|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,633.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$996.38 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.51
|
| Rate for Payer: BCN Commercial |
$1,262.51
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,388.63
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$996.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,437.64
|
| Rate for Payer: UHC Core |
$1,364.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
|
HC NM VOID CYSTO
|
Facility
|
IP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$639.36 |
| Max. Negotiated Rate |
$943.48 |
| Rate for Payer: Aetna Commercial |
$891.06
|
| Rate for Payer: BCBS Trust/PPO |
$810.13
|
| Rate for Payer: BCN Commercial |
$810.13
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$901.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.65
|
| Rate for Payer: Healthscope Commercial |
$943.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.06
|
| Rate for Payer: PHP Commercial |
$891.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$912.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$639.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.51
|
| Rate for Payer: UHC Core |
$875.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.23
|
|
|
HC NM VOID CYSTO
|
Facility
|
OP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$248.97 |
| Max. Negotiated Rate |
$943.48 |
| Rate for Payer: Aetna Commercial |
$891.06
|
| Rate for Payer: Aetna Medicare |
$272.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$327.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$327.60
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$262.08
|
| Rate for Payer: BCBS Trust/PPO |
$815.06
|
| Rate for Payer: BCN Commercial |
$815.06
|
| Rate for Payer: BCN Medicare Advantage |
$262.08
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$901.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.08
|
| Rate for Payer: Healthscope Commercial |
$943.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.23
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$275.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.06
|
| Rate for Payer: PACE Senior Care Partners |
$248.97
|
| Rate for Payer: PACE SWMI |
$262.08
|
| Rate for Payer: PHP Commercial |
$891.06
|
| Rate for Payer: PHP Medicare Advantage |
$262.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$912.03
|
| Rate for Payer: Priority Health Medicare |
$262.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$639.36
|
| Rate for Payer: Railroad Medicare Medicare |
$262.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.51
|
| Rate for Payer: UHC Core |
$875.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.08
|
| Rate for Payer: UHC Medicare Advantage |
$269.94
|
| Rate for Payer: VA VA |
$262.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.23
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,159.93 |
| Max. Negotiated Rate |
$1,711.65 |
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.73
|
| Rate for Payer: BCN Commercial |
$1,469.73
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,635.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.46
|
| Rate for Payer: Healthscope Commercial |
$1,711.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: PHP Commercial |
$1,616.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,654.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,159.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,673.61
|
| Rate for Payer: UHC Core |
$1,588.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.37
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$1,711.65 |
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: Aetna Medicare |
$494.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$594.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$594.32
|
| Rate for Payer: BCBS Complete |
$171.36
|
| Rate for Payer: BCBS MAPPO |
$475.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.67
|
| Rate for Payer: BCN Commercial |
$1,478.67
|
| Rate for Payer: BCN Medicare Advantage |
$475.46
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,635.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.46
|
| Rate for Payer: Healthscope Commercial |
$1,711.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.37
|
| Rate for Payer: Mclaren Medicaid |
$163.20
|
| Rate for Payer: Meridian Medicaid |
$171.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$499.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: PACE Senior Care Partners |
$451.68
|
| Rate for Payer: PACE SWMI |
$475.46
|
| Rate for Payer: PHP Commercial |
$1,616.56
|
| Rate for Payer: PHP Medicare Advantage |
$475.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,654.59
|
| Rate for Payer: Priority Health Medicare |
$475.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,159.93
|
| Rate for Payer: Railroad Medicare Medicare |
$475.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,673.61
|
| Rate for Payer: UHC Core |
$1,588.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.46
|
| Rate for Payer: UHC Medicare Advantage |
$489.72
|
| Rate for Payer: VA VA |
$475.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.37
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.78
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.61
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.88
|
| Rate for Payer: UHC Core |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.25
