|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.37 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna Medicare |
$128.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.43
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$123.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.27
|
| Rate for Payer: BCN Commercial |
$384.23
|
| Rate for Payer: BCN Medicare Advantage |
$123.55
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.55
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.64
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.72
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$405.24
|
| Rate for Payer: PACE Senior Care Partners |
$117.37
|
| Rate for Payer: PACE SWMI |
$123.55
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: PHP Medicare Advantage |
$123.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.22
|
| Rate for Payer: Priority Health HMO/PPO |
$429.95
|
| Rate for Payer: Priority Health Medicare |
$124.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.11
|
| Rate for Payer: Railroad Medicare Medicare |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.89
|
| Rate for Payer: UHC Core |
$412.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.55
|
| Rate for Payer: UHC Exchange |
$123.55
|
| Rate for Payer: UHC Medicare Advantage |
$123.55
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$123.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.64
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
IP
|
$1,492.97
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$970.43 |
| Max. Negotiated Rate |
$1,343.67 |
| Rate for Payer: Aetna Commercial |
$1,269.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.71
|
| Rate for Payer: BCN Commercial |
$1,153.77
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cofinity Commercial |
$1,283.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,194.38
|
| Rate for Payer: Healthscope Commercial |
$1,343.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,119.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.02
|
| Rate for Payer: Nomi Health Commercial |
$1,224.24
|
| Rate for Payer: PHP Commercial |
$1,269.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1,298.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,000.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,313.81
|
| Rate for Payer: UHC Core |
$1,246.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,119.73
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
OP
|
$1,492.97
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.58 |
| Max. Negotiated Rate |
$1,343.67 |
| Rate for Payer: Aetna Commercial |
$1,269.02
|
| Rate for Payer: Aetna Medicare |
$388.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.55
|
| Rate for Payer: BCBS Complete |
$506.74
|
| Rate for Payer: BCBS MAPPO |
$373.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.37
|
| Rate for Payer: BCN Commercial |
$1,160.78
|
| Rate for Payer: BCN Medicare Advantage |
$373.24
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cofinity Commercial |
$1,283.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,194.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.24
|
| Rate for Payer: Healthscope Commercial |
$1,343.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,119.73
|
| Rate for Payer: Mclaren Medicaid |
$482.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.90
|
| Rate for Payer: Meridian Medicaid |
$506.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.02
|
| Rate for Payer: Nomi Health Commercial |
$1,224.24
|
| Rate for Payer: PACE Senior Care Partners |
$354.58
|
| Rate for Payer: PACE SWMI |
$373.24
|
| Rate for Payer: PHP Commercial |
$1,269.02
|
| Rate for Payer: PHP Medicare Advantage |
$373.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1,298.88
|
| Rate for Payer: Priority Health Medicare |
$376.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,000.29
|
| Rate for Payer: Railroad Medicare Medicare |
$373.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,313.81
|
| Rate for Payer: UHC Core |
$1,246.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.24
|
| Rate for Payer: UHC Exchange |
$373.24
|
| Rate for Payer: UHC Medicare Advantage |
$373.24
|
| Rate for Payer: UHCCP Medicaid |
$482.58
|
| Rate for Payer: VA VA |
$373.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,119.73
|
|
|
HC MANTIS CLIP
|
Facility
|
IP
|
$1,156.68
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.84 |
| Max. Negotiated Rate |
$1,041.01 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: BCBS Trust/PPO |
$944.20
|
| Rate for Payer: BCN Commercial |
$893.88
|
| Rate for Payer: Cash Price |
$925.34
|
| Rate for Payer: Cofinity Commercial |
$994.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.34
|
| Rate for Payer: Healthscope Commercial |
$1,041.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$867.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.18
|
| Rate for Payer: Nomi Health Commercial |
$948.48
|
| Rate for Payer: PHP Commercial |
$983.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.84
|
| Rate for Payer: Priority Health HMO/PPO |
$1,006.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$774.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,017.88
|
| Rate for Payer: UHC Core |
$965.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$867.51
|
|
|
HC MANTIS CLIP
|
Facility
|
OP
|
$1,156.68
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.71 |
| Max. Negotiated Rate |
$1,041.01 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna Medicare |
$300.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.46
|
| Rate for Payer: BCBS Complete |
$462.67
|
| Rate for Payer: BCBS MAPPO |
$289.17
|
| Rate for Payer: BCBS Trust/PPO |
$950.91
|
| Rate for Payer: BCN Commercial |
$899.32
|
| Rate for Payer: BCN Medicare Advantage |
$289.17
|
| Rate for Payer: Cash Price |
$925.34
|
| Rate for Payer: Cofinity Commercial |
$994.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.17
|
| Rate for Payer: Healthscope Commercial |
$1,041.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$867.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.18
|
| Rate for Payer: Nomi Health Commercial |
$948.48
|
| Rate for Payer: PACE Senior Care Partners |
$274.71
|
| Rate for Payer: PACE SWMI |
$289.17
|
| Rate for Payer: PHP Commercial |
$983.18
|
| Rate for Payer: PHP Medicare Advantage |
$289.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.84
|
| Rate for Payer: Priority Health HMO/PPO |
$1,006.31
|
| Rate for Payer: Priority Health Medicare |
$292.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$774.98
|
| Rate for Payer: Railroad Medicare Medicare |
$289.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,017.88
|
| Rate for Payer: UHC Core |
$965.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.17
|
