,015.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Healthscope Commercial |
$1,062.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PHP Commercial |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$720.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.09
|
| Rate for Payer: UHC Core |
$985.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.58
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
OP
|
$1,180.78
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.44 |
| Max. Negotiated Rate |
$1,062.70 |
| Rate for Payer: Aetna Commercial |
$1,003.66
|
| Rate for Payer: Aetna Medicare |
$307.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.99
|
| Rate for Payer: BCBS Complete |
$470.52
|
| Rate for Payer: BCBS MAPPO |
$295.20
|
| Rate for Payer: BCBS Trust/PPO |
$918.06
|
| Rate for Payer: BCN Commercial |
$918.06
|
| Rate for Payer: BCN Medicare Advantage |
$295.20
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cash Price |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,015.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.20
|
| Rate for Payer: Healthscope Commercial |
$1,062.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.58
|
| Rate for Payer: Mclaren Medicaid |
$448.11
|
| Rate for Payer: Meridian Medicaid |
$470.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$309.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.66
|
| Rate for Payer: PACE Senior Care Partners |
$280.44
|
| Rate for Payer: PACE SWMI |
$295.20
|
| Rate for Payer: PHP Commercial |
$1,003.66
|
| Rate for Payer: PHP Medicare Advantage |
$295.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.28
|
| Rate for Payer: Priority Health Medicare |
$295.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$720.16
|
| Rate for Payer: Railroad Medicare Medicare |
$295.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.09
|
| Rate for Payer: UHC Core |
$985.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.20
|
| Rate for Payer: UHC Medicare Advantage |
$304.05
|
| Rate for Payer: VA VA |
$295.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.58
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL MULT REG
|
Facility
|
OP
|
$1,462.17
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$347.27 |
| Max. Negotiated Rate |
$1,315.95 |
| Rate for Payer: Aetna Commercial |
$1,242.84
|
| Rate for Payer: Aetna Medicare |
$380.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$456.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$456.93
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$365.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,136.84
|
| Rate for Payer: BCN Commercial |
$1,136.84
|
| Rate for Payer: BCN Medicare Advantage |
$365.54
|
| Rate for Payer: Cash Price |
$1,169.74
|
| Rate for Payer: Cash Price |
$1,169.74
|
| Rate for Payer: Cofinity Commercial |
$1,257.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.54
|
| Rate for Payer: Healthscope Commercial |
$1,315.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,096.63
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$383.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$420.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,242.84
|
| Rate for Payer: PACE Senior Care Partners |
$347.27
|
| Rate for Payer: PACE SWMI |
$365.54
|
| Rate for Payer: PHP Commercial |
$1,242.84
|
| Rate for Payer: PHP Medicare Advantage |
$365.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,272.09
|
| Rate for Payer: Priority Health Medicare |
$365.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$891.78
|
| Rate for Payer: Railroad Medicare Medicare |
$365.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,286.71
|
| Rate for Payer: UHC Core |
$1,220.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$365.54
|
| Rate for Payer: UHC Medicare Advantage |
$376.51
|
| Rate for Payer: VA VA |
$365.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,096.63
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL MULT REG
|
Facility
|
IP
|
$1,462.17
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$891.78 |
| Max. Negotiated Rate |
$1,315.95 |
| Rate for Payer: Aetna Commercial |
$1,242.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,129.96
|
| Rate for Payer: BCN Commercial |
$1,129.96
|
| Rate for Payer: Cash Price |
$1,169.74
|
| Rate for Payer: Cofinity Commercial |
$1,257.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,169.74
|
| Rate for Payer: Healthscope Commercial |
$1,315.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,096.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,242.84
|
| Rate for Payer: PHP Commercial |
$1,242.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,272.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$891.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,286.71
|
| Rate for Payer: UHC Core |
$1,220.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,096.63
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
OP
|
$743.82
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.66 |
| Max. Negotiated Rate |
$669.44 |
| Rate for Payer: Aetna Commercial |
$632.25
|
| Rate for Payer: Aetna Medicare |
$193.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$232.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$232.44
