|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$117.57 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna Commercial |
$420.79
|
| Rate for Payer: Aetna Medicare |
$128.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.70
|
| Rate for Payer: BCBS Complete |
$402.83
|
| Rate for Payer: BCBS MAPPO |
$123.76
|
| Rate for Payer: BCBS Trust/PPO |
$406.98
|
| Rate for Payer: BCN Commercial |
$384.90
|
| Rate for Payer: BCN Medicare Advantage |
$123.76
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$425.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.76
|
| Rate for Payer: Healthscope Commercial |
$445.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.29
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.95
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: PACE Senior Care Partners |
$117.57
|
| Rate for Payer: PACE SWMI |
$123.76
|
| Rate for Payer: PHP Commercial |
$420.79
|
| Rate for Payer: PHP Medicare Advantage |
$123.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: Priority Health HMO/PPO |
$430.69
|
| Rate for Payer: Priority Health Medicare |
$125.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.68
|
| Rate for Payer: Railroad Medicare Medicare |
$123.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.64
|
| Rate for Payer: UHC Core |
$413.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.76
|
| Rate for Payer: UHC Exchange |
$123.76
|
| Rate for Payer: UHC Medicare Advantage |
$123.76
|
| Rate for Payer: UHCCP Medicaid |
$383.62
|
| Rate for Payer: VA VA |
$123.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.29
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$321.78 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna Commercial |
$420.79
|
| Rate for Payer: BCBS Trust/PPO |
$404.11
|
| Rate for Payer: BCN Commercial |
$382.57
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$425.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Healthscope Commercial |
$445.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: PHP Commercial |
$420.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: Priority Health HMO/PPO |
$430.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.64
|
| Rate for Payer: UHC Core |
$413.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.29
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.38
|
| Rate for Payer: BCN Commercial |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$11.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: Meridian Medicaid |
$11.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.36
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: UHCCP Medicaid |
$11.27
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$59.95
|
| Rate for Payer: BCN Commercial |
$56.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.61
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$41.06
|
| Rate for Payer: BCN Commercial |
$38.83
|
| Rate for Payer: BCN Medicare Advantage |
$12.48
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.48
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.45
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.11
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.86
|
| Rate for Payer: PACE SWMI |
$12.48
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$12.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Medicare |
$12.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: Railroad Medicare Medicare |
$12.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.48
|
| Rate for Payer: UHC Exchange |
$12.48
|
| Rate for Payer: UHC Medicare Advantage |
$12.48
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$12.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.45
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$40.77
|
| Rate for Payer: BCN Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.45
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$153.79
|
| Rate for Payer: BCBS Trust/PPO |
$147.69
|
| Rate for Payer: BCN Commercial |
$139.82
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$155.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Healthscope Commercial |
$162.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: PHP Commercial |
$153.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO |
$157.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.22
|
| Rate for Payer: UHC Core |
$151.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.70
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$153.79
|
| Rate for Payer: Aetna Medicare |
$47.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.54
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$45.23
|
| Rate for Payer: BCBS Trust/PPO |
$148.74
|
| Rate for Payer: BCN Commercial |
$140.67
|
| Rate for Payer: BCN Medicare Advantage |
$45.23
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$155.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.23
|
| Rate for Payer: Healthscope Commercial |
$162.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.70
|
| Rate for Payer: Mclaren Medicaid |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.49
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: PACE Senior Care Partners |
$42.97
|
| Rate for Payer: PACE SWMI |
$45.23
|
| Rate for Payer: PHP Commercial |
$153.79
|
| Rate for Payer: PHP Medicare Advantage |
$45.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO |
$157.41
|
| Rate for Payer: Priority Health Medicare |
$45.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.22
|
| Rate for Payer: Railroad Medicare Medicare |
$45.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.22
|
| Rate for Payer: UHC Core |
$151.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.23
|
| Rate for Payer: UHC Exchange |
$45.23
|
| Rate for Payer: UHC Medicare Advantage |
$45.23
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| Rate for Payer: VA VA |
$45.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.70
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$521.71 |
| Rate for Payer: Aetna Commercial |
$492.73
|
| Rate for Payer: Aetna Medicare |
$150.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.15
|
| Rate for Payer: BCBS Complete |
$251.82
|
| Rate for Payer: BCBS MAPPO |
$144.92
|
| Rate for Payer: BCBS Trust/PPO |
$476.55
|
| Rate for Payer: BCN Commercial |
$450.70
|
