|
HC IR GUIDEWIRE
|
Facility
|
OP
|
$45.63
|
|
| Hospital Charge Code |
27200306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna Medicare |
$11.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.26
|
| Rate for Payer: BCBS Complete |
$8.45
|
| Rate for Payer: BCBS MAPPO |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.51
|
| Rate for Payer: BCN Commercial |
$37.51
|
| Rate for Payer: BCN Medicare Advantage |
$11.41
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.41
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.22
|
| Rate for Payer: Mclaren Medicaid |
$8.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$8.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PACE Senior Care Partners |
$10.84
|
| Rate for Payer: PACE SWMI |
$11.41
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: PHP Medicare Advantage |
$11.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.70
|
| Rate for Payer: Priority Health Medicare |
$11.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.76
|
| Rate for Payer: Railroad Medicare Medicare |
$11.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.15
|
| Rate for Payer: UHC Core |
$38.10
|
| Rate for Payer: UHC Exchange |
$11.41
|
| Rate for Payer: UHC Medicaid |
$8.04
|
| Rate for Payer: UHC Medicare Advantage |
$11.41
|
| Rate for Payer: UHCCP Medicaid |
$8.04
|
| Rate for Payer: VA VA |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.22
|
|
|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
OP
|
$495.72
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: Aetna Medicare |
$128.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.91
|
| Rate for Payer: BCBS Complete |
$91.76
|
| Rate for Payer: BCBS MAPPO |
$123.93
|
| Rate for Payer: BCBS Trust/PPO |
$407.53
|
| Rate for Payer: BCN Commercial |
$407.53
|
| Rate for Payer: BCN Medicare Advantage |
$123.93
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.93
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.79
|
| Rate for Payer: Mclaren Medicaid |
$87.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.13
|
| Rate for Payer: Meridian Medicaid |
$91.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PACE Senior Care Partners |
$117.73
|
| Rate for Payer: PACE SWMI |
$123.93
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: PHP Medicare Advantage |
$123.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.28
|
| Rate for Payer: Priority Health Medicare |
$125.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.02
|
| Rate for Payer: Railroad Medicare Medicare |
$123.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.23
|
| Rate for Payer: UHC Core |
$413.93
|
| Rate for Payer: UHC Exchange |
$123.93
|
| Rate for Payer: UHC Medicaid |
$87.40
|
| Rate for Payer: UHC Medicare Advantage |
$123.93
|
| Rate for Payer: UHCCP Medicaid |
$87.40
|
| Rate for Payer: VA VA |
$123.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.79
|
|
|
HC IR GU NEPHROSTOGRAM BILAT
|
Facility
|
IP
|
$495.72
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.02 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: BCBS Trust/PPO |
$409.42
|
| Rate for Payer: BCN Commercial |
$409.42
|
| Rate for Payer: Cash Price |
$396.58
|
| Rate for Payer: Cofinity Commercial |
$426.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.58
|
| Rate for Payer: Healthscope Commercial |
$446.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.36
|
| Rate for Payer: Nomi Health Commercial |
$406.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.79
|
| Rate for Payer: PHP Commercial |
$421.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.23
|
| Rate for Payer: UHC Core |
$413.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.79
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
IP
|
$842.20
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$586.17 |
| Max. Negotiated Rate |
$757.98 |
| Rate for Payer: Aetna Commercial |
$715.87
|
| Rate for Payer: BCBS Trust/PPO |
$695.57
|
| Rate for Payer: BCN Commercial |
$695.57
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cofinity Commercial |
$724.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.76
|
| Rate for Payer: Healthscope Commercial |
$757.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.87
|
| Rate for Payer: Nomi Health Commercial |
$690.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.65
|
| Rate for Payer: PHP Commercial |
$715.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$732.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.14
|
| Rate for Payer: UHC Core |
$703.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.65
|
|
|
HC IR GU RENAL CYST STUDY
|
Facility
|
OP
|
$842.20
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
32000167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.48 |
| Max. Negotiated Rate |
$757.98 |
| Rate for Payer: Aetna Commercial |
