|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$370.34
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$333.31 |
| Rate for Payer: Aetna Commercial |
$314.79
|
| Rate for Payer: Aetna Medicare |
$96.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.73
|
| Rate for Payer: BCBS Complete |
$108.53
|
| Rate for Payer: BCBS MAPPO |
$92.58
|
| Rate for Payer: BCBS Trust/PPO |
$287.94
|
| Rate for Payer: BCN Commercial |
$287.94
|
| Rate for Payer: BCN Medicare Advantage |
$92.58
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cofinity Commercial |
$318.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.58
|
| Rate for Payer: Healthscope Commercial |
$333.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.76
|
| Rate for Payer: Mclaren Medicaid |
$103.36
|
| Rate for Payer: Meridian Medicaid |
$108.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.79
|
| Rate for Payer: PACE Senior Care Partners |
$87.96
|
| Rate for Payer: PACE SWMI |
$92.58
|
| Rate for Payer: PHP Commercial |
$314.79
|
| Rate for Payer: PHP Medicare Advantage |
$92.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.20
|
| Rate for Payer: Priority Health Medicare |
$92.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.87
|
| Rate for Payer: Railroad Medicare Medicare |
$92.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.90
|
| Rate for Payer: UHC Core |
$309.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.58
|
| Rate for Payer: UHC Medicare Advantage |
$95.36
|
| Rate for Payer: VA VA |
$92.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.76
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
IP
|
$370.34
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$225.87 |
| Max. Negotiated Rate |
$333.31 |
| Rate for Payer: Aetna Commercial |
$314.79
|
| Rate for Payer: BCBS Trust/PPO |
$286.20
|
| Rate for Payer: BCN Commercial |
$286.20
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cofinity Commercial |
$318.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.27
|
| Rate for Payer: Healthscope Commercial |
$333.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.79
|
| Rate for Payer: PHP Commercial |
$314.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.90
|
| Rate for Payer: UHC Core |
$309.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.76
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
OP
|
$95.20
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: Aetna Medicare |
$24.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.75
|
| Rate for Payer: BCBS Complete |
$117.65
|
| Rate for Payer: BCBS MAPPO |
$23.80
|
| Rate for Payer: BCBS Trust/PPO |
$74.02
|
| Rate for Payer: BCN Commercial |
$74.02
|
| Rate for Payer: BCN Medicare Advantage |
$23.80
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.80
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.40
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Medicaid |
$117.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PACE Senior Care Partners |
$22.61
|
| Rate for Payer: PACE SWMI |
$23.80
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: PHP Medicare Advantage |
$23.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.82
|
| Rate for Payer: Priority Health Medicare |
$23.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.06
|
| Rate for Payer: Railroad Medicare Medicare |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.78
|
| Rate for Payer: UHC Core |
$79.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.80
|
| Rate for Payer: UHC Medicare Advantage |
$24.51
|
| Rate for Payer: VA VA |
$23.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.40
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
IP
|
$95.20
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$58.06 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: BCBS Trust/PPO |
$73.57
|
| Rate for Payer: BCN Commercial |
$73.57
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.78
|
| Rate for Payer: UHC Core |
$79.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.40
|
|
|
HC SPORE CHECK
|
Facility
|
IP
|
$22.80
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Aetna Commercial |
$19.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.62
|
| Rate for Payer: BCN Commercial |
$17.62
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cofinity Commercial |
$19.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.24
|
| Rate for Payer: Healthscope Commercial |
$20.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.38
|
| Rate for Payer: PHP Commercial |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.06
|
| Rate for Payer: UHC Core |
$19.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.10
|
|
|
HC SPORE CHECK
|
Facility
|
OP
|
$22.80
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Aetna Commercial |
$19.38
|
| Rate for Payer: Aetna Medicare |
$5.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.12
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS MAPPO |
$5.70
|
| Rate for Payer: BCBS Trust/PPO |
$17.73
|
| Rate for Payer: BCN Commercial |
$17.73
|
| Rate for Payer: BCN Medicare Advantage |
$5.70
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cofinity Commercial |
$19.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$20.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.38
|
| Rate for Payer: PACE Senior Care Partners |
$5.42
|
| Rate for Payer: PACE SWMI |
$5.70
|
| Rate for Payer: PHP Commercial |
$19.38
|
| Rate for Payer: PHP Medicare Advantage |
$5.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.84
|
| Rate for Payer: Priority Health Medicare |
$5.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.91
|
| Rate for Payer: Railroad Medicare Medicare |
$5.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.06
|
| Rate for Payer: UHC Core |
$19.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.70
|
| Rate for Payer: UHC Medicare Advantage |
$5.87
|
| Rate for Payer: VA VA |
$5.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.10
