|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.68 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna Medicare |
$310.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$373.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$373.44
|
| Rate for Payer: BCBS Complete |
$221.19
|
| Rate for Payer: BCBS MAPPO |
$298.75
|
| Rate for Payer: BCBS Trust/PPO |
$982.41
|
| Rate for Payer: BCN Commercial |
$982.41
|
| Rate for Payer: BCN Medicare Advantage |
$298.75
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,027.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.75
|
| Rate for Payer: Healthscope Commercial |
$1,075.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.25
|
| Rate for Payer: Mclaren Medicaid |
$210.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.69
|
| Rate for Payer: Meridian Medicaid |
$221.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$328.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.75
|
| Rate for Payer: Nomi Health Commercial |
$979.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$896.25
|
| Rate for Payer: PACE Senior Care Partners |
$283.81
|
| Rate for Payer: PACE SWMI |
$298.75
|
| Rate for Payer: PHP Commercial |
$1,015.75
|
| Rate for Payer: PHP Medicare Advantage |
$298.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,039.65
|
| Rate for Payer: Priority Health Medicare |
$301.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$831.72
|
| Rate for Payer: Railroad Medicare Medicare |
$298.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,051.60
|
| Rate for Payer: UHC Core |
$997.83
|
| Rate for Payer: UHC Exchange |
$298.75
|
| Rate for Payer: UHC Medicaid |
$210.68
|
| Rate for Payer: UHC Medicare Advantage |
$298.75
|
| Rate for Payer: UHCCP Medicaid |
$210.68
|
| Rate for Payer: VA VA |
$298.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.25
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: Aetna Medicare |
$42.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.72
|
| Rate for Payer: BCBS Complete |
$30.04
|
| Rate for Payer: BCBS MAPPO |
$40.58
|
| Rate for Payer: BCBS Trust/PPO |
$133.43
|
| Rate for Payer: BCN Commercial |
$133.43
|
| Rate for Payer: BCN Medicare Advantage |
$40.58
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.58
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.72
|
| Rate for Payer: Mclaren Medicaid |
$28.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.60
|
| Rate for Payer: Meridian Medicaid |
$30.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$133.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: PACE Senior Care Partners |
$38.55
|
| Rate for Payer: PACE SWMI |
$40.58
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: PHP Medicare Advantage |
$40.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.20
|
| Rate for Payer: Priority Health Medicare |
$40.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.96
|
| Rate for Payer: Railroad Medicare Medicare |
$40.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.82
|
| Rate for Payer: UHC Core |
$135.52
|
| Rate for Payer: UHC Exchange |
$40.58
|
| Rate for Payer: UHC Medicaid |
$28.61
|
| Rate for Payer: UHC Medicare Advantage |
$40.58
|
| Rate for Payer: UHCCP Medicaid |
$28.61
|
| Rate for Payer: VA VA |
$40.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.72
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: BCBS Trust/PPO |
$134.04
|
| Rate for Payer: BCN Commercial |
$134.04
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Nomi Health Commercial |
$133.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.82
|
| Rate for Payer: UHC Core |
$135.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.72
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna Commercial |
$286.88
|
| Rate for Payer: Aetna Medicare |
$87.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.47
|
| Rate for Payer: BCBS Complete |
$62.47
|
| Rate for Payer: BCBS MAPPO |
$84.38
|
| Rate for Payer: BCBS Trust/PPO |
$277.46
|
| Rate for Payer: BCN Commercial |
$277.46
|
| Rate for Payer: BCN Medicare Advantage |
$84.38
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.38
|
| Rate for Payer: Healthscope Commercial |
$303.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.12
|
| Rate for Payer: Mclaren Medicaid |
$59.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.59
|
| Rate for Payer: Meridian Medicaid |
$62.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.12
|
| Rate for Payer: PACE Senior Care Partners |
$80.16
|
| Rate for Payer: PACE SWMI |
$84.38
|
| Rate for Payer: PHP Commercial |
$286.88
|
| Rate for Payer: PHP Medicare Advantage |
$84.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$293.62
|
| Rate for Payer: Priority Health Medicare |
$85.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.90
|
| Rate for Payer: Railroad Medicare Medicare |
$84.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.00
|
| Rate for Payer: UHC Core |
$281.81
|
| Rate for Payer: UHC Exchange |
$84.38
|
| Rate for Payer: UHC Medicaid |
$59.50
|
| Rate for Payer: UHC Medicare Advantage |
$84.38
|
| Rate for Payer: UHCCP Medicaid |
$59.50
|
| Rate for Payer: VA VA |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.12
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.90 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna Commercial |
$286.88
|
| Rate for Payer: BCBS Trust/PPO |
$278.74
|
| Rate for Payer: BCN Commercial |
$278.74
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$303.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.12