$715.87
|
| Rate for Payer: Aetna Medicare |
$218.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.19
|
| Rate for Payer: BCBS Complete |
$155.89
|
| Rate for Payer: BCBS MAPPO |
$210.55
|
| Rate for Payer: BCBS Trust/PPO |
$692.37
|
| Rate for Payer: BCN Commercial |
$692.37
|
| Rate for Payer: BCN Medicare Advantage |
$210.55
|
| Rate for Payer: Cash Price |
$673.76
|
| Rate for Payer: Cofinity Commercial |
$724.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.55
|
| Rate for Payer: Healthscope Commercial |
$757.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.65
|
| Rate for Payer: Mclaren Medicaid |
$148.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.08
|
| Rate for Payer: Meridian Medicaid |
$155.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$231.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.87
|
| Rate for Payer: Nomi Health Commercial |
$690.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.65
|
| Rate for Payer: PACE Senior Care Partners |
$200.02
|
| Rate for Payer: PACE SWMI |
$210.55
|
| Rate for Payer: PHP Commercial |
$715.87
|
| Rate for Payer: PHP Medicare Advantage |
$210.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$732.71
|
| Rate for Payer: Priority Health Medicare |
$212.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.17
|
| Rate for Payer: Railroad Medicare Medicare |
$210.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.14
|
| Rate for Payer: UHC Core |
$703.24
|
| Rate for Payer: UHC Exchange |
$210.55
|
| Rate for Payer: UHC Medicaid |
$148.48
|
| Rate for Payer: UHC Medicare Advantage |
$210.55
|
| Rate for Payer: UHCCP Medicaid |
$148.48
|
| Rate for Payer: VA VA |
$210.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.65
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
IP
|
$1,997.16
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,390.02 |
| Max. Negotiated Rate |
$1,797.44 |
| Rate for Payer: Aetna Commercial |
$1,697.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,649.45
|
| Rate for Payer: BCN Commercial |
$1,649.45
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cofinity Commercial |
$1,717.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.73
|
| Rate for Payer: Healthscope Commercial |
$1,797.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,497.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.59
|
| Rate for Payer: Nomi Health Commercial |
$1,637.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.87
|
| Rate for Payer: PHP Commercial |
$1,697.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,737.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,390.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,757.50
|
| Rate for Payer: UHC Core |
$1,667.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,497.87
|
|
|
HC IR GU URETERAL DILATATION
|
Facility
|
OP
|
$1,997.16
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
32000173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.10 |
| Max. Negotiated Rate |
$1,797.44 |
| Rate for Payer: Aetna Commercial |
$1,697.59
|
| Rate for Payer: Aetna Medicare |
$519.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$624.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$624.11
|
| Rate for Payer: BCBS Complete |
$369.67
|
| Rate for Payer: BCBS MAPPO |
$499.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.87
|
| Rate for Payer: BCN Commercial |
$1,641.87
|
| Rate for Payer: BCN Medicare Advantage |
$499.29
|
| Rate for Payer: Cash Price |
$1,597.73
|
| Rate for Payer: Cofinity Commercial |
$1,717.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,597.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.29
|
| Rate for Payer: Healthscope Commercial |
$1,797.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,497.87
|
| Rate for Payer: Mclaren Medicaid |
$352.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$524.25
|
| Rate for Payer: Meridian Medicaid |
$369.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$574.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$549.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.59
|
| Rate for Payer: Nomi Health Commercial |
$1,637.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.87
|
| Rate for Payer: PACE Senior Care Partners |
$474.33
|
| Rate for Payer: PACE SWMI |
$499.29
|
| Rate for Payer: PHP Commercial |
$1,697.59
|
| Rate for Payer: PHP Medicare Advantage |
$499.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,737.53
|
| Rate for Payer: Priority Health Medicare |
$504.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,390.02
|
| Rate for Payer: Railroad Medicare Medicare |
$499.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,757.50
|
| Rate for Payer: UHC Core |
$1,667.63
|
| Rate for Payer: UHC Exchange |
$499.29
|
| Rate for Payer: UHC Medicaid |
$352.10
|
| Rate for Payer: UHC Medicare Advantage |
$499.29
