|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,187.11
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.02 |
| Max. Negotiated Rate |
$1,068.40 |
| Rate for Payer: Aetna Commercial |
$1,009.04
|
| Rate for Payer: BCBS Trust/PPO |
$917.40
|
| Rate for Payer: BCN Commercial |
$917.40
|
| Rate for Payer: Cash Price |
$949.69
|
| Rate for Payer: Cofinity Commercial |
$1,020.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,068.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.04
|
| Rate for Payer: PHP Commercial |
$1,009.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.66
|
| Rate for Payer: UHC Core |
$991.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.33
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$911.88 |
| Max. Negotiated Rate |
$1,345.62 |
| Rate for Payer: Aetna Commercial |
$1,270.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.44
|
| Rate for Payer: BCN Commercial |
$1,155.44
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,285.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.10
|
| Rate for Payer: Healthscope Commercial |
$1,345.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,121.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: PHP Commercial |
$1,270.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,300.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$911.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,315.71
|
| Rate for Payer: UHC Core |
$1,248.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,121.35
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,495.13
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$355.09 |
| Max. Negotiated Rate |
$1,345.62 |
| Rate for Payer: Aetna Commercial |
$1,270.86
|
| Rate for Payer: Aetna Medicare |
$388.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$467.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$467.23
|
| Rate for Payer: BCBS Complete |
$598.05
|
| Rate for Payer: BCBS MAPPO |
$373.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.46
|
| Rate for Payer: BCN Commercial |
$1,162.46
|
| Rate for Payer: BCN Medicare Advantage |
$373.78
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cofinity Commercial |
$1,285.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,196.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.78
|
| Rate for Payer: Healthscope Commercial |
$1,345.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,121.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$392.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,270.86
|
| Rate for Payer: PACE Senior Care Partners |
$355.09
|
| Rate for Payer: PACE SWMI |
$373.78
|
| Rate for Payer: PHP Commercial |
$1,270.86
|
| Rate for Payer: PHP Medicare Advantage |
$373.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,046.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,300.76
|
| Rate for Payer: Priority Health Medicare |
$373.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$911.88
|
| Rate for Payer: Railroad Medicare Medicare |
$373.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,315.71
|
| Rate for Payer: UHC Core |
$1,248.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.78
|
| Rate for Payer: UHC Medicare Advantage |
$385.00
|
| Rate for Payer: VA VA |
$373.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,121.35
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna Medicare |
$5.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.34
|
| Rate for Payer: BCBS Complete |
$8.11
|
| Rate for Payer: BCBS MAPPO |
$5.07
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: BCN Medicare Advantage |
$5.07
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PACE Senior Care Partners |
$4.82
|
| Rate for Payer: PACE SWMI |
$5.07
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: PHP Medicare Advantage |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.64
|
| Rate for Payer: Priority Health Medicare |
$5.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.85
|
| Rate for Payer: UHC Core |
$16.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.07
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: VA VA |
$5.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.21
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$20.28
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: BCBS Trust/PPO |
$15.67
|
| Rate for Payer: BCN Commercial |
$15.67
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.22
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.85
|
| Rate for Payer: UHC Core |
$16.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.21
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$911.95 |
| Rate for Payer: Aetna Commercial |
$861.29
|
| Rate for Payer: BCBS Trust/PPO |
$783.06
|
| Rate for Payer: BCN Commercial |
$783.06
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$871.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.62
|
| Rate for Payer: Healthscope Commercial |
$911.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$759.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: PHP Commercial |
$861.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$618.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$891.69
|
| Rate for Payer: UHC Core |
$846.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$759.96
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,013.28
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$911.95 |
| Rate for Payer: Aetna Commercial |
$861.29
|
| Rate for Payer: Aetna Medicare |
$263.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$316.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$316.65
|
| Rate for Payer: BCBS Complete |
$146.91
|
| Rate for Payer: BCBS MAPPO |
$253.32
|
| Rate for Payer: BCBS Trust/PPO |
$787.83
|
| Rate for Payer: BCN Commercial |
$787.83
|
| Rate for Payer: BCN Medicare Advantage |
$253.32
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cash Price |
$810.62
|
| Rate for Payer: Cofinity Commercial |
$871.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$810.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.32