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.77
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.88
|
| Rate for Payer: UHC Core |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$77.03 |
| Rate for Payer: Aetna Commercial |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$66.14
|
| Rate for Payer: BCN Commercial |
$66.14
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$73.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.47
|
| Rate for Payer: Healthscope Commercial |
$77.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: PHP Commercial |
$72.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.32
|
| Rate for Payer: UHC Core |
$71.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.19
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$77.03 |
| Rate for Payer: Aetna Commercial |
$72.75
|
| Rate for Payer: Aetna Medicare |
$22.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.75
|
| Rate for Payer: BCBS Complete |
$27.63
|
| Rate for Payer: BCBS MAPPO |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$66.55
|
| Rate for Payer: BCN Commercial |
$66.55
|
| Rate for Payer: BCN Medicare Advantage |
$21.40
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$73.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$77.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.19
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Medicaid |
$27.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: PACE Senior Care Partners |
$20.33
|
| Rate for Payer: PACE SWMI |
$21.40
|
| Rate for Payer: PHP Commercial |
$72.75
|
| Rate for Payer: PHP Medicare Advantage |
$21.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.46
|
| Rate for Payer: Priority Health Medicare |
$21.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.20
|
| Rate for Payer: Railroad Medicare Medicare |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.32
|
| Rate for Payer: UHC Core |
$71.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.40
|
| Rate for Payer: UHC Medicare Advantage |
$22.04
|
| Rate for Payer: VA VA |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.19
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,476.76 |
| Max. Negotiated Rate |
$2,179.18 |
| Rate for Payer: Aetna Commercial |
$2,058.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,871.19
|
| Rate for Payer: BCN Commercial |
$1,871.19
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$2,082.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.05
|
| Rate for Payer: Healthscope Commercial |
$2,179.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,815.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: PHP Commercial |
$2,058.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,106.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,130.75
|
| Rate for Payer: UHC Core |
$2,021.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,815.98
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$575.06 |
| Max. Negotiated Rate |
$2,179.18 |
| Rate for Payer: Aetna Commercial |
$2,058.11
|
| Rate for Payer: Aetna Medicare |
$629.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$756.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$756.66
|
| Rate for Payer: BCBS Complete |
$819.75
|
| Rate for Payer: BCBS MAPPO |
$605.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,882.57
|
| Rate for Payer: BCN Commercial |
$1,882.57
|
| Rate for Payer: BCN Medicare Advantage |
$605.33
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$2,082.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,937.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.33
|
| Rate for Payer: Healthscope Commercial |
$2,179.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,815.98
|
| Rate for Payer: Mclaren Medicaid |
$780.72
|
| Rate for Payer: Meridian Medicaid |
$819.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$635.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: PACE Senior Care Partners |
$575.06
|
| Rate for Payer: PACE SWMI |
$605.33
|
| Rate for Payer: PHP Commercial |
$2,058.11
|
| Rate for Payer: PHP Medicare Advantage |
$605.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,106.54
|
| Rate for Payer: Priority Health Medicare |
$605.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.76
|
| Rate for Payer: Railroad Medicare Medicare |
$605.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,130.75
|
| Rate for Payer: UHC Core |
$2,021.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.33
|
| Rate for Payer: UHC Medicare Advantage |
$623.49
|
| Rate for Payer: VA VA |
$605.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,815.98
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,110.46
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$677.27 |
| Max. Negotiated Rate |
$999.41 |
| Rate for Payer: Aetna Commercial |
$943.89
|
| Rate for Payer: BCBS Trust/PPO |
$858.16
|
| Rate for Payer: BCN Commercial |
$858.16
|
| Rate for Payer: Cash Price |
$888.37
|
| Rate for Payer: Cofinity Commercial |
$955.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.37
|
| Rate for Payer: Healthscope Commercial |
$999.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$832.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.89
|
| Rate for Payer: PHP Commercial |
$943.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.20
|
| Rate for Payer: UHC Core |
$927.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$832.84
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,110.46