|
| Rate for Payer: UHCCP Medicaid |
$352.10
|
| Rate for Payer: VA VA |
$499.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,497.87
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
OP
|
$4,389.97
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$773.95 |
| Max. Negotiated Rate |
$3,950.97 |
| Rate for Payer: Aetna Commercial |
$3,731.47
|
| Rate for Payer: Aetna Medicare |
$1,141.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,371.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,371.87
|
| Rate for Payer: BCBS Complete |
$812.58
|
| Rate for Payer: BCBS MAPPO |
$1,097.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,608.99
|
| Rate for Payer: BCN Commercial |
$3,608.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,097.49
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cofinity Commercial |
$3,775.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,511.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,097.49
|
| Rate for Payer: Healthscope Commercial |
$3,950.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,292.48
|
| Rate for Payer: Mclaren Medicaid |
$773.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,152.37
|
| Rate for Payer: Meridian Medicaid |
$812.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,262.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,207.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,731.47
|
| Rate for Payer: Nomi Health Commercial |
$3,599.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,292.48
|
| Rate for Payer: PACE Senior Care Partners |
$1,042.62
|
| Rate for Payer: PACE SWMI |
$1,097.49
|
| Rate for Payer: PHP Commercial |
$3,731.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,097.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,819.27
|
| Rate for Payer: Priority Health Medicare |
$1,108.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,055.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,097.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,863.17
|
| Rate for Payer: UHC Core |
$3,665.62
|
| Rate for Payer: UHC Exchange |
$1,097.49
|
| Rate for Payer: UHC Medicaid |
$773.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,097.49
|
| Rate for Payer: UHCCP Medicaid |
$773.95
|
| Rate for Payer: VA VA |
$1,097.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,292.48
|
|
|
HC IR HEPATIC VENOGRAPHY
|
Facility
|
IP
|
$4,389.97
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
32000208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,055.42 |
| Max. Negotiated Rate |
$3,950.97 |
| Rate for Payer: Aetna Commercial |
$3,731.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,625.68
|
| Rate for Payer: BCN Commercial |
$3,625.68
|
| Rate for Payer: Cash Price |
$3,511.98
|
| Rate for Payer: Cofinity Commercial |
$3,775.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,511.98
|
| Rate for Payer: Healthscope Commercial |
$3,950.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,292.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,731.47
|
| Rate for Payer: Nomi Health Commercial |
$3,599.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,292.48
|
| Rate for Payer: PHP Commercial |
$3,731.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,819.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,055.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,863.17
|
| Rate for Payer: UHC Core |
$3,665.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,292.48
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
IP
|
$3,539.77
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,463.68 |
| Max. Negotiated Rate |
$3,185.79 |
| Rate for Payer: Aetna Commercial |
$3,008.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,923.50
|
| Rate for Payer: BCN Commercial |
$2,923.50
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cofinity Commercial |
$3,044.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,831.82
|
| Rate for Payer: Healthscope Commercial |
$3,185.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,654.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,008.80
|
| Rate for Payer: Nomi Health Commercial |
$2,902.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,654.83
|
| Rate for Payer: PHP Commercial |
$3,008.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,079.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,463.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,115.00
|
| Rate for Payer: UHC Core |
$2,955.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,654.83
|
|
|
HC IR INFERIOR VENACAVAGRAM
|
Facility
|
OP
|
$3,539.77
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
32000205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$3,185.79 |
| Rate for Payer: Aetna Commercial |
$3,008.80
|
| Rate for Payer: Aetna Medicare |