|
| Rate for Payer: Healthscope Commercial |
$911.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$759.96
|
| Rate for Payer: Mclaren Medicaid |
$139.92
|
| Rate for Payer: Meridian Medicaid |
$146.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$265.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$861.29
|
| Rate for Payer: PACE Senior Care Partners |
$240.65
|
| Rate for Payer: PACE SWMI |
$253.32
|
| Rate for Payer: PHP Commercial |
$861.29
|
| Rate for Payer: PHP Medicare Advantage |
$253.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.55
|
| Rate for Payer: Priority Health Medicare |
$253.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$618.00
|
| Rate for Payer: Railroad Medicare Medicare |
$253.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$891.69
|
| Rate for Payer: UHC Core |
$846.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.32
|
| Rate for Payer: UHC Medicare Advantage |
$260.92
|
| Rate for Payer: VA VA |
$253.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$759.96
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.69
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$43.75
|
| Rate for Payer: BCBS Trust/PPO |
$136.06
|
| Rate for Payer: BCN Commercial |
$136.06
|
| Rate for Payer: BCN Medicare Advantage |
$43.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.75
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PACE Senior Care Partners |
$41.56
|
| Rate for Payer: PACE SWMI |
$43.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: PHP Medicare Advantage |
$43.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.25
|
| Rate for Payer: Priority Health Medicare |
$43.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.73
|
| Rate for Payer: Railroad Medicare Medicare |
$43.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC Core |
$146.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.75
|
| Rate for Payer: UHC Medicare Advantage |
$45.06
|
| Rate for Payer: VA VA |
$43.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: BCBS Trust/PPO |
$135.24
|
| Rate for Payer: BCN Commercial |
$135.24
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.00
|
| Rate for Payer: UHC Core |
$146.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
IP
|
$53.51
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: BCBS Trust/PPO |
$41.35
|
| Rate for Payer: BCN Commercial |
$41.35
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
OP
|
$53.51
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Medicare |
$13.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.72
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS MAPPO |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$41.60
|
| Rate for Payer: BCN Commercial |
$41.60
|
| Rate for Payer: BCN Medicare Advantage |
$13.38
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: PACE Senior Care Partners |
$12.71
|
| Rate for Payer: PACE SWMI |
$13.38
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.55
|
| Rate for Payer: Priority Health Medicare |
$13.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.64
|
| Rate for Payer: Railroad Medicare Medicare |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.38
|
| Rate for Payer: UHC Medicare Advantage |
$13.78
|
| Rate for Payer: VA VA |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
IP
|
$5,063.57
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,088.27 |
| Max. Negotiated Rate |
$4,557.21 |
| Rate for Payer: Aetna Commercial |
$4,304.03
|
| Rate for Payer: BCBS Trust/PPO |
$3,913.13
|
| Rate for Payer: BCN Commercial |
$3,913.13
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cofinity Commercial |
$4,354.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,050.86
|
| Rate for Payer: Healthscope Commercial |
$4,557.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,797.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,304.03
|
| Rate for Payer: PHP Commercial |
$4,304.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,544.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,405.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,088.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,455.94
|
| Rate for Payer: UHC Core |
$4,228.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,797.68
|
|
|
HC PERC CHOLECYSTOSTOMY
|
Facility
|
OP
|
$5,063.57
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
36100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,202.60 |
| Max. Negotiated Rate |
$4,557.21 |
| Rate for Payer: Aetna Commercial |
$4,304.03
|
| Rate for Payer: Aetna Medicare |
$1,316.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,582.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,582.37
|
| Rate for Payer: BCBS Complete |
$2,382.99
|
| Rate for Payer: BCBS MAPPO |
$1,265.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,936.93
|
| Rate for Payer: BCN Commercial |
$3,936.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,265.89
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cash Price |
$4,050.86
|
| Rate for Payer: Cofinity Commercial |
$4,354.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,050.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,265.89
|
| Rate for Payer: Healthscope Commercial |
$4,557.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,797.68
|
| Rate for Payer: Mclaren Medicaid |
$2,269.51
|
| Rate for Payer: Meridian Medicaid |
$2,382.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,329.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,455.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,304.03
|
| Rate for Payer: PACE Senior Care Partners |
$1,202.60
|
| Rate for Payer: PACE SWMI |
$1,265.89
|
| Rate for Payer: PHP Commercial |
$4,304.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,265.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,269.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,544.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,405.31
|
| Rate for Payer: Priority Health Medicare |