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
IP
|
$4,615.05
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,814.72 |
| Max. Negotiated Rate |
$4,153.54 |
| Rate for Payer: Aetna Commercial |
$3,922.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,566.51
|
| Rate for Payer: BCN Commercial |
$3,566.51
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cofinity Commercial |
$3,968.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,692.04
|
| Rate for Payer: Healthscope Commercial |
$4,153.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,461.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,922.79
|
| Rate for Payer: PHP Commercial |
$3,922.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,230.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,015.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,814.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,061.24
|
| Rate for Payer: UHC Core |
$3,853.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,461.29
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
OP
|
$4,615.05
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,096.07 |
| Max. Negotiated Rate |
$4,153.54 |
| Rate for Payer: Aetna Commercial |
$3,922.79
|
| Rate for Payer: Aetna Medicare |
$1,199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,442.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,442.20
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$1,153.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,588.20
|
| Rate for Payer: BCN Commercial |
$3,588.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,153.76
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cofinity Commercial |
$3,968.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,692.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,153.76
|
| Rate for Payer: Healthscope Commercial |
$4,153.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,461.29
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,211.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,326.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,922.79
|
| Rate for Payer: PACE Senior Care Partners |
$1,096.07
|
| Rate for Payer: PACE SWMI |
$1,153.76
|
| Rate for Payer: PHP Commercial |
$3,922.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,153.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,230.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,015.09
|
| Rate for Payer: Priority Health Medicare |
$1,153.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,814.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,153.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,061.24
|
| Rate for Payer: UHC Core |
$3,853.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,153.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,188.38
|
| Rate for Payer: VA VA |
$1,153.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,461.29
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
OP
|
$3,693.58
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$877.23 |
| Max. Negotiated Rate |
$3,324.22 |
| Rate for Payer: Aetna Commercial |
$3,139.54
|
| Rate for Payer: Aetna Medicare |
$960.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,154.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,154.24
|
| Rate for Payer: BCBS Complete |
$1,933.98
|
| Rate for Payer: BCBS MAPPO |
$923.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,871.76
|
| Rate for Payer: BCN Commercial |
$2,871.76
|
| Rate for Payer: BCN Medicare Advantage |
$923.40
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cofinity Commercial |
$3,176.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$923.40
|
| Rate for Payer: Healthscope Commercial |
$3,324.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,770.18
|
| Rate for Payer: Mclaren Medicaid |
$1,841.89
|
| Rate for Payer: Meridian Medicaid |
$1,933.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$969.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,061.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.54
|
| Rate for Payer: PACE Senior Care Partners |
$877.23
|
| Rate for Payer: PACE SWMI |
$923.40
|
| Rate for Payer: PHP Commercial |
$3,139.54
|
| Rate for Payer: PHP Medicare Advantage |
$923.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,841.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,213.41
|
| Rate for Payer: Priority Health Medicare |
$923.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,252.71
|
| Rate for Payer: Railroad Medicare Medicare |
$923.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,250.35
|
| Rate for Payer: UHC Core |
$3,084.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.40
|
| Rate for Payer: UHC Medicare Advantage |
$951.10
|
| Rate for Payer: VA VA |
$923.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,770.18
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
IP
|
$3,693.58
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,252.71 |
| Max. Negotiated Rate |
$3,324.22 |
| Rate for Payer: Aetna Commercial |
$3,139.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,854.40
|
| Rate for Payer: BCN Commercial |
$2,854.40
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cofinity Commercial |
$3,176.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,954.86
|
| Rate for Payer: Healthscope Commercial |
$3,324.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,770.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.54
|
| Rate for Payer: PHP Commercial |
$3,139.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,213.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,252.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,250.35
|
| Rate for Payer: UHC Core |
$3,084.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,770.18
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
IP
|
$4,195.50
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,558.84 |
| Max. Negotiated Rate |
$3,775.95 |
| Rate for Payer: Aetna Commercial |
