|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$4,034.29
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$711.25 |
| Max. Negotiated Rate |
$3,630.86 |
| Rate for Payer: Aetna Commercial |
$3,429.15
|
| Rate for Payer: Aetna Medicare |
$1,048.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,260.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,260.72
|
| Rate for Payer: BCBS Complete |
$746.75
|
| Rate for Payer: BCBS MAPPO |
$1,008.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,316.59
|
| Rate for Payer: BCN Commercial |
$3,316.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,008.57
|
| Rate for Payer: Cash Price |
$3,227.43
|
| Rate for Payer: Cofinity Commercial |
$3,469.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,227.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,008.57
|
| Rate for Payer: Healthscope Commercial |
$3,630.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,025.72
|
| Rate for Payer: Mclaren Medicaid |
$711.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,059.00
|
| Rate for Payer: Meridian Medicaid |
$746.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,159.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,109.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,429.15
|
| Rate for Payer: Nomi Health Commercial |
$3,308.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,025.72
|
| Rate for Payer: PACE Senior Care Partners |
$958.14
|
| Rate for Payer: PACE SWMI |
$1,008.57
|
| Rate for Payer: PHP Commercial |
$3,429.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,008.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,509.83
|
| Rate for Payer: Priority Health Medicare |
$1,018.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,807.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,008.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,550.18
|
| Rate for Payer: UHC Core |
$3,368.63
|
| Rate for Payer: UHC Exchange |
$1,008.57
|
| Rate for Payer: UHC Medicaid |
$711.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,008.57
|
| Rate for Payer: UHCCP Medicaid |
$711.25
|
| Rate for Payer: VA VA |
$1,008.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,025.72
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,777.66 |
| Max. Negotiated Rate |
$8,764.22 |
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: BCBS Trust/PPO |
$8,042.63
|
| Rate for Payer: BCN Commercial |
$8,042.63
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,303.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,472.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,777.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,569.46
|
| Rate for Payer: UHC Core |
$8,131.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,303.52
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,738.02
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,716.81 |
| Max. Negotiated Rate |
$8,764.22 |
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: Aetna Medicare |
$2,531.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,043.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,043.13
|
| Rate for Payer: BCBS Complete |
$1,802.51
|
| Rate for Payer: BCBS MAPPO |
$2,434.51
|
| Rate for Payer: BCBS Trust/PPO |
$8,005.63
|
| Rate for Payer: BCN Commercial |
$8,005.63
|
| Rate for Payer: BCN Medicare Advantage |
$2,434.51
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,434.51
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,303.52
|
| Rate for Payer: Mclaren Medicaid |
$1,716.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,556.23
|
| Rate for Payer: Meridian Medicaid |
$1,802.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,799.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,677.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PACE Senior Care Partners |
$2,312.78
|
| Rate for Payer: PACE SWMI |
$2,434.51
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: PHP Medicare Advantage |
$2,434.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,716.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,472.08
|
| Rate for Payer: Priority Health Medicare |
$2,458.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,777.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,434.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,569.46
|
| Rate for Payer: UHC Core |
$8,131.25
|
| Rate for Payer: UHC Exchange |
$2,434.51
|
| Rate for Payer: UHC Medicaid |
$1,716.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,434.51
|
| Rate for Payer: UHCCP Medicaid |
$1,716.81
|
| Rate for Payer: VA VA |
$2,434.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,303.52
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$63.38 |
| Max. Negotiated Rate |
$323.54 |
| Rate for Payer: Aetna Commercial |
$305.57
|
| Rate for Payer: Aetna Medicare |
$93.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.34
|
| Rate for Payer: BCBS Complete |
$66.54
|
| Rate for Payer: BCBS MAPPO |
$89.87
|