| Rate for Payer: BCN Medicare Advantage |
$144.92
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$498.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.92
|
| Rate for Payer: Healthscope Commercial |
$521.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.76
|
| Rate for Payer: Mclaren Medicaid |
$239.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.17
|
| Rate for Payer: Meridian Medicaid |
$251.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: PACE Senior Care Partners |
$137.67
|
| Rate for Payer: PACE SWMI |
$144.92
|
| Rate for Payer: PHP Commercial |
$492.73
|
| Rate for Payer: PHP Medicare Advantage |
$144.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health HMO/PPO |
$504.32
|
| Rate for Payer: Priority Health Medicare |
$146.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.39
|
| Rate for Payer: Railroad Medicare Medicare |
$144.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.12
|
| Rate for Payer: UHC Core |
$484.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.92
|
| Rate for Payer: UHC Exchange |
$144.92
|
| Rate for Payer: UHC Medicare Advantage |
$144.92
|
| Rate for Payer: UHCCP Medicaid |
$239.81
|
| Rate for Payer: VA VA |
$144.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.76
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$376.79 |
| Max. Negotiated Rate |
$521.71 |
| Rate for Payer: Aetna Commercial |
$492.73
|
| Rate for Payer: BCBS Trust/PPO |
$473.19
|
| Rate for Payer: BCN Commercial |
$447.98
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$498.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Healthscope Commercial |
$521.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: PHP Commercial |
$492.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health HMO/PPO |
$504.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.12
|
| Rate for Payer: UHC Core |
$484.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.76
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna Medicare |
$41.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.41
|
| Rate for Payer: BCBS Complete |
$63.24
|
| Rate for Payer: BCBS MAPPO |
$39.52
|
| Rate for Payer: BCBS Trust/PPO |
$129.97
|
| Rate for Payer: BCN Commercial |
$122.92
|
| Rate for Payer: BCN Medicare Advantage |
$39.52
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.52
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: PACE Senior Care Partners |
$37.55
|
| Rate for Payer: PACE SWMI |
$39.52
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: PHP Medicare Advantage |
$39.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.77
|
| Rate for Payer: Priority Health HMO/PPO |
$137.55
|
| Rate for Payer: Priority Health Medicare |
$39.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.93
|
| Rate for Payer: Railroad Medicare Medicare |
$39.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.13
|
| Rate for Payer: UHC Core |
$132.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.52
|
| Rate for Payer: UHC Exchange |
$39.52
|
| Rate for Payer: UHC Medicare Advantage |
$39.52
|
| Rate for Payer: VA VA |
$39.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.58
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.77 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.06
|
| Rate for Payer: BCN Commercial |
$122.18
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.77
|
| Rate for Payer: Priority Health HMO/PPO |
$137.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.13
|
| Rate for Payer: UHC Core |
$132.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.58
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: BCBS Trust/PPO |
$103.61
|
| Rate for Payer: BCN Commercial |
$98.09
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$109.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Healthscope Commercial |
$114.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: PHP Commercial |
$107.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health HMO/PPO |
$110.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.70
|
| Rate for Payer: UHC Core |
$105.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.20
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.67
|
| Rate for Payer: BCBS Complete |
$70.23
|
| Rate for Payer: BCBS MAPPO |
$31.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.35
|
| Rate for Payer: BCN Commercial |
$98.69
|
| Rate for Payer: BCN Medicare Advantage |
$31.73
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$109.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.73
|
| Rate for Payer: Healthscope Commercial |
$114.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.20
|
| Rate for Payer: Mclaren Medicaid |
$66.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.32
|
| Rate for Payer: Meridian Medicaid |
$70.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: PACE Senior Care Partners |
$30.15
|
| Rate for Payer: PACE SWMI |
$31.73
|
| Rate for Payer: PHP Commercial |
$107.89
|
| Rate for Payer: PHP Medicare Advantage |
$31.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health HMO/PPO |
$110.43
|
| Rate for Payer: Priority Health Medicare |
$32.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.04
|
| Rate for Payer: Railroad Medicare Medicare |
$31.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.70
|
| Rate for Payer: UHC Core |
$105.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.73
|
| Rate for Payer: UHC Exchange |
$31.73
|
| Rate for Payer: UHC Medicare Advantage |
$31.73
|
| Rate for Payer: UHCCP Medicaid |
$66.88
|
| Rate for Payer: VA VA |
$31.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.20
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.06 |
| Max. Negotiated Rate |
$868.02 |
| Rate for Payer: Aetna Commercial |
$819.80
|
| Rate for Payer: Aetna Medicare |
$250.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.40
|
| Rate for Payer: BCBS Complete |
$385.79
|
| Rate for Payer: BCBS MAPPO |
$241.12
|
| Rate for Payer: BCBS Trust/PPO |
$792.89
|
| Rate for Payer: BCN Commercial |
$749.88
|
| Rate for Payer: BCN Medicare Advantage |
$241.12
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$829.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.12
|
| Rate for Payer: Healthscope Commercial |
$868.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: PACE Senior Care Partners |