$3,566.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,242.28
|
| Rate for Payer: BCN Commercial |
$3,242.28
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cofinity Commercial |
$3,608.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,356.40
|
| Rate for Payer: Healthscope Commercial |
$3,775.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,146.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,566.18
|
| Rate for Payer: PHP Commercial |
$3,566.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,936.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,650.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,558.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,692.04
|
| Rate for Payer: UHC Core |
$3,503.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,146.62
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
OP
|
$4,195.50
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$996.43 |
| Max. Negotiated Rate |
$3,775.95 |
| Rate for Payer: Aetna Commercial |
$3,566.18
|
| Rate for Payer: Aetna Medicare |
$1,090.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.09
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$1,048.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,262.00
|
| Rate for Payer: BCN Commercial |
$3,262.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.88
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cofinity Commercial |
$3,608.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,356.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.88
|
| Rate for Payer: Healthscope Commercial |
$3,775.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,146.62
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,566.18
|
| Rate for Payer: PACE Senior Care Partners |
$996.43
|
| Rate for Payer: PACE SWMI |
$1,048.88
|
| Rate for Payer: PHP Commercial |
$3,566.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,936.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,650.08
|
| Rate for Payer: Priority Health Medicare |
$1,048.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,558.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,692.04
|
| Rate for Payer: UHC Core |
$3,503.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.34
|
| Rate for Payer: VA VA |
$1,048.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,146.62
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
OP
|
$682.65
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$614.38 |
| Rate for Payer: Aetna Commercial |
$580.25
|
| Rate for Payer: Aetna Medicare |
$177.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$213.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$213.33
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$170.66
|
| Rate for Payer: BCBS Trust/PPO |
$530.76
|
| Rate for Payer: BCN Commercial |
$530.76
|
| Rate for Payer: BCN Medicare Advantage |
$170.66
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cofinity Commercial |
$587.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.66
|
| Rate for Payer: Healthscope Commercial |
$614.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$511.99
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.25
|
| Rate for Payer: PACE Senior Care Partners |
$162.13
|
| Rate for Payer: PACE SWMI |
$170.66
|
| Rate for Payer: PHP Commercial |
$580.25
|
| Rate for Payer: PHP Medicare Advantage |
$170.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$593.91
|
| Rate for Payer: Priority Health Medicare |
$170.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.35
|
| Rate for Payer: Railroad Medicare Medicare |
$170.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$600.73
|
| Rate for Payer: UHC Core |
$570.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.66
|
| Rate for Payer: UHC Medicare Advantage |
$175.78
|
| Rate for Payer: VA VA |
$170.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$511.99
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
IP
|
$682.65
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$416.35 |
| Max. Negotiated Rate |
$614.38 |
| Rate for Payer: Aetna Commercial |
$580.25
|
| Rate for Payer: BCBS Trust/PPO |
$527.55
|
| Rate for Payer: BCN Commercial |
$527.55
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cofinity Commercial |
$587.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.12
|
| Rate for Payer: Healthscope Commercial |
$614.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$511.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.25
|
| Rate for Payer: PHP Commercial |
$580.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$593.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$600.73
|
| Rate for Payer: UHC Core |
$570.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$511.99
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
IP
|
$1,053.73
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.67 |
| Max. Negotiated Rate |
$948.36 |
| Rate for Payer: Aetna Commercial |
$895.67
|
| Rate for Payer: BCBS Trust/PPO |
$814.32
|
| Rate for Payer: BCN Commercial |
$814.32
|
| Rate for Payer: Cash Price |
$842.98
|
| Rate for Payer: Cofinity Commercial |
$906.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.98
|
| Rate for Payer: Healthscope Commercial |
$948.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.67
|
| Rate for Payer: PHP Commercial |
$895.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$642.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.28
|
| Rate for Payer: UHC Core |
$879.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.30
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
OP
|
$1,053.73
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.26 |
| Max. Negotiated Rate |
$948.36 |
| Rate for Payer: Aetna Commercial |
$895.67
|
| Rate for Payer: Aetna Medicare |
$273.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.29
|
| Rate for Payer: BCBS Complete |
$421.49
|
| Rate for Payer: BCBS MAPPO |
$263.43
|
| Rate for Payer: BCBS Trust/PPO |
$819.28
|
| Rate for Payer: BCN Commercial |