| Rate for Payer: BCBS Trust/PPO |
$295.54
|
| Rate for Payer: BCN Commercial |
$295.54
|
| Rate for Payer: BCN Medicare Advantage |
$89.87
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Commercial |
$309.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.87
|
| Rate for Payer: Healthscope Commercial |
$323.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.62
|
| Rate for Payer: Mclaren Medicaid |
$63.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.37
|
| Rate for Payer: Meridian Medicaid |
$66.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Nomi Health Commercial |
$294.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: PACE Senior Care Partners |
$85.38
|
| Rate for Payer: PACE SWMI |
$89.87
|
| Rate for Payer: PHP Commercial |
$305.57
|
| Rate for Payer: PHP Medicare Advantage |
$89.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.76
|
| Rate for Payer: Priority Health Medicare |
$90.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.21
|
| Rate for Payer: Railroad Medicare Medicare |
$89.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.35
|
| Rate for Payer: UHC Core |
$300.17
|
| Rate for Payer: UHC Exchange |
$89.87
|
| Rate for Payer: UHC Medicaid |
$63.38
|
| Rate for Payer: UHC Medicare Advantage |
$89.87
|
| Rate for Payer: UHCCP Medicaid |
$63.38
|
| Rate for Payer: VA VA |
$89.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.62
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$359.49
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$323.54 |
| Rate for Payer: Aetna Commercial |
$305.57
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$296.90
|
| Rate for Payer: Cash Price |
$287.59
|
| Rate for Payer: Cofinity Commercial |
$309.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.59
|
| Rate for Payer: Healthscope Commercial |
$323.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.57
|
| Rate for Payer: Nomi Health Commercial |
$294.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.62
|
| Rate for Payer: PHP Commercial |
$305.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.35
|
| Rate for Payer: UHC Core |
$300.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.62
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$595.60 |
| Max. Negotiated Rate |
$3,040.49 |
| Rate for Payer: Aetna Commercial |
$2,871.57
|
| Rate for Payer: Aetna Medicare |
$878.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,055.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,055.72
|
| Rate for Payer: BCBS Complete |
$625.33
|
| Rate for Payer: BCBS MAPPO |
$844.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,777.32
|
| Rate for Payer: BCN Commercial |
$2,777.32
|
| Rate for Payer: BCN Medicare Advantage |
$844.58
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Commercial |
$2,905.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$844.58
|
| Rate for Payer: Healthscope Commercial |
$3,040.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,533.74
|
| Rate for Payer: Mclaren Medicaid |
$595.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$886.81
|
| Rate for Payer: Meridian Medicaid |
$625.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$971.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$929.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Nomi Health Commercial |
$2,770.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: PACE Senior Care Partners |
$802.35
|
| Rate for Payer: PACE SWMI |
$844.58
|
| Rate for Payer: PHP Commercial |
$2,871.57
|
| Rate for Payer: PHP Medicare Advantage |
$844.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,939.14
|
| Rate for Payer: Priority Health Medicare |
$853.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,351.31
|
| Rate for Payer: Railroad Medicare Medicare |
$844.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,972.92
|
| Rate for Payer: UHC Core |
$2,820.90
|
| Rate for Payer: UHC Exchange |
$844.58
|
| Rate for Payer: UHC Medicaid |
$595.60
|
| Rate for Payer: UHC Medicare Advantage |
$844.58
|
| Rate for Payer: UHCCP Medicaid |
$595.60
|
| Rate for Payer: VA VA |
$844.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,533.74
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,378.32
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.31 |
| Max. Negotiated Rate |
$3,040.49 |
| Rate for Payer: Aetna Commercial |
$2,871.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,790.15
|
| Rate for Payer: BCN Commercial |
$2,790.15
|
| Rate for Payer: Cash Price |
$2,702.66
|
| Rate for Payer: Cofinity Commercial |
$2,905.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,702.66
|
| Rate for Payer: Healthscope Commercial |
$3,040.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,533.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,871.57
|
| Rate for Payer: Nomi Health Commercial |
$2,770.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.74
|
| Rate for Payer: PHP Commercial |