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$185.96
|
| Rate for Payer: BCBS Trust/PPO |
$578.32
|
| Rate for Payer: BCN Commercial |
$578.32
|
| Rate for Payer: BCN Medicare Advantage |
$185.96
|
| Rate for Payer: Cash Price |
$595.06
|
| Rate for Payer: Cash Price |
$595.06
|
| Rate for Payer: Cofinity Commercial |
$639.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.96
|
| Rate for Payer: Healthscope Commercial |
$669.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.86
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$632.25
|
| Rate for Payer: PACE Senior Care Partners |
$176.66
|
| Rate for Payer: PACE SWMI |
$185.96
|
| Rate for Payer: PHP Commercial |
$632.25
|
| Rate for Payer: PHP Medicare Advantage |
$185.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$647.12
|
| Rate for Payer: Priority Health Medicare |
$185.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$453.66
|
| Rate for Payer: Railroad Medicare Medicare |
$185.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.56
|
| Rate for Payer: UHC Core |
$621.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.96
|
| Rate for Payer: UHC Medicare Advantage |
$191.53
|
| Rate for Payer: VA VA |
$185.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.86
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
IP
|
$743.82
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$453.66 |
| Max. Negotiated Rate |
$669.44 |
| Rate for Payer: Aetna Commercial |
$632.25
|
| Rate for Payer: BCBS Trust/PPO |
$574.82
|
| Rate for Payer: BCN Commercial |
$574.82
|
| Rate for Payer: Cash Price |
$595.06
|
| Rate for Payer: Cofinity Commercial |
$639.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.06
|
| Rate for Payer: Healthscope Commercial |
$669.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$632.25
|
| Rate for Payer: PHP Commercial |
$632.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$647.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$453.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.56
|
| Rate for Payer: UHC Core |
$621.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.86
|
|
|
HC NETTLE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC NETTLE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
OP
|
$132.60
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: Aetna Medicare |
$34.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.44
|
| Rate for Payer: BCBS Complete |
$53.04
|
| Rate for Payer: BCBS MAPPO |
$33.15
|
| Rate for Payer: BCBS Trust/PPO |
$103.10
|
| Rate for Payer: BCN Commercial |
$103.10
|
| Rate for Payer: BCN Medicare Advantage |
$33.15
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.15
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.71
|
| Rate for Payer: PACE Senior Care Partners |
$31.49
|
| Rate for Payer: PACE SWMI |
$33.15
|
| Rate for Payer: PHP Commercial |
$112.71
|
| Rate for Payer: PHP Medicare Advantage |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.36
|
| Rate for Payer: Priority Health Medicare |
$33.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.87
|
| Rate for Payer: Railroad Medicare Medicare |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.69
|
| Rate for Payer: UHC Core |
$110.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.15
|
| Rate for Payer: UHC Medicare Advantage |
$34.14
|
| Rate for Payer: VA VA |
$33.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.45
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
IP
|
$132.60
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$80.87 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: BCBS Trust/PPO |
$102.47
|
| Rate for Payer: BCN Commercial |
$102.47
|
| Rate for Payer: Cash Price |
$106.08
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.08
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.71
|
| Rate for Payer: PHP Commercial |
$112.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.69
|
| Rate for Payer: UHC Core |
$110.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.45
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM FIRST HOUR
|
Facility
|
OP
|
$269.71
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
91800001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$242.74 |
| Rate for Payer: Aetna Commercial |
$229.25
|
| Rate for Payer: Aetna Medicare |
$70.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.28
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$67.43
|
| Rate for Payer: BCBS Trust/PPO |
$209.70
|
| Rate for Payer: BCN Commercial |
$209.70
|
| Rate for Payer: BCN Medicare Advantage |
$67.43
|
| Rate for Payer: Cash Price |
$215.77
|
| Rate for Payer: Cash Price |
$215.77
|
| Rate for Payer: Cofinity Commercial |
$231.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.43
|
| Rate for Payer: Healthscope Commercial |
$242.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.28
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.25
|
| Rate for Payer: PACE Senior Care Partners |
$64.06
|
| Rate for Payer: PACE SWMI |
$67.43
|
| Rate for Payer: PHP Commercial |
$229.25
|
| Rate for Payer: PHP Medicare Advantage |
$67.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.65
|
| Rate for Payer: Priority Health Medicare |