$920.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,106.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,106.18
|
| Rate for Payer: BCBS Complete |
$655.21
|
| Rate for Payer: BCBS MAPPO |
$884.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,910.04
|
| Rate for Payer: BCN Commercial |
$2,910.04
|
| Rate for Payer: BCN Medicare Advantage |
$884.94
|
| Rate for Payer: Cash Price |
$2,831.82
|
| Rate for Payer: Cofinity Commercial |
$3,044.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,831.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.94
|
| Rate for Payer: Healthscope Commercial |
$3,185.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,654.83
|
| Rate for Payer: Mclaren Medicaid |
$624.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$929.19
|
| Rate for Payer: Meridian Medicaid |
$655.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,017.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$973.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,008.80
|
| Rate for Payer: Nomi Health Commercial |
$2,902.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,654.83
|
| Rate for Payer: PACE Senior Care Partners |
$840.70
|
| Rate for Payer: PACE SWMI |
$884.94
|
| Rate for Payer: PHP Commercial |
$3,008.80
|
| Rate for Payer: PHP Medicare Advantage |
$884.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,079.60
|
| Rate for Payer: Priority Health Medicare |
$893.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,463.68
|
| Rate for Payer: Railroad Medicare Medicare |
$884.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,115.00
|
| Rate for Payer: UHC Core |
$2,955.71
|
| Rate for Payer: UHC Exchange |
$884.94
|
| Rate for Payer: UHC Medicaid |
$624.06
|
| Rate for Payer: UHC Medicare Advantage |
$884.94
|
| Rate for Payer: UHCCP Medicaid |
$624.06
|
| Rate for Payer: VA VA |
$884.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,654.83
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
IP
|
$1,293.40
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$900.21 |
| Max. Negotiated Rate |
$1,164.06 |
| Rate for Payer: Aetna Commercial |
$1,099.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.22
|
| Rate for Payer: BCN Commercial |
$1,068.22
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cofinity Commercial |
$1,112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.72
|
| Rate for Payer: Healthscope Commercial |
$1,164.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$970.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.39
|
| Rate for Payer: Nomi Health Commercial |
$1,060.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$970.05
|
| Rate for Payer: PHP Commercial |
$1,099.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,125.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.19
|
| Rate for Payer: UHC Core |
$1,079.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$970.05
|
|
|
HC IR INJECTION FACET JOINT C OR T 1ST LEVEL
|
Facility
|
OP
|
$1,293.40
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.03 |
| Max. Negotiated Rate |
$1,164.06 |
| Rate for Payer: Aetna Commercial |
$1,099.39
|
| Rate for Payer: Aetna Medicare |
$336.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.19
|
| Rate for Payer: BCBS Complete |
$239.41
|
| Rate for Payer: BCBS MAPPO |
$323.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.30
|
| Rate for Payer: BCN Commercial |
$1,063.30
|
| Rate for Payer: BCN Medicare Advantage |
$323.35
|
| Rate for Payer: Cash Price |
$1,034.72
|
| Rate for Payer: Cofinity Commercial |
$1,112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.35
|
| Rate for Payer: Healthscope Commercial |
$1,164.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$970.05
|
| Rate for Payer: Mclaren Medicaid |
$228.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.52
|
| Rate for Payer: Meridian Medicaid |
$239.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$355.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.39
|
| Rate for Payer: Nomi Health Commercial |
$1,060.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$970.05
|
| Rate for Payer: PACE Senior Care Partners |
$307.18
|
| Rate for Payer: PACE SWMI |
$323.35
|
| Rate for Payer: PHP Commercial |
$1,099.39
|
| Rate for Payer: PHP Medicare Advantage |
$323.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,125.26
|
| Rate for Payer: Priority Health Medicare |
$326.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.21
|
| Rate for Payer: Railroad Medicare Medicare |
$323.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.19
|
| Rate for Payer: UHC Core |
$1,079.99
|
| Rate for Payer: UHC Exchange |
$323.35
|
| Rate for Payer: UHC Medicaid |
$228.03
|
| Rate for Payer: UHC Medicare Advantage |
$323.35
|
| Rate for Payer: UHCCP Medicaid |
$228.03
|
| Rate for Payer: VA VA |
$323.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$970.05