$1,265.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,088.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,265.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,455.94
|
| Rate for Payer: UHC Core |
$4,228.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,265.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,303.87
|
| Rate for Payer: VA VA |
$1,265.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,797.68
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC PERCH OCEAN IGE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200481
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$55.18
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
OP
|
$13,824.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,283.34 |
| Max. Negotiated Rate |
$12,442.11 |
| Rate for Payer: Aetna Commercial |
$11,750.88
|
| Rate for Payer: Aetna Medicare |
$3,594.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,320.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,320.18
|
| Rate for Payer: BCBS Complete |
$4,710.75
|
| Rate for Payer: BCBS MAPPO |
$3,456.14
|
| Rate for Payer: BCBS Trust/PPO |
$10,748.60
|
| Rate for Payer: BCN Commercial |
$10,748.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,456.14
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cofinity Commercial |
$11,889.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,059.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,456.14
|
| Rate for Payer: Healthscope Commercial |
$12,442.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,368.43
|
| Rate for Payer: Mclaren Medicaid |
$4,486.43
|
| Rate for Payer: Meridian Medicaid |
$4,710.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,628.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,974.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,750.88
|
| Rate for Payer: PACE Senior Care Partners |
$3,283.34
|
| Rate for Payer: PACE SWMI |
$3,456.14
|
| Rate for Payer: PHP Commercial |
$11,750.88
|
| Rate for Payer: PHP Medicare Advantage |
$3,456.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,486.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,677.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,027.38
|
| Rate for Payer: Priority Health Medicare |
$3,456.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,431.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3,456.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,165.62
|
| Rate for Payer: UHC Core |
$11,543.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,456.14
|
| Rate for Payer: UHC Medicare Advantage |
$3,559.83
|
| Rate for Payer: VA VA |
$3,456.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,368.43
|
|
|
HC PERC IMPLANT OF NEUROSTIM EPIDURAL
|
Facility
|
IP
|
$13,824.57
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
36100610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,431.61 |
| Max. Negotiated Rate |
$12,442.11 |
| Rate for Payer: Aetna Commercial |
$11,750.88
|
| Rate for Payer: BCBS Trust/PPO |
$10,683.63
|
| Rate for Payer: BCN Commercial |
$10,683.63
|
| Rate for Payer: Cash Price |
$11,059.66
|
| Rate for Payer: Cofinity Commercial |
$11,889.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,059.66
|
| Rate for Payer: Healthscope Commercial |
$12,442.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,368.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,750.88
|
| Rate for Payer: PHP Commercial |
$11,750.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,677.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,027.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,431.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,165.62
|
| Rate for Payer: UHC Core |
$11,543.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,368.43
|
|
|
HC PERCLOSE
|
Facility
|
IP
|
$1,031.60
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.17 |
| Max. Negotiated Rate |
$928.44 |
| Rate for Payer: Aetna Commercial |
$876.86
|
| Rate for Payer: BCBS Trust/PPO |
$797.22
|
| Rate for Payer: BCN Commercial |
$797.22
|
| Rate for Payer: Cash Price |
$825.28
|
| Rate for Payer: Cofinity Commercial |
$887.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.28
|
| Rate for Payer: Healthscope Commercial |
$928.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.86
|
| Rate for Payer: PHP Commercial |
$876.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.81
|
| Rate for Payer: UHC Core |
$861.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.70
|
|
|
HC PERCLOSE
|
Facility
|
OP
|
$1,031.60
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$928.44 |
| Rate for Payer: Aetna Commercial |
$876.86
|
| Rate for Payer: Aetna Medicare |
$268.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.38
|
| Rate for Payer: BCBS Complete |
$412.64
|
| Rate for Payer: BCBS MAPPO |
$257.90
|
| Rate for Payer: BCBS Trust/PPO |
$802.07
|
| Rate for Payer: BCN Commercial |
$802.07
|
| Rate for Payer: BCN Medicare Advantage |
$257.90
|
| Rate for Payer: Cash Price |
$825.28
|
| Rate for Payer: Cofinity Commercial |
$887.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.90
|
| Rate for Payer: Healthscope Commercial |
$928.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.86
|
| Rate for Payer: PACE Senior Care Partners |
$245.00
|
| Rate for Payer: PACE SWMI |
$257.90
|
| Rate for Payer: PHP Commercial |
$876.86
|
| Rate for Payer: PHP Medicare Advantage |
$257.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.49
|
| Rate for Payer: Priority Health Medicare |
$257.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.17
|
| Rate for Payer: Railroad Medicare Medicare |
$257.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.81
|
| Rate for Payer: UHC Core |
$861.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.90
|
| Rate for Payer: UHC Medicare Advantage |
$265.64
|
| Rate for Payer: VA VA |
$257.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.70
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$6,381.71
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,515.66 |
| Max. Negotiated Rate |
$5,743.54 |
| Rate for Payer: Aetna Commercial |