| Rate for Payer: UHC Exchange |
$289.17
|
| Rate for Payer: UHC Medicare Advantage |
$289.17
|
| Rate for Payer: VA VA |
$289.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$867.51
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.47
|
| Rate for Payer: BCBS Complete |
$2.88
|
| Rate for Payer: BCBS MAPPO |
$11.58
|
| Rate for Payer: BCBS Trust/PPO |
$38.07
|
| Rate for Payer: BCN Commercial |
$36.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.58
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.58
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Mclaren Medicaid |
$2.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.16
|
| Rate for Payer: Meridian Medicaid |
$2.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: PACE Senior Care Partners |
$11.00
|
| Rate for Payer: PACE SWMI |
$11.58
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: PHP Medicare Advantage |
$11.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO |
$40.29
|
| Rate for Payer: Priority Health Medicare |
$11.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.75
|
| Rate for Payer: UHC Core |
$38.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.58
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$11.58
|
| Rate for Payer: UHCCP Medicaid |
$2.75
|
| Rate for Payer: VA VA |
$11.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$37.80
|
| Rate for Payer: BCN Commercial |
$35.79
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO |
$40.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.75
|
| Rate for Payer: UHC Core |
$38.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC MAPLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MAPLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
OP
|
$6,169.57
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,465.27 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: Aetna Medicare |
$1,604.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,927.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,927.99
|
| Rate for Payer: BCBS Complete |
$2,467.83
|
| Rate for Payer: BCBS MAPPO |
$1,542.39
|
| Rate for Payer: BCBS Trust/PPO |
$5,072.00
|
| Rate for Payer: BCN Commercial |
$4,796.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,542.39
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,542.39
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,627.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,619.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,773.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Nomi Health Commercial |
$5,059.05
|
| Rate for Payer: PACE Senior Care Partners |
$1,465.27
|
| Rate for Payer: PACE SWMI |
$1,542.39
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,542.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,010.22
|
| Rate for Payer: Priority Health HMO/PPO |
$5,367.53
|
| Rate for Payer: Priority Health Medicare |
$1,557.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,133.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,542.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,429.22
|
| Rate for Payer: UHC Core |
$5,151.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,542.39
|
| Rate for Payer: UHC Exchange |
$1,542.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,542.39
|
| Rate for Payer: VA VA |
$1,542.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,627.18
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
IP
|
$6,169.57
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,010.22 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,036.22
|
| Rate for Payer: BCN Commercial |
$4,767.84
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,627.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Nomi Health Commercial |
$5,059.05
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,010.22
|
| Rate for Payer: Priority Health HMO/PPO |
$5,367.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,133.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,429.22
|
| Rate for Payer: UHC Core |
$5,151.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,627.18
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
OP
|
$4,398.08
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,044.54 |
| Max. Negotiated Rate |
$3,958.27 |
| Rate for Payer: Aetna Commercial |
$3,738.37
|
| Rate for Payer: Aetna Medicare |
$1,143.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,374.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,374.40
|
| Rate for Payer: BCBS Complete |
$1,759.23
|
| Rate for Payer: BCBS MAPPO |
$1,099.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,615.66
|
| Rate for Payer: BCN Commercial |
$3,419.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.52
|
| Rate for Payer: Cash Price |
$3,518.46
|
| Rate for Payer: Cofinity Commercial |
$3,782.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.52
|
| Rate for Payer: Healthscope Commercial |
$3,958.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,298.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,154.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,264.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.37
|
| Rate for Payer: Nomi Health Commercial |
$3,606.43
|
| Rate for Payer: PACE Senior Care Partners |
$1,044.54
|
| Rate for Payer: PACE SWMI |
$1,099.52
|
| Rate for Payer: PHP Commercial |
$3,738.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,858.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3,826.33
|
| Rate for Payer: Priority Health Medicare |
$1,110.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,946.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,099.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,870.31
|
| Rate for Payer: UHC Core |
$3,672.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.52
|
| Rate for Payer: UHC Exchange |
$1,099.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.52
|
| Rate for Payer: VA VA |
$1,099.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,298.56
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
IP
|
$4,398.08
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,858.75 |
| Max. Negotiated Rate |
$3,958.27 |
| Rate for Payer: Aetna Commercial |
$3,738.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,590.15
|
| Rate for Payer: BCN Commercial |
$3,398.84
|
| Rate for Payer: Cash Price |
$3,518.46
|
| Rate for Payer: Cofinity Commercial |
$3,782.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,518.46
|
| Rate for Payer: Healthscope Commercial |
$3,958.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,298.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,738.37
|
| Rate for Payer: Nomi Health Commercial |
$3,606.43
|
| Rate for Payer: PHP Commercial |
$3,738.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,858.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3,826.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,946.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,870.31