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
OP
|
$1,683.91
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$296.87 |
| Max. Negotiated Rate |
$1,515.52 |
| Rate for Payer: Aetna Commercial |
$1,431.32
|
| Rate for Payer: Aetna Medicare |
$437.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$526.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$526.22
|
| Rate for Payer: BCBS Complete |
$311.69
|
| Rate for Payer: BCBS MAPPO |
$420.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.34
|
| Rate for Payer: BCN Commercial |
$1,384.34
|
| Rate for Payer: BCN Medicare Advantage |
$420.98
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cofinity Commercial |
$1,448.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.98
|
| Rate for Payer: Healthscope Commercial |
$1,515.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,262.93
|
| Rate for Payer: Mclaren Medicaid |
$296.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.03
|
| Rate for Payer: Meridian Medicaid |
$311.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$484.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$463.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.32
|
| Rate for Payer: Nomi Health Commercial |
$1,380.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,262.93
|
| Rate for Payer: PACE Senior Care Partners |
$399.93
|
| Rate for Payer: PACE SWMI |
$420.98
|
| Rate for Payer: PHP Commercial |
$1,431.32
|
| Rate for Payer: PHP Medicare Advantage |
$420.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,465.00
|
| Rate for Payer: Priority Health Medicare |
$425.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,172.00
|
| Rate for Payer: Railroad Medicare Medicare |
$420.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,481.84
|
| Rate for Payer: UHC Core |
$1,406.06
|
| Rate for Payer: UHC Exchange |
$420.98
|
| Rate for Payer: UHC Medicaid |
$296.87
|
| Rate for Payer: UHC Medicare Advantage |
$420.98
|
| Rate for Payer: UHCCP Medicaid |
$296.87
|
| Rate for Payer: VA VA |
$420.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,262.93
|
|
|
HC IR INJECTION FACET JOINT L OR S 1ST LEVEL
|
Facility
|
IP
|
$1,683.91
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,172.00 |
| Max. Negotiated Rate |
$1,515.52 |
| Rate for Payer: Aetna Commercial |
$1,431.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,390.74
|
| Rate for Payer: BCN Commercial |
$1,390.74
|
| Rate for Payer: Cash Price |
$1,347.13
|
| Rate for Payer: Cofinity Commercial |
$1,448.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.13
|
| Rate for Payer: Healthscope Commercial |
$1,515.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,262.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.32
|
| Rate for Payer: Nomi Health Commercial |
$1,380.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,262.93
|
| Rate for Payer: PHP Commercial |
$1,431.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,465.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,172.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,481.84
|
| Rate for Payer: UHC Core |
$1,406.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,262.93
|
|
|
HC IR INSERTION CATH TUNNELED INTRAPERI W FLUORO
|
Facility
|
IP
|
$4,942.81
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
36100219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,440.20 |
| Max. Negotiated Rate |
$4,448.53 |
| Rate for Payer: Aetna Commercial |
$4,201.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,082.27
|
| Rate for Payer: BCN Commercial |
$4,082.27
|
| Rate for Payer: Cash Price |
$3,954.25
|
| Rate for Payer: Cofinity Commercial |
$4,250.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.25
|
| Rate for Payer: Healthscope Commercial |
$4,448.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,707.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.39
|
| Rate for Payer: Nomi Health Commercial |
$4,053.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.11
|
| Rate for Payer: PHP Commercial |
$4,201.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,300.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,440.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,349.67
|
| Rate for Payer: UHC Core |
$4,127.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,707.11
|
|
|
HC IR INSERTION CATH TUNNELED INTRAPERI W FLUORO
|
Facility
|
OP
|
$4,942.81
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
36100219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$871.42 |
| Max. Negotiated Rate |
$4,448.53 |
| Rate for Payer: Aetna Commercial |
$4,201.39
|
| Rate for Payer: Aetna Medicare |
$1,285.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,544.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,544.63
|
| Rate for Payer: BCBS Complete |
$914.91
|
| Rate for Payer: BCBS MAPPO |
$1,235.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,063.48
