|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
OP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.22 |
| Max. Negotiated Rate |
$178.93 |
| Rate for Payer: Aetna Commercial |
$168.99
|
| Rate for Payer: Aetna Medicare |
$51.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.13
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$49.70
|
| Rate for Payer: BCBS Trust/PPO |
$163.44
|
| Rate for Payer: BCN Commercial |
$154.57
|
| Rate for Payer: BCN Medicare Advantage |
$49.70
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$170.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.70
|
| Rate for Payer: Healthscope Commercial |
$178.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.11
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.19
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: Nomi Health Commercial |
$163.02
|
| Rate for Payer: PACE Senior Care Partners |
$47.22
|
| Rate for Payer: PACE SWMI |
$49.70
|
| Rate for Payer: PHP Commercial |
$168.99
|
| Rate for Payer: PHP Medicare Advantage |
$49.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: Priority Health HMO/PPO |
$172.96
|
| Rate for Payer: Priority Health Medicare |
$50.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.20
|
| Rate for Payer: Railroad Medicare Medicare |
$49.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.95
|
| Rate for Payer: UHC Core |
$166.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.70
|
| Rate for Payer: UHC Exchange |
$49.70
|
| Rate for Payer: UHC Medicare Advantage |
$49.70
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$49.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.11
|
|
|
HC NASAL BONES COMP MIN 3 VW
|
Facility
|
IP
|
$198.81
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.23 |
| Max. Negotiated Rate |
$178.93 |
| Rate for Payer: Aetna Commercial |
$168.99
|
| Rate for Payer: BCBS Trust/PPO |
$162.29
|
| Rate for Payer: BCN Commercial |
$153.64
|
| Rate for Payer: Cash Price |
$159.05
|
| Rate for Payer: Cofinity Commercial |
$170.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.05
|
| Rate for Payer: Healthscope Commercial |
$178.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.99
|
| Rate for Payer: Nomi Health Commercial |
$163.02
|
| Rate for Payer: PHP Commercial |
$168.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.23
|
| Rate for Payer: Priority Health HMO/PPO |
$172.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.95
|
| Rate for Payer: UHC Core |
$166.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.11
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.78 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Aetna Commercial |
$217.52
|
| Rate for Payer: Aetna Medicare |
$66.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.97
|
| Rate for Payer: BCBS Complete |
$144.41
|
| Rate for Payer: BCBS MAPPO |
$63.98
|
| Rate for Payer: BCBS Trust/PPO |
$210.38
|
| Rate for Payer: BCN Commercial |
$198.96
|
| Rate for Payer: BCN Medicare Advantage |
$63.98
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.98
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.92
|
| Rate for Payer: Mclaren Medicaid |
$137.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.17
|
| Rate for Payer: Meridian Medicaid |
$144.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: PACE Senior Care Partners |
$60.78
|
| Rate for Payer: PACE SWMI |
$63.98
|
| Rate for Payer: PHP Commercial |
$217.52
|
| Rate for Payer: PHP Medicare Advantage |
$63.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO |
$222.63
|
| Rate for Payer: Priority Health Medicare |
$64.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.45
|
| Rate for Payer: Railroad Medicare Medicare |
$63.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.19
|
| Rate for Payer: UHC Core |
$213.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.98
|
| Rate for Payer: UHC Exchange |
$63.98
|
| Rate for Payer: UHC Medicare Advantage |
$63.98
|
| Rate for Payer: UHCCP Medicaid |
$137.52
|
| Rate for Payer: VA VA |
$63.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.92
|
|
|
HC NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
76100183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Aetna Commercial |
$217.52
|
| Rate for Payer: BCBS Trust/PPO |
$208.89
|
| Rate for Payer: BCN Commercial |
$197.76
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: PHP Commercial |
$217.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO |
$222.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.19
|
| Rate for Payer: UHC Core |
$213.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.92
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
OP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,053.79 |
| Max. Negotiated Rate |
$3,993.30 |
| Rate for Payer: Aetna Commercial |
$3,771.45
|
| Rate for Payer: Aetna Medicare |
$1,153.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,386.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,386.56
|
| Rate for Payer: BCBS Complete |
$1,282.74
|
| Rate for Payer: BCBS MAPPO |
$1,109.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,647.66
|
| Rate for Payer: BCN Commercial |
$3,449.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,109.25
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$3,815.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,109.25
|
| Rate for Payer: Healthscope Commercial |
$3,993.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,327.75
|
| Rate for Payer: Mclaren Medicaid |
$1,221.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,164.71
|
| Rate for Payer: Meridian Medicaid |
$1,282.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,275.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: Nomi Health Commercial |
$3,638.34
|
| Rate for Payer: PACE Senior Care Partners |
$1,053.79
|
| Rate for Payer: PACE SWMI |
$1,109.25
|
| Rate for Payer: PHP Commercial |