$229.06
|
| Rate for Payer: PACE SWMI |
$241.12
|
| Rate for Payer: PHP Commercial |
$819.80
|
| Rate for Payer: PHP Medicare Advantage |
$241.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health HMO/PPO |
$839.09
|
| Rate for Payer: Priority Health Medicare |
$243.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.19
|
| Rate for Payer: Railroad Medicare Medicare |
$241.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.73
|
| Rate for Payer: UHC Core |
$805.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.12
|
| Rate for Payer: UHC Exchange |
$241.12
|
| Rate for Payer: UHC Medicare Advantage |
$241.12
|
| Rate for Payer: VA VA |
$241.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.35
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$626.91 |
| Max. Negotiated Rate |
$868.02 |
| Rate for Payer: Aetna Commercial |
$819.80
|
| Rate for Payer: BCBS Trust/PPO |
$787.30
|
| Rate for Payer: BCN Commercial |
$745.34
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$829.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$868.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: PHP Commercial |
$819.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health HMO/PPO |
$839.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.73
|
| Rate for Payer: UHC Core |
$805.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.35
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
OP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.96 |
| Max. Negotiated Rate |
$1,140.49 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: Aetna Medicare |
$329.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$396.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$396.00
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$316.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.77
|
| Rate for Payer: BCN Commercial |
$985.26
|
| Rate for Payer: BCN Medicare Advantage |
$316.80
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.80
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.41
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.64
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$364.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: PACE Senior Care Partners |
$300.96
|
| Rate for Payer: PACE SWMI |
$316.80
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$316.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,102.47
|
| Rate for Payer: Priority Health Medicare |
$319.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.03
|
| Rate for Payer: Railroad Medicare Medicare |
$316.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,115.14
|
| Rate for Payer: UHC Core |
$1,058.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.80
|
| Rate for Payer: UHC Exchange |
$316.80
|
| Rate for Payer: UHC Medicare Advantage |
$316.80
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$316.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.41
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
IP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$823.69 |
| Max. Negotiated Rate |
$1,140.49 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.42
|
| Rate for Payer: BCN Commercial |
$979.30
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,102.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,115.14
|
| Rate for Payer: UHC Core |
$1,058.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.41
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
OP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.61 |
| Max. Negotiated Rate |
$1,669.70 |
| Rate for Payer: Aetna Commercial |
$1,576.94
|
| Rate for Payer: Aetna Medicare |
$482.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$579.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$579.76
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$463.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.18
|
| Rate for Payer: BCN Commercial |
$1,442.43
|
| Rate for Payer: BCN Medicare Advantage |
$463.81
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,595.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.81
|
| Rate for Payer: Healthscope Commercial |
$1,669.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,391.41
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.00
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$533.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: Nomi Health Commercial |
$1,521.28
|
| Rate for Payer: PACE Senior Care Partners |
$440.61
|
| Rate for Payer: PACE SWMI |
$463.81
|
| Rate for Payer: PHP Commercial |
$1,576.94
|
| Rate for Payer: PHP Medicare Advantage |
$463.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1,614.04
|
| Rate for Payer: Priority Health Medicare |
$468.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,243.00
|
| Rate for Payer: Railroad Medicare Medicare |
$463.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,632.59
|
| Rate for Payer: UHC Core |
$1,549.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$463.81
|
| Rate for Payer: UHC Exchange |
$463.81
|
| Rate for Payer: UHC Medicare Advantage |
$463.81
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$463.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,391.41
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
IP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,205.89 |
| Max. Negotiated Rate |
$1,669.70 |
| Rate for Payer: Aetna Commercial |
$1,576.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,514.42
|
| Rate for Payer: BCN Commercial |
$1,433.71
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,595.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Healthscope Commercial |
$1,669.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,391.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: Nomi Health Commercial |
$1,521.28
|
| Rate for Payer: PHP Commercial |
$1,576.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1,614.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,243.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,632.59
|
| Rate for Payer: UHC Core |
$1,549.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,391.41
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
OP
|
$1,267.21
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.96 |
| Max. Negotiated Rate |