|
| Rate for Payer: BCN Commercial |
$4,063.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,235.70
|
| Rate for Payer: Cash Price |
$3,954.25
|
| Rate for Payer: Cofinity Commercial |
$4,250.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,235.70
|
| Rate for Payer: Healthscope Commercial |
$4,448.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,707.11
|
| Rate for Payer: Mclaren Medicaid |
$871.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,297.49
|
| Rate for Payer: Meridian Medicaid |
$914.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,421.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,359.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.39
|
| Rate for Payer: Nomi Health Commercial |
$4,053.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.11
|
| Rate for Payer: PACE Senior Care Partners |
$1,173.92
|
| Rate for Payer: PACE SWMI |
$1,235.70
|
| Rate for Payer: PHP Commercial |
$4,201.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,235.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$871.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,300.24
|
| Rate for Payer: Priority Health Medicare |
$1,248.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,440.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,235.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,349.67
|
| Rate for Payer: UHC Core |
$4,127.25
|
| Rate for Payer: UHC Exchange |
$1,235.70
|
| Rate for Payer: UHC Medicaid |
$871.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,235.70
|
| Rate for Payer: UHCCP Medicaid |
$871.42
|
| Rate for Payer: VA VA |
$1,235.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,707.11
|
|
|
HC IR INSERTION CHEST PORT ABOVE 5 YRS AGE
|
Facility
|
IP
|
$5,103.92
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36100125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,552.33 |
| Max. Negotiated Rate |
$4,593.53 |
| Rate for Payer: Aetna Commercial |
$4,338.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,215.33
|
| Rate for Payer: BCN Commercial |
$4,215.33
|
| Rate for Payer: Cash Price |
$4,083.14
|
| Rate for Payer: Cofinity Commercial |
$4,389.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,083.14
|
| Rate for Payer: Healthscope Commercial |
$4,593.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,827.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,338.33
|
| Rate for Payer: Nomi Health Commercial |
$4,185.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,827.94
|
| Rate for Payer: PHP Commercial |
$4,338.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,440.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,552.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,491.45
|
| Rate for Payer: UHC Core |
$4,261.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,827.94
|
|
|
HC IR INSERTION CHEST PORT ABOVE 5 YRS AGE
|
Facility
|
OP
|
$5,103.92
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
36100125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$899.82 |
| Max. Negotiated Rate |
$4,593.53 |
| Rate for Payer: Aetna Commercial |
$4,338.33
|
| Rate for Payer: Aetna Medicare |
$1,327.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,594.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,594.97
|
| Rate for Payer: BCBS Complete |
$944.74
|
| Rate for Payer: BCBS MAPPO |
$1,275.98
|
| Rate for Payer: BCBS Trust/PPO |
$4,195.93
|
| Rate for Payer: BCN Commercial |
$4,195.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,275.98
|
| Rate for Payer: Cash Price |
$4,083.14
|
| Rate for Payer: Cofinity Commercial |
$4,389.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,083.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,275.98
|
| Rate for Payer: Healthscope Commercial |
$4,593.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,827.94
|
| Rate for Payer: Mclaren Medicaid |
$899.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,339.78
|
| Rate for Payer: Meridian Medicaid |
$944.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,467.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,403.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,338.33
|
| Rate for Payer: Nomi Health Commercial |
$4,185.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,827.94
|
| Rate for Payer: PACE Senior Care Partners |
$1,212.18
|
| Rate for Payer: PACE SWMI |
$1,275.98
|
| Rate for Payer: PHP Commercial |
$4,338.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,275.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$899.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,440.41
|
| Rate for Payer: Priority Health Medicare |
$1,288.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,552.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,275.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,491.45
|
