|
HC TRACHEOBRNCHSC THRU EST TRACHS INC
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$792.87 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$1,105.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.64
|
| Rate for Payer: BCN Commercial |
$1,004.64
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cofinity Commercial |
$1,118.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.00
|
| Rate for Payer: Healthscope Commercial |
$1,170.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.00
|
| Rate for Payer: PHP Commercial |
$1,105.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$792.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.00
|
| Rate for Payer: UHC Core |
$1,085.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.00
|
|
|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,824.31 |
| Max. Negotiated Rate |
$7,119.00 |
| Rate for Payer: Aetna Commercial |
$6,723.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,112.85
|
| Rate for Payer: BCN Commercial |
$6,112.85
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cofinity Commercial |
$6,802.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,328.00
|
| Rate for Payer: Healthscope Commercial |
$7,119.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,932.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,723.50
|
| Rate for Payer: PHP Commercial |
$6,723.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,537.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,881.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,824.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,960.80
|
| Rate for Payer: UHC Core |
$6,604.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,932.50
|
|
|
HC TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
CPT 31613
|
| Hospital Charge Code |
76100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,878.62 |
| Max. Negotiated Rate |
$7,119.00 |
| Rate for Payer: Aetna Commercial |
$6,723.50
|
| Rate for Payer: Aetna Medicare |
$2,056.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,471.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,471.88
|
| Rate for Payer: BCBS Complete |
$2,217.64
|
| Rate for Payer: BCBS MAPPO |
$1,977.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,150.02
|
| Rate for Payer: BCN Commercial |
$6,150.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,977.50
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cash Price |
$6,328.00
|
| Rate for Payer: Cofinity Commercial |
$6,802.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,977.50
|
| Rate for Payer: Healthscope Commercial |
$7,119.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,932.50
|
| Rate for Payer: Mclaren Medicaid |
$2,112.04
|
| Rate for Payer: Meridian Medicaid |
$2,217.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,076.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,274.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,723.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,878.62
|
| Rate for Payer: PACE SWMI |
$1,977.50
|
| Rate for Payer: PHP Commercial |
$6,723.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,977.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,537.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,881.70
|
| Rate for Payer: Priority Health Medicare |
$1,977.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,824.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,977.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,960.80
|
| Rate for Payer: UHC Core |
$6,604.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,977.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,036.82
|
| Rate for Payer: VA VA |
$1,977.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,932.50
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
IP
|
$497.59
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.48 |
| Max. Negotiated Rate |
$447.83 |
| Rate for Payer: Aetna Commercial |
$422.95
|
| Rate for Payer: BCBS Trust/PPO |
$384.54
|
| Rate for Payer: BCN Commercial |
$384.54
|
| Rate for Payer: Cash Price |
$398.07
|
| Rate for Payer: Cofinity Commercial |
$427.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.07
|
| Rate for Payer: Healthscope Commercial |
$447.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.95
|
| Rate for Payer: PHP Commercial |
$422.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.88
|
| Rate for Payer: UHC Core |
$415.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.19
|
|
|
HC TRACH TUBE INSERTION
|
Facility
|
OP
|
$497.59
|
|
| Hospital Charge Code |
27000160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$118.18 |
| Max. Negotiated Rate |
$447.83 |
| Rate for Payer: Aetna Commercial |
$422.95
|
| Rate for Payer: Aetna Medicare |
$129.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.50
|
| Rate for Payer: BCBS Complete |
$199.04
|
| Rate for Payer: BCBS MAPPO |
$124.40
|
| Rate for Payer: BCBS Trust/PPO |
$386.88
|
| Rate for Payer: BCN Commercial |
$386.88
|
| Rate for Payer: BCN Medicare Advantage |
$124.40
|
| Rate for Payer: Cash Price |
$398.07
|
| Rate for Payer: Cofinity Commercial |
$427.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.40
|
| Rate for Payer: Healthscope Commercial |
$447.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$130.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.95
|
| Rate for Payer: PACE Senior Care Partners |
$118.18
|
| Rate for Payer: PACE SWMI |
$124.40
|
| Rate for Payer: PHP Commercial |
$422.95
|
| Rate for Payer: PHP Medicare Advantage |
$124.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.90
|
| Rate for Payer: Priority Health Medicare |
$124.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.48
|