$2,871.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,939.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,351.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,972.92
|
| Rate for Payer: UHC Core |
$2,820.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,533.74
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,206.34 |
| Max. Negotiated Rate |
$4,146.13 |
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,804.76
|
| Rate for Payer: BCN Commercial |
$3,804.76
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Commercial |
$3,961.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Healthscope Commercial |
$4,146.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,455.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Nomi Health Commercial |
$3,777.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: PHP Commercial |
$3,915.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,007.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,206.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,053.99
|
| Rate for Payer: UHC Core |
$3,846.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,455.11
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,606.81
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$812.18 |
| Max. Negotiated Rate |
$4,146.13 |
| Rate for Payer: Aetna Commercial |
$3,915.79
|
| Rate for Payer: Aetna Medicare |
$1,197.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,439.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,439.63
|
| Rate for Payer: BCBS Complete |
$852.72
|
| Rate for Payer: BCBS MAPPO |
$1,151.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,787.26
|
| Rate for Payer: BCN Commercial |
$3,787.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,151.70
|
| Rate for Payer: Cash Price |
$3,685.45
|
| Rate for Payer: Cofinity Commercial |
$3,961.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,685.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,151.70
|
| Rate for Payer: Healthscope Commercial |
$4,146.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,455.11
|
| Rate for Payer: Mclaren Medicaid |
$812.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,209.29
|
| Rate for Payer: Meridian Medicaid |
$852.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,324.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,266.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,915.79
|
| Rate for Payer: Nomi Health Commercial |
$3,777.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,455.11
|
| Rate for Payer: PACE Senior Care Partners |
$1,094.12
|
| Rate for Payer: PACE SWMI |
$1,151.70
|
| Rate for Payer: PHP Commercial |
$3,915.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,151.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,007.92
|
| Rate for Payer: Priority Health Medicare |
$1,163.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,206.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,151.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,053.99
|
| Rate for Payer: UHC Core |
$3,846.69
|
| Rate for Payer: UHC Exchange |
$1,151.70
|
| Rate for Payer: UHC Medicaid |
$812.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,151.70
|
| Rate for Payer: UHCCP Medicaid |
$812.18
|
| Rate for Payer: VA VA |
$1,151.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,455.11
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: BCBS Trust/PPO |
$21.04
|
| Rate for Payer: BCN Commercial |
$21.04
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.41
|
| Rate for Payer: UHC Core |
$21.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$25.47
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.71
|
| Rate for Payer: BCBS MAPPO |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$20.94
|
| Rate for Payer: BCN Commercial |
$20.94
|
| Rate for Payer: BCN Medicare Advantage |
$6.37
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.37
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PACE Senior Care Partners |
$6.05
|
| Rate for Payer: PACE SWMI |
$6.37
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Medicare Advantage |
$6.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.16
|
| Rate for Payer: Priority Health Medicare |
$6.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.41
|
| Rate for Payer: UHC Core |
$21.27
|
| Rate for Payer: UHC Exchange |
$6.37
|
| Rate for Payer: UHC Medicaid |
$4.49
|
| Rate for Payer: UHC Medicare Advantage |
$6.37
|
| Rate for Payer: UHCCP Medicaid |
$4.49
|
| Rate for Payer: VA VA |
$6.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: BCBS Trust/PPO |
$36.95
|
| Rate for Payer: BCN Commercial |
$36.95
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.37
|
| Rate for Payer: UHC Core |
$37.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$11.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.98
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$36.78
|
| Rate for Payer: BCN Commercial |
$36.78
|
| Rate for Payer: BCN Medicare Advantage |
$11.19