| Rate for Payer: UHC Core |
$4,261.77
|
| Rate for Payer: UHC Exchange |
$1,275.98
|
| Rate for Payer: UHC Medicaid |
$899.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,275.98
|
| Rate for Payer: UHCCP Medicaid |
$899.82
|
| Rate for Payer: VA VA |
$1,275.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,827.94
|
|
|
HC IR INSERTION CHEST PORT LESS THAN 5 YRS AGE
|
Facility
|
IP
|
$4,665.30
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
36100124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,247.05 |
| Max. Negotiated Rate |
$4,198.77 |
| Rate for Payer: Aetna Commercial |
$3,965.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,853.07
|
| Rate for Payer: BCN Commercial |
$3,853.07
|
| Rate for Payer: Cash Price |
$3,732.24
|
| Rate for Payer: Cofinity Commercial |
$4,012.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,732.24
|
| Rate for Payer: Healthscope Commercial |
$4,198.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,498.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,965.51
|
| Rate for Payer: Nomi Health Commercial |
$3,825.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,498.97
|
| Rate for Payer: PHP Commercial |
$3,965.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,058.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,247.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,105.46
|
| Rate for Payer: UHC Core |
$3,895.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,498.97
|
|
|
HC IR INSERTION CHEST PORT LESS THAN 5 YRS AGE
|
Facility
|
OP
|
$4,665.30
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
36100124
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$822.49 |
| Max. Negotiated Rate |
$4,198.77 |
| Rate for Payer: Aetna Commercial |
$3,965.51
|
| Rate for Payer: Aetna Medicare |
$1,212.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,457.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,457.91
|
| Rate for Payer: BCBS Complete |
$863.55
|
| Rate for Payer: BCBS MAPPO |
$1,166.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,835.34
|
| Rate for Payer: BCN Commercial |
$3,835.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,166.33
|
| Rate for Payer: Cash Price |
$3,732.24
|
| Rate for Payer: Cofinity Commercial |
$4,012.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,732.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,166.33
|
| Rate for Payer: Healthscope Commercial |
$4,198.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,498.97
|
| Rate for Payer: Mclaren Medicaid |
$822.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,224.64
|
| Rate for Payer: Meridian Medicaid |
$863.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,341.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,282.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,965.51
|
| Rate for Payer: Nomi Health Commercial |
$3,825.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,498.97
|
| Rate for Payer: PACE Senior Care Partners |
$1,108.01
|
| Rate for Payer: PACE SWMI |
$1,166.33
|
| Rate for Payer: PHP Commercial |
$3,965.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,166.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$822.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,058.81
|
| Rate for Payer: Priority Health Medicare |
$1,177.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,247.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,166.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,105.46
|
| Rate for Payer: UHC Core |
$3,895.53
|
| Rate for Payer: UHC Exchange |
$1,166.33
|
| Rate for Payer: UHC Medicaid |
$822.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,166.33
|
| Rate for Payer: UHCCP Medicaid |
$822.49
|
| Rate for Payer: VA VA |
$1,166.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,498.97
|
|
|
HC IR INSERT TUNNEL PERI CATH W PORT
|
Facility
|
IP
|
$4,963.24
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
36100366
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,454.42 |
| Max. Negotiated Rate |
$4,466.92 |
| Rate for Payer: Aetna Commercial |
$4,218.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,099.14
|
| Rate for Payer: BCN Commercial |
$4,099.14
|
| Rate for Payer: Cash Price |
$3,970.59
|
| Rate for Payer: Cofinity Commercial |
$4,268.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,970.59
|
| Rate for Payer: Healthscope Commercial |
$4,466.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,722.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,218.75
|
| Rate for Payer: Nomi Health Commercial |
$4,069.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,722.43
|
| Rate for Payer: PHP Commercial |
$4,218.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,318.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,454.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,367.65
|