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$263.73 |
| Max. Negotiated Rate |
$999.41 |
| Rate for Payer: Aetna Commercial |
$943.89
|
| Rate for Payer: Aetna Medicare |
$288.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$347.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$347.02
|
| Rate for Payer: BCBS Complete |
$444.18
|
| Rate for Payer: BCBS MAPPO |
$277.62
|
| Rate for Payer: BCBS Trust/PPO |
$863.38
|
| Rate for Payer: BCN Commercial |
$863.38
|
| Rate for Payer: BCN Medicare Advantage |
$277.62
|
| Rate for Payer: Cash Price |
$888.37
|
| Rate for Payer: Cofinity Commercial |
$955.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.62
|
| Rate for Payer: Healthscope Commercial |
$999.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$832.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$291.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.89
|
| Rate for Payer: PACE Senior Care Partners |
$263.73
|
| Rate for Payer: PACE SWMI |
$277.62
|
| Rate for Payer: PHP Commercial |
$943.89
|
| Rate for Payer: PHP Medicare Advantage |
$277.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.10
|
| Rate for Payer: Priority Health Medicare |
$277.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.27
|
| Rate for Payer: Railroad Medicare Medicare |
$277.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.20
|
| Rate for Payer: UHC Core |
$927.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$277.62
|
| Rate for Payer: UHC Medicare Advantage |
$285.94
|
| Rate for Payer: VA VA |
$277.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$832.84
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$906.19
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$215.22 |
| Max. Negotiated Rate |
$815.57 |
| Rate for Payer: Aetna Commercial |
$770.26
|
| Rate for Payer: Aetna Medicare |
$235.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.18
|
| Rate for Payer: BCBS Complete |
$362.48
|
| Rate for Payer: BCBS MAPPO |
$226.55
|
| Rate for Payer: BCBS Trust/PPO |
$704.56
|
| Rate for Payer: BCN Commercial |
$704.56
|
| Rate for Payer: BCN Medicare Advantage |
$226.55
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cofinity Commercial |
$779.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.55
|
| Rate for Payer: Healthscope Commercial |
$815.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$679.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.26
|
| Rate for Payer: PACE Senior Care Partners |
$215.22
|
| Rate for Payer: PACE SWMI |
$226.55
|
| Rate for Payer: PHP Commercial |
$770.26
|
| Rate for Payer: PHP Medicare Advantage |
$226.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$788.39
|
| Rate for Payer: Priority Health Medicare |
$226.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.69
|
| Rate for Payer: Railroad Medicare Medicare |
$226.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$797.45
|
| Rate for Payer: UHC Core |
$756.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.55
|
| Rate for Payer: UHC Medicare Advantage |
$233.34
|
| Rate for Payer: VA VA |
$226.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$679.64
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$906.19
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$552.69 |
| Max. Negotiated Rate |
$815.57 |
| Rate for Payer: Aetna Commercial |
$770.26
|
| Rate for Payer: BCBS Trust/PPO |
$700.30
|
| Rate for Payer: BCN Commercial |
$700.30
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cofinity Commercial |
$779.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.95
|
| Rate for Payer: Healthscope Commercial |
$815.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$679.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.26
|
| Rate for Payer: PHP Commercial |
$770.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$788.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$797.45
|
| Rate for Payer: UHC Core |
$756.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$679.64
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$351.90
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.58 |
| Max. Negotiated Rate |
$316.71 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: Aetna Medicare |
$91.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.97
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$87.98
|
| Rate for Payer: BCBS Trust/PPO |
$273.60
|
| Rate for Payer: BCN Commercial |
$273.60
|
| Rate for Payer: BCN Medicare Advantage |
$87.98
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.98
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.92
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.12
|
| Rate for Payer: PACE Senior Care Partners |
$83.58
|
| Rate for Payer: PACE SWMI |
$87.98
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: PHP Medicare Advantage |
$87.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.15
|
| Rate for Payer: Priority Health Medicare |
$87.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.62
|
| Rate for Payer: Railroad Medicare Medicare |
$87.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.67
|
| Rate for Payer: UHC Core |
$293.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.98
|
| Rate for Payer: UHC Medicare Advantage |
$90.61
|
| Rate for Payer: VA VA |
$87.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.92
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$351.90
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.62 |
| Max. Negotiated Rate |