$1,140.49 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: Aetna Medicare |
$329.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$396.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$396.00
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$316.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.77
|
| Rate for Payer: BCN Commercial |
$985.26
|
| Rate for Payer: BCN Medicare Advantage |
$316.80
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.80
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.41
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.64
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$364.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: PACE Senior Care Partners |
$300.96
|
| Rate for Payer: PACE SWMI |
$316.80
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$316.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,102.47
|
| Rate for Payer: Priority Health Medicare |
$319.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.03
|
| Rate for Payer: Railroad Medicare Medicare |
$316.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,115.14
|
| Rate for Payer: UHC Core |
$1,058.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.80
|
| Rate for Payer: UHC Exchange |
$316.80
|
| Rate for Payer: UHC Medicare Advantage |
$316.80
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$316.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.41
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,267.21
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$823.69 |
| Max. Negotiated Rate |
$1,140.49 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.42
|
| Rate for Payer: BCN Commercial |
$979.30
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO |
$1,102.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,115.14
|
| Rate for Payer: UHC Core |
$1,058.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.41
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
IP
|
$1,911.24
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,242.31 |
| Max. Negotiated Rate |
$1,720.12 |
| Rate for Payer: Aetna Commercial |
$1,624.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,560.15
|
| Rate for Payer: BCN Commercial |
$1,477.01
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,643.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.99
|
| Rate for Payer: Healthscope Commercial |
$1,720.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,433.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,624.55
|
| Rate for Payer: Nomi Health Commercial |
$1,567.22
|
| Rate for Payer: PHP Commercial |
$1,624.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,662.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,280.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,681.89
|
| Rate for Payer: UHC Core |
$1,595.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,433.43
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
OP
|
$1,911.24
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$453.92 |
| Max. Negotiated Rate |
$1,720.12 |
| Rate for Payer: Aetna Commercial |
$1,624.55
|
| Rate for Payer: Aetna Medicare |
$496.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$597.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$597.26
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$477.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,571.23
|
| Rate for Payer: BCN Commercial |
$1,485.99
|
| Rate for Payer: BCN Medicare Advantage |
$477.81
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,643.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.81
|
| Rate for Payer: Healthscope Commercial |
$1,720.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,433.43
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.70
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$549.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,624.55
|
| Rate for Payer: Nomi Health Commercial |
$1,567.22
|
| Rate for Payer: PACE Senior Care Partners |
$453.92
|
| Rate for Payer: PACE SWMI |
$477.81
|
| Rate for Payer: PHP Commercial |
$1,624.55
|
| Rate for Payer: PHP Medicare Advantage |
$477.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1,662.78
|
| Rate for Payer: Priority Health Medicare |
$482.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,280.53
|
| Rate for Payer: Railroad Medicare Medicare |
$477.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,681.89
|
| Rate for Payer: UHC Core |
$1,595.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.81
|
| Rate for Payer: UHC Exchange |
$477.81
|
| Rate for Payer: UHC Medicare Advantage |
$477.81
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$477.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,433.43
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
OP
|
$3,172.12
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$643.68 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: Aetna Medicare |
$824.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$991.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$991.29
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$793.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,607.80
|
| Rate for Payer: BCN Commercial |
$2,466.32
|
| Rate for Payer: BCN Medicare Advantage |
$793.03
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.03
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,379.09
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.68
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$911.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: PACE Senior Care Partners |
$753.38
|
| Rate for Payer: PACE SWMI |
$793.03
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: PHP Medicare Advantage |
$793.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2,759.74
|
| Rate for Payer: Priority Health Medicare |
$800.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,125.32
|
| Rate for Payer: Railroad Medicare Medicare |
$793.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,791.47
|
| Rate for Payer: UHC Core |
$2,648.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.03
|
| Rate for Payer: UHC Exchange |
$793.03
|
| Rate for Payer: UHC Medicare Advantage |
$793.03
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$793.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,379.09
|
|