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.19
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: Mclaren Medicaid |
$7.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.74
|
| Rate for Payer: Meridian Medicaid |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PACE Senior Care Partners |
$10.63
|
| Rate for Payer: PACE SWMI |
$11.19
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$11.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.92
|
| Rate for Payer: Priority Health Medicare |
$11.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.14
|
| Rate for Payer: Railroad Medicare Medicare |
$11.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.37
|
| Rate for Payer: UHC Core |
$37.36
|
| Rate for Payer: UHC Exchange |
$11.19
|
| Rate for Payer: UHC Medicaid |
$7.89
|
| Rate for Payer: UHC Medicare Advantage |
$11.19
|
| Rate for Payer: UHCCP Medicaid |
$7.89
|
| Rate for Payer: VA VA |
$11.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.28 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: BCBS Trust/PPO |
$349.21
|
| Rate for Payer: BCN Commercial |
$349.21
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Nomi Health Commercial |
$346.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.08
|
| Rate for Payer: UHC Core |
$353.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.12
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$422.82
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.54 |
| Max. Negotiated Rate |
$380.54 |
| Rate for Payer: Aetna Commercial |
$359.40
|
| Rate for Payer: Aetna Medicare |
$109.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.13
|
| Rate for Payer: BCBS Complete |
$78.26
|
| Rate for Payer: BCBS MAPPO |
$105.70
|
| Rate for Payer: BCBS Trust/PPO |
$347.60
|
| Rate for Payer: BCN Commercial |
$347.60
|
| Rate for Payer: BCN Medicare Advantage |
$105.70
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cash Price |
$338.26
|
| Rate for Payer: Cofinity Commercial |
$363.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.70
|
| Rate for Payer: Healthscope Commercial |
$380.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.12
|
| Rate for Payer: Mclaren Medicaid |
$74.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.99
|
| Rate for Payer: Meridian Medicaid |
$78.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.40
|
| Rate for Payer: Nomi Health Commercial |
$346.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.12
|
| Rate for Payer: PACE Senior Care Partners |
$100.42
|
| Rate for Payer: PACE SWMI |
$105.70
|
| Rate for Payer: PHP Commercial |
$359.40
|
| Rate for Payer: PHP Medicare Advantage |
$105.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.85
|
| Rate for Payer: Priority Health Medicare |
$106.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.28
|
| Rate for Payer: Railroad Medicare Medicare |
$105.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.08
|
| Rate for Payer: UHC Core |
$353.05
|
| Rate for Payer: UHC Exchange |
$105.70
|
| Rate for Payer: UHC Medicaid |
$74.54
|
| Rate for Payer: UHC Medicare Advantage |
$105.70
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$105.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.12
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$673.19 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: BCBS Trust/PPO |
$798.84
|
| Rate for Payer: BCN Commercial |
$798.84
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$793.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PHP Commercial |
$822.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$841.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$673.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.16
|
| Rate for Payer: UHC Core |
$807.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.42
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: Aetna Medicare |
$251.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$302.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$302.26
|
| Rate for Payer: BCBS Complete |
$179.03
|
| Rate for Payer: BCBS MAPPO |
$241.81
|
| Rate for Payer: BCBS Trust/PPO |
$795.16
|
| Rate for Payer: BCN Commercial |
$795.16
|
| Rate for Payer: BCN Medicare Advantage |
$241.81
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.81
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$725.42
|
| Rate for Payer: Mclaren Medicaid |
$170.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.90
|
| Rate for Payer: Meridian Medicaid |
$179.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$793.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PACE Senior Care Partners |
$229.72
|
| Rate for Payer: PACE SWMI |
$241.81
|
| Rate for Payer: PHP Commercial |
$822.15
|
| Rate for Payer: PHP Medicare Advantage |
$241.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$841.49
|
| Rate for Payer: Priority Health Medicare |
$244.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$673.19
|
| Rate for Payer: Railroad Medicare Medicare |