$819.28
|
| Rate for Payer: BCN Medicare Advantage |
$263.43
|
| Rate for Payer: Cash Price |
$842.98
|
| Rate for Payer: Cofinity Commercial |
$906.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.43
|
| Rate for Payer: Healthscope Commercial |
$948.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.67
|
| Rate for Payer: PACE Senior Care Partners |
$250.26
|
| Rate for Payer: PACE SWMI |
$263.43
|
| Rate for Payer: PHP Commercial |
$895.67
|
| Rate for Payer: PHP Medicare Advantage |
$263.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.75
|
| Rate for Payer: Priority Health Medicare |
$263.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$642.67
|
| Rate for Payer: Railroad Medicare Medicare |
$263.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.28
|
| Rate for Payer: UHC Core |
$879.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.43
|
| Rate for Payer: UHC Medicare Advantage |
$271.34
|
| Rate for Payer: VA VA |
$263.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.30
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
OP
|
$6,140.07
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,458.27 |
| Max. Negotiated Rate |
$5,526.06 |
| Rate for Payer: Aetna Commercial |
$5,219.06
|
| Rate for Payer: Aetna Medicare |
$1,596.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,918.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,918.77
|
| Rate for Payer: BCBS Complete |
$2,456.03
|
| Rate for Payer: BCBS MAPPO |
$1,535.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,773.90
|
| Rate for Payer: BCN Commercial |
$4,773.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,535.02
|
| Rate for Payer: Cash Price |
$4,912.06
|
| Rate for Payer: Cofinity Commercial |
$5,280.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,535.02
|
| Rate for Payer: Healthscope Commercial |
$5,526.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,605.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,611.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,765.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.06
|
| Rate for Payer: PACE Senior Care Partners |
$1,458.27
|
| Rate for Payer: PACE SWMI |
$1,535.02
|
| Rate for Payer: PHP Commercial |
$5,219.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,535.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,341.86
|
| Rate for Payer: Priority Health Medicare |
$1,535.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,744.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,535.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,403.26
|
| Rate for Payer: UHC Core |
$5,126.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,535.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,581.07
|
| Rate for Payer: VA VA |
$1,535.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,605.05
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
IP
|
$6,140.07
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,744.83 |
| Max. Negotiated Rate |
$5,526.06 |
| Rate for Payer: Aetna Commercial |
$5,219.06
|
| Rate for Payer: BCBS Trust/PPO |
$4,745.05
|
| Rate for Payer: BCN Commercial |
$4,745.05
|
| Rate for Payer: Cash Price |
$4,912.06
|
| Rate for Payer: Cofinity Commercial |
$5,280.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.06
|
| Rate for Payer: Healthscope Commercial |
$5,526.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,605.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.06
|
| Rate for Payer: PHP Commercial |
$5,219.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,341.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,744.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,403.26
|
| Rate for Payer: UHC Core |
$5,126.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,605.05
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
IP
|
$2,396.89
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,461.86 |
| Max. Negotiated Rate |
$2,157.20 |
| Rate for Payer: Aetna Commercial |
$2,037.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,852.32
|
| Rate for Payer: BCN Commercial |
$1,852.32
|
| Rate for Payer: Cash Price |
$1,917.51
|
| Rate for Payer: Cofinity Commercial |
$2,061.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.51
|
| Rate for Payer: Healthscope Commercial |
$2,157.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,797.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,037.36
|
| Rate for Payer: PHP Commercial |
$2,037.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,085.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,461.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,109.26
|
| Rate for Payer: UHC Core |
$2,001.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,797.67
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
OP
|
$2,396.89
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.26 |
| Max. Negotiated Rate |
$2,157.20 |
| Rate for Payer: Aetna Commercial |
$2,037.36
|
| Rate for Payer: Aetna Medicare |
$623.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.03
|
| Rate for Payer: BCBS Complete |
$958.76
|
| Rate for Payer: BCBS MAPPO |
$599.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,863.58
|
| Rate for Payer: BCN Commercial |
$1,863.58
|
| Rate for Payer: BCN Medicare Advantage |
$599.22
|
| Rate for Payer: Cash Price |
$1,917.51
|
| Rate for Payer: Cofinity Commercial |
$2,061.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.22
|
| Rate for Payer: Healthscope Commercial |
$2,157.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,797.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$629.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,037.36
|
| Rate for Payer: PACE Senior Care Partners |
$569.26
|
| Rate for Payer: PACE SWMI |
$599.22
|
| Rate for Payer: PHP Commercial |
$2,037.36
|
| Rate for Payer: PHP Medicare Advantage |
$599.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,085.29
|
| Rate for Payer: Priority Health Medicare |