| Rate for Payer: UHC Core |
$4,144.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,722.43
|
|
|
HC IR INSERT TUNNEL PERI CATH W PORT
|
Facility
|
OP
|
$4,963.24
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
36100366
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.02 |
| Max. Negotiated Rate |
$4,466.92 |
| Rate for Payer: Aetna Commercial |
$4,218.75
|
| Rate for Payer: Aetna Medicare |
$1,290.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,551.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,551.01
|
| Rate for Payer: BCBS Complete |
$918.70
|
| Rate for Payer: BCBS MAPPO |
$1,240.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,080.28
|
| Rate for Payer: BCN Commercial |
$4,080.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,240.81
|
| Rate for Payer: Cash Price |
$3,970.59
|
| Rate for Payer: Cofinity Commercial |
$4,268.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,970.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,240.81
|
| Rate for Payer: Healthscope Commercial |
$4,466.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,722.43
|
| Rate for Payer: Mclaren Medicaid |
$875.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,302.85
|
| Rate for Payer: Meridian Medicaid |
$918.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,426.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,364.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,218.75
|
| Rate for Payer: Nomi Health Commercial |
$4,069.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,722.43
|
| Rate for Payer: PACE Senior Care Partners |
$1,178.77
|
| Rate for Payer: PACE SWMI |
$1,240.81
|
| Rate for Payer: PHP Commercial |
$4,218.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,240.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$875.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,318.02
|
| Rate for Payer: Priority Health Medicare |
$1,253.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,454.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,240.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,367.65
|
| Rate for Payer: UHC Core |
$4,144.31
|
| Rate for Payer: UHC Exchange |
$1,240.81
|
| Rate for Payer: UHC Medicaid |
$875.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,240.81
|
| Rate for Payer: UHCCP Medicaid |
$875.02
|
| Rate for Payer: VA VA |
$1,240.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,722.43
|
|
|
HC IR INTERNAL MAMM ARTERIOGRAM
|
Facility
|
OP
|
$2,015.23
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
32000198
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$355.29 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna Medicare |
$523.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$629.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$629.76
|
| Rate for Payer: BCBS Complete |
$373.02
|
| Rate for Payer: BCBS MAPPO |
$503.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.72
|
| Rate for Payer: BCN Commercial |
$1,656.72
|
| Rate for Payer: BCN Medicare Advantage |
$503.81
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$503.81
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.42
|
| Rate for Payer: Mclaren Medicaid |
$355.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$529.00
|
| Rate for Payer: Meridian Medicaid |
$373.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$554.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,652.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PACE Senior Care Partners |
$478.62
|
| Rate for Payer: PACE SWMI |
$503.81
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: PHP Medicare Advantage |
$503.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,753.25
|
| Rate for Payer: Priority Health Medicare |
$508.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,402.60
|
| Rate for Payer: Railroad Medicare Medicare |
$503.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,773.40
|
| Rate for Payer: UHC Core |
$1,682.72
|
| Rate for Payer: UHC Exchange |
$503.81
|
| Rate for Payer: UHC Medicaid |
$355.29
|
| Rate for Payer: UHC Medicare Advantage |
$503.81
|
| Rate for Payer: UHCCP Medicaid |
$355.29
|
| Rate for Payer: VA VA |
$503.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.42
|
|
|
HC IR INTERNAL MAMM ARTERIOGRAM
|
Facility
|
IP
|
$2,015.23
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
32000198
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,402.60 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.38
|
| Rate for Payer: BCN Commercial |
$1,664.38
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,652.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,753.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,402.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,773.40
|
| Rate for Payer: UHC Core |
$1,682.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.42
|
|