$3,771.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,109.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,221.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health HMO/PPO |
$3,860.19
|
| Rate for Payer: Priority Health Medicare |
$1,120.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,972.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,109.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,904.56
|
| Rate for Payer: UHC Core |
$3,704.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,109.25
|
| Rate for Payer: UHC Exchange |
$1,109.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,109.25
|
| Rate for Payer: UHCCP Medicaid |
$1,221.58
|
| Rate for Payer: VA VA |
$1,109.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,327.75
|
|
|
HC NASAL/SINUS ENDSC SURG W/BX POLYPEC/DBRD SPX
|
Facility
|
IP
|
$4,437.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,884.05 |
| Max. Negotiated Rate |
$3,993.30 |
| Rate for Payer: Aetna Commercial |
$3,771.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,621.92
|
| Rate for Payer: BCN Commercial |
$3,428.91
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$3,815.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,549.60
|
| Rate for Payer: Healthscope Commercial |
$3,993.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.45
|
| Rate for Payer: Nomi Health Commercial |
$3,638.34
|
| Rate for Payer: PHP Commercial |
$3,771.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health HMO/PPO |
$3,860.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,972.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,904.56
|
| Rate for Payer: UHC Core |
$3,704.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,327.75
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.34 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Aetna Commercial |
$217.52
|
| Rate for Payer: BCBS Trust/PPO |
$208.89
|
| Rate for Payer: BCN Commercial |
$197.76
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: PHP Commercial |
$217.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO |
$222.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.19
|
| Rate for Payer: UHC Core |
$213.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.92
|
|
|
HC NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$255.90
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.78 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Aetna Commercial |
$217.52
|
| Rate for Payer: Aetna Medicare |
$66.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.97
|
| Rate for Payer: BCBS Complete |
$144.41
|
| Rate for Payer: BCBS MAPPO |
$63.98
|
| Rate for Payer: BCBS Trust/PPO |
$210.38
|
| Rate for Payer: BCN Commercial |
$198.96
|
| Rate for Payer: BCN Medicare Advantage |
$63.98
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cash Price |
$204.72
|
| Rate for Payer: Cofinity Commercial |
$220.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.98
|
| Rate for Payer: Healthscope Commercial |
$230.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.92
|
| Rate for Payer: Mclaren Medicaid |
$137.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.17
|
| Rate for Payer: Meridian Medicaid |
$144.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.52
|
| Rate for Payer: Nomi Health Commercial |
$209.84
|
| Rate for Payer: PACE Senior Care Partners |
$60.78
|
| Rate for Payer: PACE SWMI |
$63.98
|
| Rate for Payer: PHP Commercial |
$217.52
|
| Rate for Payer: PHP Medicare Advantage |
$63.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.34
|
| Rate for Payer: Priority Health HMO/PPO |
$222.63
|
| Rate for Payer: Priority Health Medicare |
$64.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.45
|
| Rate for Payer: Railroad Medicare Medicare |
$63.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.19
|
| Rate for Payer: UHC Core |
$213.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.98
|
| Rate for Payer: UHC Exchange |
$63.98
|
| Rate for Payer: UHC Medicare Advantage |
$63.98
|
| Rate for Payer: UHCCP Medicaid |
$137.52
|
| Rate for Payer: VA VA |
$63.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.92
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,895.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$4,264.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,125.00
|
| Rate for Payer: BCBS Complete |
$4,400.36
|
| Rate for Payer: BCBS MAPPO |
$4,100.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,482.44
|
| Rate for Payer: BCN Commercial |
$12,751.00
|
| Rate for Payer: BCN Medicare Advantage |
$4,100.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,100.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Mclaren Medicaid |
$4,190.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,305.00
|
| Rate for Payer: Meridian Medicaid |
$4,400.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,715.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PACE Senior Care Partners |
$3,895.00
|
| Rate for Payer: PACE SWMI |
$4,100.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$4,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,190.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO |
$14,268.00
|
| Rate for Payer: Priority Health Medicare |
$4,141.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,988.00
|
| Rate for Payer: Railroad Medicare Medicare |
$4,100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,432.00
|
| Rate for Payer: UHC Core |
$13,694.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,100.00
|
| Rate for Payer: UHC Exchange |
$4,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,100.00
|
| Rate for Payer: UHCCP Medicaid |
$4,190.54
|
| Rate for Payer: VA VA |
$4,100.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69706
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,660.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,387.32
|
| Rate for Payer: BCN Commercial |
$12,673.92
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO |
$14,268.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,988.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,432.00
|
| Rate for Payer: UHC Core |
$13,694.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
OP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,895.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: Aetna Medicare |
$4,264.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,125.00
|
| Rate for Payer: BCBS Complete |
$4,400.36
|
| Rate for Payer: BCBS MAPPO |
$4,100.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,482.44
|
| Rate for Payer: BCN Commercial |
$12,751.00
|
| Rate for Payer: BCN Medicare Advantage |
$4,100.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,100.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Mclaren Medicaid |
$4,190.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,305.00
|
| Rate for Payer: Meridian Medicaid |
$4,400.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,715.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PACE Senior Care Partners |
$3,895.00
|
| Rate for Payer: PACE SWMI |
$4,100.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: PHP Medicare Advantage |
$4,100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,190.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO |
$14,268.00
|
| Rate for Payer: Priority Health Medicare |
$4,141.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,988.00
|
| Rate for Payer: Railroad Medicare Medicare |
$4,100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,432.00
|
| Rate for Payer: UHC Core |
$13,694.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,100.00
|
| Rate for Payer: UHC Exchange |
$4,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,100.00
|
| Rate for Payer: UHCCP Medicaid |
$4,190.54
|
| Rate for Payer: VA VA |
$4,100.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Facility
|
IP
|
$16,400.00
|
|
|
Service Code
|
CPT 69705
|
| Hospital Charge Code |
76100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,660.00 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna Commercial |
$13,940.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,387.32
|
| Rate for Payer: BCN Commercial |
$12,673.92
|
| Rate for Payer: Cash Price |
$13,120.00
|
| Rate for Payer: Cofinity Commercial |
$14,104.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,120.00
|
| Rate for Payer: Healthscope Commercial |
$14,760.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,940.00
|
| Rate for Payer: Nomi Health Commercial |
$13,448.00
|
| Rate for Payer: PHP Commercial |
$13,940.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,660.00
|
| Rate for Payer: Priority Health HMO/PPO |
$14,268.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,988.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,432.00
|
| Rate for Payer: UHC Core |
$13,694.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,300.00
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
IP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$251.03 |
| Rate for Payer: Aetna Commercial |
$237.08
|
| Rate for Payer: BCBS Trust/PPO |
$227.68
|
| Rate for Payer: BCN Commercial |
$215.55
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$239.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Healthscope Commercial |
$251.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: Nomi Health Commercial |
$228.71
|
| Rate for Payer: PHP Commercial |
$237.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health HMO/PPO |
$242.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.45
|
| Rate for Payer: UHC Core |
$232.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.19
|
|
|
HC NASOTRACHEAL SUCTION
|
Facility
|
OP
|
$278.92
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
41000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$251.03 |
| Rate for Payer: Aetna Commercial |
$237.08
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$151.29
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$229.30
|
| Rate for Payer: BCN Commercial |
$216.86
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cash Price |
$223.14
|
| Rate for Payer: Cofinity Commercial |
$239.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$251.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.19
|
| Rate for Payer: Mclaren Medicaid |
$144.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$151.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.08
|
| Rate for Payer: Nomi Health Commercial |
$228.71
|
| Rate for Payer: PACE Senior Care Partners |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$237.08
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.30
|
| Rate for Payer: Priority Health HMO/PPO |
$242.66
|
| Rate for Payer: Priority Health Medicare |
$70.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.88
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.45
|
| Rate for Payer: UHC Core |
$232.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$69.73
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$144.08
|
| Rate for Payer: VA VA |
$69.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.19
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC NCCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,480.12 |
| Max. Negotiated Rate |
$2,049.39 |
| Rate for Payer: Aetna Commercial |
$1,935.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.80
|
| Rate for Payer: BCN Commercial |
$1,759.74
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$1,958.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Healthscope Commercial |
$2,049.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: Nomi Health Commercial |
$1,867.22
|
| Rate for Payer: PHP Commercial |
$1,935.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health HMO/PPO |
$1,981.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,525.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,003.85
|
| Rate for Payer: UHC Core |
$1,901.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.82