|
| Rate for Payer: PHP Commercial |
$286.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$293.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.00
|
| Rate for Payer: UHC Core |
$281.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.12
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
OP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.53 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: Aetna Medicare |
$126.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.61
|
| Rate for Payer: BCBS Complete |
$89.80
|
| Rate for Payer: BCBS MAPPO |
$121.29
|
| Rate for Payer: BCBS Trust/PPO |
$398.85
|
| Rate for Payer: BCN Commercial |
$398.85
|
| Rate for Payer: BCN Medicare Advantage |
$121.29
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.29
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.87
|
| Rate for Payer: Mclaren Medicaid |
$85.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.35
|
| Rate for Payer: Meridian Medicaid |
$89.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Nomi Health Commercial |
$397.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.87
|
| Rate for Payer: PACE Senior Care Partners |
$115.23
|
| Rate for Payer: PACE SWMI |
$121.29
|
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: PHP Medicare Advantage |
$121.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$422.09
|
| Rate for Payer: Priority Health Medicare |
$122.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.67
|
| Rate for Payer: Railroad Medicare Medicare |
$121.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.94
|
| Rate for Payer: UHC Core |
$405.11
|
| Rate for Payer: UHC Exchange |
$121.29
|
| Rate for Payer: UHC Medicaid |
$85.53
|
| Rate for Payer: UHC Medicare Advantage |
$121.29
|
| Rate for Payer: UHCCP Medicaid |
$85.53
|
| Rate for Payer: VA VA |
$121.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.87
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.67 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: BCBS Trust/PPO |
$400.69
|
| Rate for Payer: BCN Commercial |
$400.69
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Nomi Health Commercial |
$397.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.87
|
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$422.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.94
|
| Rate for Payer: UHC Core |
$405.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.87
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: BCBS Complete |
$11.79
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$52.34
|
| Rate for Payer: BCN Commercial |
$52.34
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$11.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: Meridian Medicaid |
$11.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Senior Care Partners |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.39
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.31
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.03
|
| Rate for Payer: UHC Core |
$53.16
|
| Rate for Payer: UHC Exchange |
$15.92
|
| Rate for Payer: UHC Medicaid |
$11.23
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: UHCCP Medicaid |
$11.23
|
| Rate for Payer: VA VA |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.31 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: BCBS Trust/PPO |
$52.59
|
| Rate for Payer: BCN Commercial |
$52.59
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.03
|
| Rate for Payer: UHC Core |
$53.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,545.36
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$977.65 |
| Max. Negotiated Rate |
$4,990.82 |
| Rate for Payer: Aetna Commercial |
$4,713.56
|
| Rate for Payer: Aetna Medicare |
$1,441.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,732.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,732.92
|
| Rate for Payer: BCBS Complete |
$1,026.45
|
| Rate for Payer: BCBS MAPPO |
$1,386.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,558.84
|
| Rate for Payer: BCN Commercial |
$4,558.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,386.34
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cofinity Commercial |
$4,769.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,386.34
|
| Rate for Payer: Healthscope Commercial |
$4,990.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,159.02
|
| Rate for Payer: Mclaren Medicaid |
$977.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,455.66
|
| Rate for Payer: Meridian Medicaid |
$1,026.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,594.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,524.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,713.56
|
| Rate for Payer: Nomi Health Commercial |
$4,547.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,159.02
|
| Rate for Payer: PACE Senior Care Partners |
$1,317.02
|
| Rate for Payer: PACE SWMI |
$1,386.34
|
| Rate for Payer: PHP Commercial |
$4,713.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,386.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$977.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,824.46
|
| Rate for Payer: Priority Health Medicare |
$1,400.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,859.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,386.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,879.92
|
| Rate for Payer: UHC Core |
$4,630.38
|
| Rate for Payer: UHC Exchange |
$1,386.34
|
| Rate for Payer: UHC Medicaid |