$5,424.45
|
| Rate for Payer: Aetna Medicare |
$1,659.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,994.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,994.28
|
| Rate for Payer: BCBS Complete |
$3,936.90
|
| Rate for Payer: BCBS MAPPO |
$1,595.43
|
| Rate for Payer: BCBS Trust/PPO |
$4,961.78
|
| Rate for Payer: BCN Commercial |
$4,961.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,595.43
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cofinity Commercial |
$5,488.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,105.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,595.43
|
| Rate for Payer: Healthscope Commercial |
$5,743.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,786.28
|
| Rate for Payer: Mclaren Medicaid |
$3,749.43
|
| Rate for Payer: Meridian Medicaid |
$3,936.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,675.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,834.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,424.45
|
| Rate for Payer: PACE Senior Care Partners |
$1,515.66
|
| Rate for Payer: PACE SWMI |
$1,595.43
|
| Rate for Payer: PHP Commercial |
$5,424.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,595.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,749.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,467.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,552.09
|
| Rate for Payer: Priority Health Medicare |
$1,595.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,892.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,595.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,615.90
|
| Rate for Payer: UHC Core |
$5,328.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,595.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,643.29
|
| Rate for Payer: VA VA |
$1,595.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,786.28
|
|
|
HC PERC THROMBECTOMY OR INFUSION DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$6,381.71
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
36100528
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,892.20 |
| Max. Negotiated Rate |
$5,743.54 |
| Rate for Payer: Aetna Commercial |
$5,424.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,931.79
|
| Rate for Payer: BCN Commercial |
$4,931.79
|
| Rate for Payer: Cash Price |
$5,105.37
|
| Rate for Payer: Cofinity Commercial |
$5,488.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,105.37
|
| Rate for Payer: Healthscope Commercial |
$5,743.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,786.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,424.45
|
| Rate for Payer: PHP Commercial |
$5,424.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,467.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,552.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,892.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,615.90
|
| Rate for Payer: UHC Core |
$5,328.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,786.28
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
IP
|
$17,345.63
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,579.10 |
| Max. Negotiated Rate |
$15,611.07 |
| Rate for Payer: Aetna Commercial |
$14,743.79
|
| Rate for Payer: BCBS Trust/PPO |
$13,404.70
|
| Rate for Payer: BCN Commercial |
$13,404.70
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cofinity Commercial |
$14,917.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,876.50
|
| Rate for Payer: Healthscope Commercial |
$15,611.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,009.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,743.79
|
| Rate for Payer: PHP Commercial |
$14,743.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,090.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,579.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,264.15
|
| Rate for Payer: UHC Core |
$14,483.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,009.22
|
|
|
HC PERC THROMBECT OR INF W ANGIOPLASTY PERIPH DIALYSIS W IMAGING
|
Facility
|
OP
|
$17,345.63
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
36100529
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,119.59 |
| Max. Negotiated Rate |
$15,611.07 |
| Rate for Payer: Aetna Commercial |
$14,743.79
|
| Rate for Payer: Aetna Medicare |
$4,509.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,420.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,420.51
|
| Rate for Payer: BCBS Complete |
$7,577.51
|
| Rate for Payer: BCBS MAPPO |
$4,336.41
|
| Rate for Payer: BCBS Trust/PPO |
$13,486.23
|
| Rate for Payer: BCN Commercial |
$13,486.23
|
| Rate for Payer: BCN Medicare Advantage |
$4,336.41
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cash Price |
$13,876.50
|
| Rate for Payer: Cofinity Commercial |
$14,917.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,876.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,336.41
|
| Rate for Payer: Healthscope Commercial |
$15,611.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,009.22
|
| Rate for Payer: Mclaren Medicaid |
$7,216.67
|
| Rate for Payer: Meridian Medicaid |
$7,577.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,553.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,986.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,743.79
|
| Rate for Payer: PACE Senior Care Partners |
$4,119.59
|
| Rate for Payer: PACE SWMI |
$4,336.41
|
| Rate for Payer: PHP Commercial |
$14,743.79
|
| Rate for Payer: PHP Medicare Advantage |
$4,336.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,216.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,090.70
|
| Rate for Payer: Priority Health Medicare |
$4,336.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,579.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4,336.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,264.15
|
| Rate for Payer: UHC Core |
$14,483.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,336.41
|
| Rate for Payer: UHC Medicare Advantage |
$4,466.50
|
| Rate for Payer: VA VA |
$4,336.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,009.22
|
|