$599.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,461.86
|
| Rate for Payer: Railroad Medicare Medicare |
$599.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,109.26
|
| Rate for Payer: UHC Core |
$2,001.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.22
|
| Rate for Payer: UHC Medicare Advantage |
$617.20
|
| Rate for Payer: VA VA |
$599.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,797.67
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,301.76 |
| Max. Negotiated Rate |
$3,396.60 |
| Rate for Payer: Aetna Commercial |
$3,207.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,916.55
|
| Rate for Payer: BCN Commercial |
$2,916.55
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,245.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Healthscope Commercial |
$3,396.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,830.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PHP Commercial |
$3,207.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,283.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,301.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,321.12
|
| Rate for Payer: UHC Core |
$3,151.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.50
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$896.32 |
| Max. Negotiated Rate |
$3,396.60 |
| Rate for Payer: Aetna Commercial |
$3,207.90
|
| Rate for Payer: Aetna Medicare |
$981.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,179.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,179.38
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$943.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,934.28
|
| Rate for Payer: BCN Commercial |
$2,934.28
|
| Rate for Payer: BCN Medicare Advantage |
$943.50
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,245.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.50
|
| Rate for Payer: Healthscope Commercial |
$3,396.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,830.50
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$990.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,085.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PACE Senior Care Partners |
$896.32
|
| Rate for Payer: PACE SWMI |
$943.50
|
| Rate for Payer: PHP Commercial |
$3,207.90
|
| Rate for Payer: PHP Medicare Advantage |
$943.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,283.38
|
| Rate for Payer: Priority Health Medicare |
$943.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,301.76
|
| Rate for Payer: Railroad Medicare Medicare |
$943.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,321.12
|
| Rate for Payer: UHC Core |
$3,151.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$943.50
|
| Rate for Payer: UHC Medicare Advantage |
$971.80
|
| Rate for Payer: VA VA |
$943.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.50
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$896.32 |
| Max. Negotiated Rate |
$3,785.15 |
| Rate for Payer: Aetna Commercial |
$3,207.90
|
| Rate for Payer: Aetna Medicare |
$981.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,179.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,179.38
|
| Rate for Payer: BCBS Complete |
$3,785.15
|
| Rate for Payer: BCBS MAPPO |
$943.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,934.28
|
| Rate for Payer: BCN Commercial |
$2,934.28
|
| Rate for Payer: BCN Medicare Advantage |
$943.50
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,245.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.50
|
| Rate for Payer: Healthscope Commercial |
$3,396.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,830.50
|
| Rate for Payer: Mclaren Medicaid |
$3,604.90
|
| Rate for Payer: Meridian Medicaid |
$3,785.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$990.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,085.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PACE Senior Care Partners |
$896.32
|
| Rate for Payer: PACE SWMI |
$943.50
|
| Rate for Payer: PHP Commercial |
$3,207.90
|
| Rate for Payer: PHP Medicare Advantage |
$943.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,604.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,283.38
|
| Rate for Payer: Priority Health Medicare |
$943.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,301.76
|
| Rate for Payer: Railroad Medicare Medicare |
$943.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,321.12
|
| Rate for Payer: UHC Core |
$3,151.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$943.50
|
| Rate for Payer: UHC Medicare Advantage |
$971.80
|
| Rate for Payer: VA VA |
$943.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.50
|
|
|
HC SP Z ANGIO SUPERSELECT RENAL UNI
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
36100349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,301.76 |
| Max. Negotiated Rate |
$3,396.60 |
| Rate for Payer: Aetna Commercial |
$3,207.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,916.55
|
| Rate for Payer: BCN Commercial |
$2,916.55
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,245.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Healthscope Commercial |
$3,396.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,830.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PHP Commercial |
$3,207.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,283.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,301.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,321.12
|
| Rate for Payer: UHC Core |
$3,151.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.50
|
|
|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
IP
|
$406.40
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.86 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: BCBS Trust/PPO |
$314.07
|
| Rate for Payer: BCN Commercial |
$314.07
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.12
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.63
|
| Rate for Payer: UHC Core |
$339.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.80
|
|