$977.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,386.34
|
| Rate for Payer: UHCCP Medicaid |
$977.65
|
| Rate for Payer: VA VA |
$1,386.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,159.02
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,545.36
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,859.57 |
| Max. Negotiated Rate |
$4,990.82 |
| Rate for Payer: Aetna Commercial |
$4,713.56
|
| Rate for Payer: BCBS Trust/PPO |
$4,579.91
|
| Rate for Payer: BCN Commercial |
$4,579.91
|
| Rate for Payer: Cash Price |
$4,436.29
|
| Rate for Payer: Cofinity Commercial |
$4,769.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.29
|
| Rate for Payer: Healthscope Commercial |
$4,990.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,159.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,713.56
|
| Rate for Payer: Nomi Health Commercial |
$4,547.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,159.02
|
| Rate for Payer: PHP Commercial |
$4,713.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,824.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,859.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,879.92
|
| Rate for Payer: UHC Core |
$4,630.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,159.02
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,323.85
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$921.40 |
| Max. Negotiated Rate |
$1,191.46 |
| Rate for Payer: Aetna Commercial |
$1,125.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.37
|
| Rate for Payer: BCN Commercial |
$1,093.37
|
| Rate for Payer: Cash Price |
$1,059.08
|
| Rate for Payer: Cofinity Commercial |
$1,138.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.08
|
| Rate for Payer: Healthscope Commercial |
$1,191.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$992.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,125.27
|
| Rate for Payer: Nomi Health Commercial |
$1,085.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$992.89
|
| Rate for Payer: PHP Commercial |
$1,125.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,151.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$921.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,164.99
|
| Rate for Payer: UHC Core |
$1,105.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$992.89
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,323.85
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$233.39 |
| Max. Negotiated Rate |
$1,191.46 |
| Rate for Payer: Aetna Commercial |
$1,125.27
|
| Rate for Payer: Aetna Medicare |
$344.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$413.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$413.70
|
| Rate for Payer: BCBS Complete |
$245.04
|
| Rate for Payer: BCBS MAPPO |
$330.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.34
|
| Rate for Payer: BCN Commercial |
$1,088.34
|
| Rate for Payer: BCN Medicare Advantage |
$330.96
|
| Rate for Payer: Cash Price |
$1,059.08
|
| Rate for Payer: Cofinity Commercial |
$1,138.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$330.96
|
| Rate for Payer: Healthscope Commercial |
$1,191.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$992.89
|
| Rate for Payer: Mclaren Medicaid |
$233.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.51
|
| Rate for Payer: Meridian Medicaid |
$245.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$380.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$364.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,125.27
|
| Rate for Payer: Nomi Health Commercial |
$1,085.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$992.89
|
| Rate for Payer: PACE Senior Care Partners |
$314.41
|
| Rate for Payer: PACE SWMI |
$330.96
|
| Rate for Payer: PHP Commercial |
$1,125.27
|
| Rate for Payer: PHP Medicare Advantage |
$330.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,151.75
|
| Rate for Payer: Priority Health Medicare |
$334.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$921.40
|
| Rate for Payer: Railroad Medicare Medicare |
$330.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,164.99
|
| Rate for Payer: UHC Core |
$1,105.41
|
| Rate for Payer: UHC Exchange |
$330.96
|
| Rate for Payer: UHC Medicaid |
$233.39
|
| Rate for Payer: UHC Medicare Advantage |
$330.96
|
| Rate for Payer: UHCCP Medicaid |
$233.39
|
| Rate for Payer: VA VA |
$330.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$992.89
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$190.81
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$171.73 |
| Rate for Payer: Aetna Commercial |
$162.19
|
| Rate for Payer: BCBS Trust/PPO |
$157.59
|
| Rate for Payer: BCN Commercial |
$157.59
|
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.65
|
| Rate for Payer: Healthscope Commercial |
$171.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.19
|
| Rate for Payer: Nomi Health Commercial |
$156.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.11
|
| Rate for Payer: PHP Commercial |
$162.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$166.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.91
|
| Rate for Payer: UHC Core |
$159.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.11
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$190.81
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$171.73 |
| Rate for Payer: Aetna Commercial |
$162.19
|
| Rate for Payer: Aetna Medicare |
$49.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.63
|
| Rate for Payer: BCBS Complete |
$35.32
|
| Rate for Payer: BCBS MAPPO |