|
|
|
HC NCS 11-12 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,277.10
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
92200032
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$375.87 |
| Max. Negotiated Rate |
$2,049.39 |
| Rate for Payer: Aetna Commercial |
$1,935.54
|
| Rate for Payer: Aetna Medicare |
$592.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$711.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$711.59
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$569.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.00
|
| Rate for Payer: BCN Commercial |
$1,770.45
|
| Rate for Payer: BCN Medicare Advantage |
$569.28
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cash Price |
$1,821.68
|
| Rate for Payer: Cofinity Commercial |
$1,958.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.28
|
| Rate for Payer: Healthscope Commercial |
$2,049.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.82
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$597.74
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$654.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.54
|
| Rate for Payer: Nomi Health Commercial |
$1,867.22
|
| Rate for Payer: PACE Senior Care Partners |
$540.81
|
| Rate for Payer: PACE SWMI |
$569.28
|
| Rate for Payer: PHP Commercial |
$1,935.54
|
| Rate for Payer: PHP Medicare Advantage |
$569.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.12
|
| Rate for Payer: Priority Health HMO/PPO |
$1,981.08
|
| Rate for Payer: Priority Health Medicare |
$574.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,525.66
|
| Rate for Payer: Railroad Medicare Medicare |
$569.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,003.85
|
| Rate for Payer: UHC Core |
$1,901.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.28
|
| Rate for Payer: UHC Exchange |
$569.28
|
| Rate for Payer: UHC Medicare Advantage |
$569.28
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$569.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.82
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$494.34
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$420.19
|
| Rate for Payer: BCBS Trust/PPO |
$403.53
|
| Rate for Payer: BCN Commercial |
$382.03
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$425.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Healthscope Commercial |
$444.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: Nomi Health Commercial |
$405.36
|
| Rate for Payer: PHP Commercial |
$420.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: Priority Health HMO/PPO |
$430.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.02
|
| Rate for Payer: UHC Core |
$412.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.76
|
|
|
HC NCS 1-2 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$494.34
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
92200027
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$420.19
|
| Rate for Payer: Aetna Medicare |
$128.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.48
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$123.58
|
| Rate for Payer: BCBS Trust/PPO |
$406.40
|
| Rate for Payer: BCN Commercial |
$384.35
|
| Rate for Payer: BCN Medicare Advantage |
$123.58
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cash Price |
$395.47
|
| Rate for Payer: Cofinity Commercial |
$425.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$444.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.76
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.76
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.19
|
| Rate for Payer: Nomi Health Commercial |
$405.36
|
| Rate for Payer: PACE Senior Care Partners |
$117.41
|
| Rate for Payer: PACE SWMI |
$123.58
|
| Rate for Payer: PHP Commercial |
$420.19
|
| Rate for Payer: PHP Medicare Advantage |
$123.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.32
|
| Rate for Payer: Priority Health HMO/PPO |
$430.08
|
| Rate for Payer: Priority Health Medicare |
$124.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.21
|
| Rate for Payer: Railroad Medicare Medicare |
$123.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.02
|
| Rate for Payer: UHC Core |
$412.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.58
|
| Rate for Payer: UHC Exchange |
$123.58
|
| Rate for Payer: UHC Medicare Advantage |
$123.58
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$123.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.76
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$2,954.43
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,920.38 |
| Max. Negotiated Rate |
$2,658.99 |
| Rate for Payer: Aetna Commercial |
$2,511.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,411.70
|
| Rate for Payer: BCN Commercial |
$2,283.18
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cofinity Commercial |
$2,540.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,363.54
|
| Rate for Payer: Healthscope Commercial |
$2,658.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,215.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: Nomi Health Commercial |
$2,422.63
|
| Rate for Payer: PHP Commercial |
$2,511.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: Priority Health HMO/PPO |
$2,570.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,979.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,599.90
|
| Rate for Payer: UHC Core |
$2,466.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,215.82
|
|
|
HC NCS 13 OR MORE STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$2,954.43
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
92200033
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$375.87 |
| Max. Negotiated Rate |
$2,658.99 |
| Rate for Payer: Aetna Commercial |
$2,511.27
|
| Rate for Payer: Aetna Medicare |
$768.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$923.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$923.26