$316.71 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: BCBS Trust/PPO |
$271.95
|
| Rate for Payer: BCN Commercial |
$271.95
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.12
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.67
|
| Rate for Payer: UHC Core |
$293.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.92
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$3,877.64
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,364.97 |
| Max. Negotiated Rate |
$3,489.88 |
| Rate for Payer: Aetna Commercial |
$3,295.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,996.64
|
| Rate for Payer: BCN Commercial |
$2,996.64
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cofinity Commercial |
$3,334.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.11
|
| Rate for Payer: Healthscope Commercial |
$3,489.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,295.99
|
| Rate for Payer: PHP Commercial |
$3,295.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,714.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,373.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,364.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,412.32
|
| Rate for Payer: UHC Core |
$3,237.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.23
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$3,877.64
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$920.94 |
| Max. Negotiated Rate |
$3,489.88 |
| Rate for Payer: Aetna Commercial |
$3,295.99
|
| Rate for Payer: Aetna Medicare |
$1,008.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,211.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,211.76
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$969.41
|
| Rate for Payer: BCBS Trust/PPO |
$3,014.87
|
| Rate for Payer: BCN Commercial |
$3,014.87
|
| Rate for Payer: BCN Medicare Advantage |
$969.41
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cofinity Commercial |
$3,334.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$969.41
|
| Rate for Payer: Healthscope Commercial |
$3,489.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.23
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,017.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,114.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,295.99
|
| Rate for Payer: PACE Senior Care Partners |
$920.94
|
| Rate for Payer: PACE SWMI |
$969.41
|
| Rate for Payer: PHP Commercial |
$3,295.99
|
| Rate for Payer: PHP Medicare Advantage |
$969.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,714.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,373.55
|
| Rate for Payer: Priority Health Medicare |
$969.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,364.97
|
| Rate for Payer: Railroad Medicare Medicare |
$969.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,412.32
|
| Rate for Payer: UHC Core |
$3,237.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$969.41
|
| Rate for Payer: UHC Medicare Advantage |
$998.49
|
| Rate for Payer: VA VA |
$969.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.23
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,359.88
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,708.59 |
| Max. Negotiated Rate |
$8,423.89 |
| Rate for Payer: Aetna Commercial |
$7,955.90
|
| Rate for Payer: BCBS Trust/PPO |
$7,233.32
|
| Rate for Payer: BCN Commercial |
$7,233.32
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$8,049.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.90
|
| Rate for Payer: Healthscope Commercial |
$8,423.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,019.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,955.90
|
| Rate for Payer: PHP Commercial |
$7,955.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,551.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,143.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,708.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,236.69
|
| Rate for Payer: UHC Core |
$7,815.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,019.91
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,359.88
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,090.97 |
| Max. Negotiated Rate |
$8,423.89 |
| Rate for Payer: Aetna Commercial |
$7,955.90
|
| Rate for Payer: Aetna Medicare |
$2,433.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,924.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,924.96
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$2,339.97
|
| Rate for Payer: BCBS Trust/PPO |
$7,277.31
|
| Rate for Payer: BCN Commercial |
$7,277.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,339.97
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$8,049.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,487.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,339.97
|
| Rate for Payer: Healthscope Commercial |
$8,423.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,019.91
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,456.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,690.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,955.90
|
| Rate for Payer: PACE Senior Care Partners |
$2,222.97
|
| Rate for Payer: PACE SWMI |
$2,339.97
|
| Rate for Payer: PHP Commercial |
$7,955.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,339.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,551.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,143.10
|
| Rate for Payer: Priority Health Medicare |