$47.70
|
| Rate for Payer: BCBS Trust/PPO |
$156.86
|
| Rate for Payer: BCN Commercial |
$156.86
|
| Rate for Payer: BCN Medicare Advantage |
$47.70
|
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$171.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.11
|
| Rate for Payer: Mclaren Medicaid |
$33.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.09
|
| Rate for Payer: Meridian Medicaid |
$35.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.19
|
| Rate for Payer: Nomi Health Commercial |
$156.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.11
|
| Rate for Payer: PACE Senior Care Partners |
$45.32
|
| Rate for Payer: PACE SWMI |
$47.70
|
| Rate for Payer: PHP Commercial |
$162.19
|
| Rate for Payer: PHP Medicare Advantage |
$47.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$166.00
|
| Rate for Payer: Priority Health Medicare |
$48.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.80
|
| Rate for Payer: Railroad Medicare Medicare |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.91
|
| Rate for Payer: UHC Core |
$159.33
|
| Rate for Payer: UHC Exchange |
$47.70
|
| Rate for Payer: UHC Medicaid |
$33.64
|
| Rate for Payer: UHC Medicare Advantage |
$47.70
|
| Rate for Payer: UHCCP Medicaid |
$33.64
|
| Rate for Payer: VA VA |
$47.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.11
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
IP
|
$364.53
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$253.71 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: BCBS Trust/PPO |
$301.07
|
| Rate for Payer: BCN Commercial |
$301.07
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
OP
|
$364.53
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$94.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.92
|
| Rate for Payer: BCBS Complete |
$67.47
|
| Rate for Payer: BCBS MAPPO |
$91.13
|
| Rate for Payer: BCBS Trust/PPO |
$299.68
|
| Rate for Payer: BCN Commercial |
$299.68
|
| Rate for Payer: BCN Medicare Advantage |
$91.13
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.13
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.69
|
| Rate for Payer: Meridian Medicaid |
$67.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Senior Care Partners |
$86.58
|
| Rate for Payer: PACE SWMI |
$91.13
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$91.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Medicare |
$92.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.71
|
| Rate for Payer: Railroad Medicare Medicare |
$91.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: UHC Exchange |
$91.13
|
| Rate for Payer: UHC Medicaid |
$64.27
|
| Rate for Payer: UHC Medicare Advantage |
$91.13
|
| Rate for Payer: UHCCP Medicaid |
$64.27
|
| Rate for Payer: VA VA |
$91.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
OP
|
$15.67
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$4.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.90
|
| Rate for Payer: BCBS Complete |
$2.90
|
| Rate for Payer: BCBS MAPPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.88
|
| Rate for Payer: BCN Commercial |
$12.88
|
| Rate for Payer: BCN Medicare Advantage |
$3.92
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$14.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.75
|
| Rate for Payer: Mclaren Medicaid |
$2.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.11
|
| Rate for Payer: Meridian Medicaid |
$2.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.32
|
| Rate for Payer: Nomi Health Commercial |
$12.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.75
|
| Rate for Payer: PACE Senior Care Partners |
$3.72
|
| Rate for Payer: PACE SWMI |
$3.92
|
| Rate for Payer: PHP Commercial |
$13.32
|
| Rate for Payer: PHP Medicare Advantage |
$3.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.63
|
| Rate for Payer: Priority Health Medicare |
$3.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.79
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: UHC Exchange |
$3.92
|
| Rate for Payer: UHC Medicaid |
$2.76
|
| Rate for Payer: UHC Medicare Advantage |
$3.92
|
| Rate for Payer: UHCCP Medicaid |
$2.76
|
| Rate for Payer: VA VA |
$3.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.75
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
IP
|
$15.67
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCN Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.54
|
| Rate for Payer: Healthscope Commercial |
$14.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.32
|
| Rate for Payer: Nomi Health Commercial |
$12.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.75
|
| Rate for Payer: PHP Commercial |
$13.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.79
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.75
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna Medicare |
$28.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.27
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: BCBS MAPPO |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$90.15
|
| Rate for Payer: BCN Commercial |
$90.15
|
| Rate for Payer: BCN Medicare Advantage |
$27.41
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.41
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.25
|
| Rate for Payer: Mclaren Medicaid |
$19.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.79
|
| Rate for Payer: Meridian Medicaid |
$20.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Senior Care Partners |
$26.04
|
| Rate for Payer: PACE SWMI |
$27.41