|
| Rate for Payer: UHC Core |
$3,672.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,298.56
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,887.06 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna Medicare |
$2,065.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,482.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,482.98
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$1,986.38
|
| Rate for Payer: BCBS Trust/PPO |
$6,532.02
|
| Rate for Payer: BCN Commercial |
$6,177.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,986.38
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,986.38
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.15
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,085.70
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,284.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PACE Senior Care Partners |
$1,887.06
|
| Rate for Payer: PACE SWMI |
$1,986.38
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,986.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO |
$6,912.61
|
| Rate for Payer: Priority Health Medicare |
$2,006.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,323.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,986.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,992.07
|
| Rate for Payer: UHC Core |
$6,634.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,986.38
|
| Rate for Payer: UHC Exchange |
$1,986.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,986.38
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$1,986.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.15
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,164.59 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: BCBS Trust/PPO |
$6,485.94
|
| Rate for Payer: BCN Commercial |
$6,140.31
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO |
$6,912.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,323.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,992.07
|
| Rate for Payer: UHC Core |
$6,634.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.15
|
|
|
HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,237.70 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: BCBS Trust/PPO |
$6,577.75
|
| Rate for Payer: BCN Commercial |
$6,227.22
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,043.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO |
$7,010.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,398.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,091.04
|
| Rate for Payer: UHC Core |
$6,728.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,043.50
|
|
|
HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,913.78 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna Medicare |
$2,095.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,518.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,518.12
|
| Rate for Payer: BCBS Complete |
$2,462.14
|
| Rate for Payer: BCBS MAPPO |
$2,014.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,624.48
|
| Rate for Payer: BCN Commercial |
$6,265.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,014.50
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,014.50
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,043.50
|
| Rate for Payer: Mclaren Medicaid |
$2,344.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,115.22
|
| Rate for Payer: Meridian Medicaid |
$2,462.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,316.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: PACE Senior Care Partners |
$1,913.78
|
| Rate for Payer: PACE SWMI |
$2,014.50
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,014.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,344.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO |
$7,010.46
|
| Rate for Payer: Priority Health Medicare |
$2,034.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,398.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,014.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,091.04
|
| Rate for Payer: UHC Core |
$6,728.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,014.50
|
| Rate for Payer: UHC Exchange |
$2,014.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,014.50
|
| Rate for Payer: UHCCP Medicaid |
$2,344.74
|
| Rate for Payer: VA VA |
$2,014.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,043.50
|
|
|
HC MASSAGE THERAPY
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$24.98
|
| Rate for Payer: BCN Commercial |
$23.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC MASSAGE THERAPY
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.16
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Exchange |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC MASTECTOMY SLEEVE EA $100
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.88
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$83.85
|
| Rate for Payer: BCN Commercial |
$79.31
|
| Rate for Payer: BCN Medicare Advantage |
$25.50
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PACE Senior Care Partners |
$24.23
|
| Rate for Payer: PACE SWMI |
$25.50
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Medicare |
$25.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.50
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.50
|
| Rate for Payer: VA VA |
$25.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC MASTECTOMY SLEEVE EA $100
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$83.26
|
| Rate for Payer: BCN Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC MASTECTOMY SLEEVE EA $125
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$98.53
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC MASTECTOMY SLEEVE EA $125
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.84
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS MAPPO |
$31.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.82
|
| Rate for Payer: BCN Commercial |
$99.13
|
| Rate for Payer: BCN Medicare Advantage |
$31.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.88
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PACE Senior Care Partners |
$30.28
|
| Rate for Payer: PACE SWMI |
$31.88
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: PHP Medicare Advantage |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Medicare |
$32.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: Railroad Medicare Medicare |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.88
|
| Rate for Payer: UHC Exchange |
$31.88
|
| Rate for Payer: UHC Medicare Advantage |
$31.88
|
| Rate for Payer: VA VA |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC MASTECTOMY SLEEVE EA $150
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC MASTECTOMY SLEEVE EA $150
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