$2,339.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,708.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,339.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,236.69
|
| Rate for Payer: UHC Core |
$7,815.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,339.97
|
| Rate for Payer: UHC Medicare Advantage |
$2,410.17
|
| Rate for Payer: VA VA |
$2,339.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,019.91
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$320.40
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$195.41 |
| Max. Negotiated Rate |
$288.36 |
| Rate for Payer: Aetna Commercial |
$272.34
|
| Rate for Payer: BCBS Trust/PPO |
$247.61
|
| Rate for Payer: BCN Commercial |
$247.61
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cofinity Commercial |
$275.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.32
|
| Rate for Payer: Healthscope Commercial |
$288.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.34
|
| Rate for Payer: PHP Commercial |
$272.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.95
|
| Rate for Payer: UHC Core |
$267.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.30
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$320.40
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$76.10 |
| Max. Negotiated Rate |
$288.36 |
| Rate for Payer: Aetna Commercial |
$272.34
|
| Rate for Payer: Aetna Medicare |
$83.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.12
|
| Rate for Payer: BCBS Complete |
$137.25
|
| Rate for Payer: BCBS MAPPO |
$80.10
|
| Rate for Payer: BCBS Trust/PPO |
$249.11
|
| Rate for Payer: BCN Commercial |
$249.11
|
| Rate for Payer: BCN Medicare Advantage |
$80.10
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cofinity Commercial |
$275.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.10
|
| Rate for Payer: Healthscope Commercial |
$288.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.30
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Meridian Medicaid |
$137.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.34
|
| Rate for Payer: PACE Senior Care Partners |
$76.10
|
| Rate for Payer: PACE SWMI |
$80.10
|
| Rate for Payer: PHP Commercial |
$272.34
|
| Rate for Payer: PHP Medicare Advantage |
$80.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.75
|
| Rate for Payer: Priority Health Medicare |
$80.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.41
|
| Rate for Payer: Railroad Medicare Medicare |
$80.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.95
|
| Rate for Payer: UHC Core |
$267.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.10
|
| Rate for Payer: UHC Medicare Advantage |
$82.50
|
| Rate for Payer: VA VA |
$80.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.30
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,247.14
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,980.43 |
| Max. Negotiated Rate |
$2,922.43 |
| Rate for Payer: Aetna Commercial |
$2,760.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,509.39
|
| Rate for Payer: BCN Commercial |
$2,509.39
|
| Rate for Payer: Cash Price |
$2,597.71
|
| Rate for Payer: Cofinity Commercial |
$2,792.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,597.71
|
| Rate for Payer: Healthscope Commercial |
$2,922.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,435.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,760.07
|
| Rate for Payer: PHP Commercial |
$2,760.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,825.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,980.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,857.48
|
| Rate for Payer: UHC Core |
$2,711.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,435.36
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,247.14
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$771.20 |
| Max. Negotiated Rate |
$2,922.43 |
| Rate for Payer: Aetna Commercial |
$2,760.07
|
| Rate for Payer: Aetna Medicare |
$844.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,014.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,014.73
|
| Rate for Payer: BCBS Complete |
$1,298.86
|
| Rate for Payer: BCBS MAPPO |
$811.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,524.65
|
| Rate for Payer: BCN Commercial |
$2,524.65
|
| Rate for Payer: BCN Medicare Advantage |
$811.78
|
| Rate for Payer: Cash Price |
$2,597.71
|
| Rate for Payer: Cofinity Commercial |
$2,792.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,597.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.78
|
| Rate for Payer: Healthscope Commercial |
$2,922.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,435.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$852.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$933.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,760.07
|
| Rate for Payer: PACE Senior Care Partners |
$771.20
|
| Rate for Payer: PACE SWMI |
$811.78
|
| Rate for Payer: PHP Commercial |
$2,760.07
|
| Rate for Payer: PHP Medicare Advantage |
$811.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,825.01
|
| Rate for Payer: Priority Health Medicare |
$811.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,980.43
|
| Rate for Payer: Railroad Medicare Medicare |
$811.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,857.48
|
| Rate for Payer: UHC Core |
$2,711.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.78
|
| Rate for Payer: UHC Medicare Advantage |
$836.14
|
| Rate for Payer: VA VA |
$811.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,435.36
|
|