$241.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.16
|
| Rate for Payer: UHC Core |
$807.64
|
| Rate for Payer: UHC Exchange |
$241.81
|
| Rate for Payer: UHC Medicaid |
$170.52
|
| Rate for Payer: UHC Medicare Advantage |
$241.81
|
| Rate for Payer: UHCCP Medicaid |
$170.52
|
| Rate for Payer: VA VA |
$241.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$725.42
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$220.29
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$198.26 |
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: Aetna Medicare |
$57.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.84
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: BCBS MAPPO |
$55.07
|
| Rate for Payer: BCBS Trust/PPO |
$181.10
|
| Rate for Payer: BCN Commercial |
$181.10
|
| Rate for Payer: BCN Medicare Advantage |
$55.07
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cofinity Commercial |
$189.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.07
|
| Rate for Payer: Healthscope Commercial |
$198.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.22
|
| Rate for Payer: Mclaren Medicaid |
$38.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.83
|
| Rate for Payer: Meridian Medicaid |
$40.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.25
|
| Rate for Payer: Nomi Health Commercial |
$180.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.22
|
| Rate for Payer: PACE Senior Care Partners |
$52.32
|
| Rate for Payer: PACE SWMI |
$55.07
|
| Rate for Payer: PHP Commercial |
$187.25
|
| Rate for Payer: PHP Medicare Advantage |
$55.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.65
|
| Rate for Payer: Priority Health Medicare |
$55.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.32
|
| Rate for Payer: Railroad Medicare Medicare |
$55.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.86
|
| Rate for Payer: UHC Core |
$183.94
|
| Rate for Payer: UHC Exchange |
$55.07
|
| Rate for Payer: UHC Medicaid |
$38.84
|
| Rate for Payer: UHC Medicare Advantage |
$55.07
|
| Rate for Payer: UHCCP Medicaid |
$38.84
|
| Rate for Payer: VA VA |
$55.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.22
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$220.29
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.32 |
| Max. Negotiated Rate |
$198.26 |
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: BCBS Trust/PPO |
$181.94
|
| Rate for Payer: BCN Commercial |
$181.94
|
| Rate for Payer: Cash Price |
$176.23
|
| Rate for Payer: Cofinity Commercial |
$189.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.23
|
| Rate for Payer: Healthscope Commercial |
$198.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.25
|
| Rate for Payer: Nomi Health Commercial |
$180.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.22
|
| Rate for Payer: PHP Commercial |
$187.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.86
|
| Rate for Payer: UHC Core |
$183.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.22
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$437.62 |
| Max. Negotiated Rate |
$565.89 |
| Rate for Payer: Aetna Commercial |
$534.45
|
| Rate for Payer: BCBS Trust/PPO |
$519.30
|
| Rate for Payer: BCN Commercial |
$519.30
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Commercial |
$540.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Healthscope Commercial |
$565.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Nomi Health Commercial |
$515.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: PHP Commercial |
$534.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$547.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$437.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.32
|
| Rate for Payer: UHC Core |
$525.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.58
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$628.77
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.85 |
| Max. Negotiated Rate |
$565.89 |
| Rate for Payer: Aetna Commercial |
$534.45
|
| Rate for Payer: Aetna Medicare |
$163.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$196.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$196.49
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$157.19
|
| Rate for Payer: BCBS Trust/PPO |
$516.91
|
| Rate for Payer: BCN Commercial |
$516.91
|
| Rate for Payer: BCN Medicare Advantage |
$157.19
|
| Rate for Payer: Cash Price |
$503.02
|
| Rate for Payer: Cofinity Commercial |
$540.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$503.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.19
|
| Rate for Payer: Healthscope Commercial |
$565.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$471.58
|
| Rate for Payer: Mclaren Medicaid |
$110.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.05
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$172.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.45
|
| Rate for Payer: Nomi Health Commercial |
$515.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$471.58