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: PHP Medicare Advantage |
$27.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.40
|
| Rate for Payer: Priority Health Medicare |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.32
|
| Rate for Payer: Railroad Medicare Medicare |
$27.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.50
|
| Rate for Payer: UHC Core |
$91.57
|
| Rate for Payer: UHC Exchange |
$27.41
|
| Rate for Payer: UHC Medicaid |
$19.33
|
| Rate for Payer: UHC Medicare Advantage |
$27.41
|
| Rate for Payer: UHCCP Medicaid |
$19.33
|
| Rate for Payer: VA VA |
$27.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.25
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.57
|
| Rate for Payer: BCN Commercial |
$90.57
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.50
|
| Rate for Payer: UHC Core |
$91.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.25
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna Medicare |
$28.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.83
|
| Rate for Payer: BCBS Complete |
$20.04
|
| Rate for Payer: BCBS MAPPO |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$88.98
|
| Rate for Payer: BCN Commercial |
$88.98
|
| Rate for Payer: BCN Medicare Advantage |
$27.06
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.18
|
| Rate for Payer: Mclaren Medicaid |
$19.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.41
|
| Rate for Payer: Meridian Medicaid |
$20.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$88.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PACE Senior Care Partners |
$25.71
|
| Rate for Payer: PACE SWMI |
$27.06
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: PHP Medicare Advantage |
$27.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.17
|
| Rate for Payer: Priority Health Medicare |
$27.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.34
|
| Rate for Payer: Railroad Medicare Medicare |
$27.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.25
|
| Rate for Payer: UHC Core |
$90.38
|
| Rate for Payer: UHC Exchange |
$27.06
|
| Rate for Payer: UHC Medicaid |
$19.08
|
| Rate for Payer: UHC Medicare Advantage |
$27.06
|
| Rate for Payer: UHCCP Medicaid |
$19.08
|
| Rate for Payer: VA VA |
$27.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.18
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.40
|
| Rate for Payer: BCN Commercial |
$89.40
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$88.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.25
|
| Rate for Payer: UHC Core |
$90.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.18
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
IP
|
$1,430.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$995.28 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Aetna Commercial |
$1,215.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,181.04
|
| Rate for Payer: BCN Commercial |
$1,181.04
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$1,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,144.00
|
| Rate for Payer: Healthscope Commercial |
$1,287.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.50
|
| Rate for Payer: Nomi Health Commercial |
$1,172.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PHP Commercial |
$1,215.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,244.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$995.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.40
|
| Rate for Payer: UHC Core |
$1,194.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.50
|
|
|
HC IP 1:1 HEMODIALYSIS
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
80100002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$252.11 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Aetna Commercial |
$1,215.50
|
| Rate for Payer: Aetna Medicare |
$371.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.88
|
| Rate for Payer: BCBS Complete |
$264.69
|
| Rate for Payer: BCBS MAPPO |
$357.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.60
|
| Rate for Payer: BCN Commercial |
$1,175.60
|
| Rate for Payer: BCN Medicare Advantage |
$357.50
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$1,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.50
|
| Rate for Payer: Healthscope Commercial |
$1,287.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.50
|
| Rate for Payer: Mclaren Medicaid |
$252.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.38
|
| Rate for Payer: Meridian Medicaid |
$264.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$411.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$393.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.50
|
| Rate for Payer: Nomi Health Commercial |
$1,172.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE Senior Care Partners |
$339.62
|
| Rate for Payer: PACE SWMI |
$357.50
|
| Rate for Payer: PHP Commercial |
$1,215.50
|
| Rate for Payer: PHP Medicare Advantage |
$357.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,244.10
|
| Rate for Payer: Priority Health Medicare |
$361.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$995.28
|
| Rate for Payer: Railroad Medicare Medicare |
$357.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.40
|
| Rate for Payer: UHC Core |
$1,194.05
|
| Rate for Payer: UHC Exchange |
$357.50
|
| Rate for Payer: UHC Medicaid |
$252.11
|
| Rate for Payer: UHC Medicare Advantage |
$357.50
|
| Rate for Payer: UHCCP Medicaid |
$252.11
|
| Rate for Payer: VA VA |
$357.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.50
|
|