$67.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.50
|
| Rate for Payer: Railroad Medicare Medicare |
$67.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.34
|
| Rate for Payer: UHC Core |
$225.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.43
|
| Rate for Payer: UHC Medicare Advantage |
$69.45
|
| Rate for Payer: VA VA |
$67.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.28
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM FIRST HOUR
|
Facility
|
IP
|
$269.71
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
91800001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$242.74 |
| Rate for Payer: Aetna Commercial |
$229.25
|
| Rate for Payer: BCBS Trust/PPO |
$208.43
|
| Rate for Payer: BCN Commercial |
$208.43
|
| Rate for Payer: Cash Price |
$215.77
|
| Rate for Payer: Cofinity Commercial |
$231.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.77
|
| Rate for Payer: Healthscope Commercial |
$242.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.25
|
| Rate for Payer: PHP Commercial |
$229.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.34
|
| Rate for Payer: UHC Core |
$225.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.28
|
|
|
HC NEUROFORM ATLAS STENT
|
Facility
|
OP
|
$11,647.13
|
|
| Hospital Charge Code |
27800118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.19 |
| Max. Negotiated Rate |
$10,482.42 |
| Rate for Payer: Aetna Commercial |
$9,900.06
|
| Rate for Payer: Aetna Medicare |
$3,028.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,639.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,639.73
|
| Rate for Payer: BCBS Complete |
$4,658.85
|
| Rate for Payer: BCBS MAPPO |
$2,911.78
|
| Rate for Payer: BCBS Trust/PPO |
$9,055.64
|
| Rate for Payer: BCN Commercial |
$9,055.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,911.78
|
| Rate for Payer: Cash Price |
$9,317.70
|
| Rate for Payer: Cofinity Commercial |
$10,016.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,317.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,911.78
|
| Rate for Payer: Healthscope Commercial |
$10,482.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,735.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,057.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,348.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,900.06
|
| Rate for Payer: PACE Senior Care Partners |
$2,766.19
|
| Rate for Payer: PACE SWMI |
$2,911.78
|
| Rate for Payer: PHP Commercial |
$9,900.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,911.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,152.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,133.00
|
| Rate for Payer: Priority Health Medicare |
$2,911.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,103.58
|
| Rate for Payer: Railroad Medicare Medicare |
$2,911.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,249.47
|
| Rate for Payer: UHC Core |
$9,725.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,911.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,999.14
|
| Rate for Payer: VA VA |
$2,911.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,735.35
|
|
|
HC NEUROFORM ATLAS STENT
|
Facility
|
IP
|
$11,647.13
|
|
| Hospital Charge Code |
27800118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,103.58 |
| Max. Negotiated Rate |
$10,482.42 |
| Rate for Payer: Aetna Commercial |
$9,900.06
|
| Rate for Payer: BCBS Trust/PPO |
$9,000.90
|
| Rate for Payer: BCN Commercial |
$9,000.90
|
| Rate for Payer: Cash Price |
$9,317.70
|
| Rate for Payer: Cofinity Commercial |
$10,016.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,317.70
|
| Rate for Payer: Healthscope Commercial |
$10,482.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,735.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,900.06
|
| Rate for Payer: PHP Commercial |
$9,900.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,152.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,133.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,103.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,249.47
|
| Rate for Payer: UHC Core |
$9,725.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,735.35
|
|
|
HC NEUROLYSIS CELIAC PLEXUS
|
Facility
|
IP
|
$1,892.10
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
36100479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,153.99 |
| Max. Negotiated Rate |
$1,702.89 |
| Rate for Payer: Aetna Commercial |
$1,608.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,462.21
|
| Rate for Payer: BCN Commercial |
$1,462.21
|
| Rate for Payer: Cash Price |
$1,513.68
|
| Rate for Payer: Cofinity Commercial |
$1,627.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,513.68
|
| Rate for Payer: Healthscope Commercial |
$1,702.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,419.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,608.28
|
| Rate for Payer: PHP Commercial |
$1,608.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,324.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,646.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,153.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,665.05
|
| Rate for Payer: UHC Core |
$1,579.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,419.08
|
|