|
| Rate for Payer: PACE Senior Care Partners |
$149.33
|
| Rate for Payer: PACE SWMI |
$157.19
|
| Rate for Payer: PHP Commercial |
$534.45
|
| Rate for Payer: PHP Medicare Advantage |
$157.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$547.03
|
| Rate for Payer: Priority Health Medicare |
$158.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$437.62
|
| Rate for Payer: Railroad Medicare Medicare |
$157.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.32
|
| Rate for Payer: UHC Core |
$525.02
|
| Rate for Payer: UHC Exchange |
$157.19
|
| Rate for Payer: UHC Medicaid |
$110.85
|
| Rate for Payer: UHC Medicare Advantage |
$157.19
|
| Rate for Payer: UHCCP Medicaid |
$110.85
|
| Rate for Payer: VA VA |
$157.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$471.58
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.54 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$285.22
|
| Rate for Payer: BCBS Trust/PPO |
$277.13
|
| Rate for Payer: BCN Commercial |
$277.13
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$288.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Nomi Health Commercial |
$275.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: PHP Commercial |
$285.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.28
|
| Rate for Payer: UHC Core |
$280.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.66
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$335.55
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$285.22
|
| Rate for Payer: Aetna Medicare |
$87.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.86
|
| Rate for Payer: BCBS Complete |
$62.11
|
| Rate for Payer: BCBS MAPPO |
$83.89
|
| Rate for Payer: BCBS Trust/PPO |
$275.86
|
| Rate for Payer: BCN Commercial |
$275.86
|
| Rate for Payer: BCN Medicare Advantage |
$83.89
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$288.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.89
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.66
|
| Rate for Payer: Mclaren Medicaid |
$59.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.08
|
| Rate for Payer: Meridian Medicaid |
$62.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.22
|
| Rate for Payer: Nomi Health Commercial |
$275.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.66
|
| Rate for Payer: PACE Senior Care Partners |
$79.69
|
| Rate for Payer: PACE SWMI |
$83.89
|
| Rate for Payer: PHP Commercial |
$285.22
|
| Rate for Payer: PHP Medicare Advantage |
$83.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.93
|
| Rate for Payer: Priority Health Medicare |
$84.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.54
|
| Rate for Payer: Railroad Medicare Medicare |
$83.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.28
|
| Rate for Payer: UHC Core |
$280.18
|
| Rate for Payer: UHC Exchange |
$83.89
|
| Rate for Payer: UHC Medicaid |
$59.16
|
| Rate for Payer: UHC Medicare Advantage |
$83.89
|
| Rate for Payer: UHCCP Medicaid |
$59.16
|
| Rate for Payer: VA VA |
$83.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.66
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$283.55 |
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: Aetna Medicare |
$81.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.46
|
| Rate for Payer: BCBS Complete |
$58.32
|
| Rate for Payer: BCBS MAPPO |
$78.77
|
| Rate for Payer: BCBS Trust/PPO |
$259.01
|
| Rate for Payer: BCN Commercial |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.77
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.29
|
| Rate for Payer: Mclaren Medicaid |
$55.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.70
|
| Rate for Payer: Meridian Medicaid |
$58.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: PACE Senior Care Partners |
$74.83
|
| Rate for Payer: PACE SWMI |
$78.77
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: PHP Medicare Advantage |
$78.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.10
|
| Rate for Payer: Priority Health Medicare |
$79.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.28
|
| Rate for Payer: Railroad Medicare Medicare |
$78.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.25
|
| Rate for Payer: UHC Core |
$263.08
|
| Rate for Payer: UHC Exchange |
$78.77
|
| Rate for Payer: UHC Medicaid |
$55.55
|
| Rate for Payer: UHC Medicare Advantage |
$78.77
|
| Rate for Payer: UHCCP Medicaid |
$55.55
|
| Rate for Payer: VA VA |
$78.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.29
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$315.06
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.28 |
| Max. Negotiated Rate |
$283.55 |
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: BCBS Trust/PPO |
$260.21
|
| Rate for Payer: BCN Commercial |
$260.21
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.29
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.25
|
| Rate for Payer: UHC Core |
$263.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.29
|
|