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$738.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,428.84
|
| Rate for Payer: BCN Commercial |
$2,297.07
|
| Rate for Payer: BCN Medicare Advantage |
$738.61
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cash Price |
$2,363.54
|
| Rate for Payer: Cofinity Commercial |
$2,540.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,363.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.61
|
| Rate for Payer: Healthscope Commercial |
$2,658.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,215.82
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$775.54
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$849.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,511.27
|
| Rate for Payer: Nomi Health Commercial |
$2,422.63
|
| Rate for Payer: PACE Senior Care Partners |
$701.68
|
| Rate for Payer: PACE SWMI |
$738.61
|
| Rate for Payer: PHP Commercial |
$2,511.27
|
| Rate for Payer: PHP Medicare Advantage |
$738.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,920.38
|
| Rate for Payer: Priority Health HMO/PPO |
$2,570.35
|
| Rate for Payer: Priority Health Medicare |
$745.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,979.47
|
| Rate for Payer: Railroad Medicare Medicare |
$738.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,599.90
|
| Rate for Payer: UHC Core |
$2,466.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$738.61
|
| Rate for Payer: UHC Exchange |
$738.61
|
| Rate for Payer: UHC Medicare Advantage |
$738.61
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$738.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,215.82
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$913.43
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$216.94 |
| Max. Negotiated Rate |
$822.09 |
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna Medicare |
$237.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$285.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$285.45
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$228.36
|
| Rate for Payer: BCBS Trust/PPO |
$750.93
|
| Rate for Payer: BCN Commercial |
$710.19
|
| Rate for Payer: BCN Medicare Advantage |
$228.36
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.36
|
| Rate for Payer: Healthscope Commercial |
$822.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.07
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$239.78
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: Nomi Health Commercial |
$749.01
|
| Rate for Payer: PACE Senior Care Partners |
$216.94
|
| Rate for Payer: PACE SWMI |
$228.36
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: PHP Medicare Advantage |
$228.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: Priority Health HMO/PPO |
$794.68
|
| Rate for Payer: Priority Health Medicare |
$230.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.00
|
| Rate for Payer: Railroad Medicare Medicare |
$228.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.82
|
| Rate for Payer: UHC Core |
$762.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.36
|
| Rate for Payer: UHC Exchange |
$228.36
|
| Rate for Payer: UHC Medicare Advantage |
$228.36
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$228.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.07
|
|
|
HC NCS 3-4 STUDIES INCL F&H WAVES
|
Facility
|
IP
|
$913.43
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
92200028
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$593.73 |
| Max. Negotiated Rate |
$822.09 |
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: BCBS Trust/PPO |
$745.63
|
| Rate for Payer: BCN Commercial |
$705.90
|
| Rate for Payer: Cash Price |
$730.74
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.74
|
| Rate for Payer: Healthscope Commercial |
$822.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: Nomi Health Commercial |
$749.01
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.73
|
| Rate for Payer: Priority Health HMO/PPO |
$794.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.82
|
| Rate for Payer: UHC Core |
$762.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.07
|
|
|
HC NCS 5-6 STUDIES INCL F&H WAVES
|
Facility
|
OP
|
$1,128.89
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
92200029
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna Commercial |
$959.56
|
| Rate for Payer: Aetna Medicare |
$293.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$352.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$352.78
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$282.22
|
| Rate for Payer: BCBS Trust/PPO |
$928.06
|
| Rate for Payer: BCN Commercial |
$877.71
|
| Rate for Payer: BCN Medicare Advantage |
$282.22
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$970.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.22
|
| Rate for Payer: Healthscope Commercial |
$1,016.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.67
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.33
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.56
|
| Rate for Payer: Nomi Health Commercial |
$925.69
|
| Rate for Payer: PACE Senior Care Partners |
$268.11
|
| Rate for Payer: PACE SWMI |
$282.22
|
| Rate for Payer: PHP Commercial |
$959.56
|
| Rate for Payer: PHP Medicare Advantage |
$282.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.78
|
| Rate for Payer: Priority Health HMO/PPO |
$982.13
|
| Rate for Payer: Priority Health Medicare |
$285.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$756.36
|
| Rate for Payer: Railroad Medicare Medicare |
$282.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.42
|
| Rate for Payer: UHC Core |
$942.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.22
|
| Rate for Payer: UHC Exchange |
$282.22
|
| Rate for Payer: UHC Medicare Advantage |
$282.22
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$282.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.67
|
|