| Rate for Payer: Railroad Medicare Medicare |
$124.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.88
|
| Rate for Payer: UHC Core |
$415.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.40
|
| Rate for Payer: UHC Medicare Advantage |
$128.13
|
| Rate for Payer: VA VA |
$124.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.19
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
OP
|
$174.08
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$168.25 |
| Rate for Payer: Aetna Commercial |
$147.97
|
| Rate for Payer: Aetna Medicare |
$45.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.40
|
| Rate for Payer: BCBS Complete |
$168.25
|
| Rate for Payer: BCBS MAPPO |
$43.52
|
| Rate for Payer: BCBS Trust/PPO |
$135.35
|
| Rate for Payer: BCN Commercial |
$135.35
|
| Rate for Payer: BCN Medicare Advantage |
$43.52
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cofinity Commercial |
$149.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.52
|
| Rate for Payer: Healthscope Commercial |
$156.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.56
|
| Rate for Payer: Mclaren Medicaid |
$160.23
|
| Rate for Payer: Meridian Medicaid |
$168.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.97
|
| Rate for Payer: PACE Senior Care Partners |
$41.34
|
| Rate for Payer: PACE SWMI |
$43.52
|
| Rate for Payer: PHP Commercial |
$147.97
|
| Rate for Payer: PHP Medicare Advantage |
$43.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.45
|
| Rate for Payer: Priority Health Medicare |
$43.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.17
|
| Rate for Payer: Railroad Medicare Medicare |
$43.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.19
|
| Rate for Payer: UHC Core |
$145.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.52
|
| Rate for Payer: UHC Medicare Advantage |
$44.83
|
| Rate for Payer: VA VA |
$43.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.56
|
|
|
HC TRACH TUBE REPLACEMENT
|
Facility
|
IP
|
$174.08
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.17 |
| Max. Negotiated Rate |
$156.67 |
| Rate for Payer: Aetna Commercial |
$147.97
|
| Rate for Payer: BCBS Trust/PPO |
$134.53
|
| Rate for Payer: BCN Commercial |
$134.53
|
| Rate for Payer: Cash Price |
$139.26
|
| Rate for Payer: Cofinity Commercial |
$149.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.26
|
| Rate for Payer: Healthscope Commercial |
$156.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.97
|
| Rate for Payer: PHP Commercial |
$147.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.19
|
| Rate for Payer: UHC Core |
$145.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.56
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.66
|
| Rate for Payer: BCBS Complete |
$46.92
|
| Rate for Payer: BCBS MAPPO |
$29.32
|
| Rate for Payer: BCBS Trust/PPO |
$91.20
|
| Rate for Payer: BCN Commercial |
$91.20
|
| Rate for Payer: BCN Medicare Advantage |
$29.32
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.32
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PACE Senior Care Partners |
$27.86
|
| Rate for Payer: PACE SWMI |
$29.32
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.05
|
| Rate for Payer: Priority Health Medicare |
$29.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.54
|
| Rate for Payer: Railroad Medicare Medicare |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$30.20
|
| Rate for Payer: VA VA |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC TRACTION MECHANICAL
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: BCBS Trust/PPO |
$90.65
|
| Rate for Payer: BCN Commercial |
$90.65
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: BCBS Trust/PPO |
$90.65
|
| Rate for Payer: BCN Commercial |
$90.65
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.66
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$29.32
|
| Rate for Payer: BCBS Trust/PPO |
$91.20
|
| Rate for Payer: BCN Commercial |
$91.20
|
| Rate for Payer: BCN Medicare Advantage |
$29.32
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.32
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Mclaren Medicaid |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PACE Senior Care Partners |
$27.86
|
| Rate for Payer: PACE SWMI |
$29.32
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.05
|
| Rate for Payer: Priority Health Medicare |
$29.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.54
|
| Rate for Payer: Railroad Medicare Medicare |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$30.20
|
| Rate for Payer: VA VA |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: BCBS Trust/PPO |
$90.65
|
| Rate for Payer: BCN Commercial |
$90.65
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.66
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$29.32
|
| Rate for Payer: BCBS Trust/PPO |
$91.20
|
| Rate for Payer: BCN Commercial |
$91.20
|
| Rate for Payer: BCN Medicare Advantage |
$29.32
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.32
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Mclaren Medicaid |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.70
|
| Rate for Payer: PACE Senior Care Partners |
$27.86
|
| Rate for Payer: PACE SWMI |
$29.32
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.05
|
| Rate for Payer: Priority Health Medicare |
$29.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.54
|
| Rate for Payer: Railroad Medicare Medicare |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$30.20
|
| Rate for Payer: VA VA |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC TRANSCATH INSERT/REPLACE PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$24,480.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$14,930.35 |
| Max. Negotiated Rate |
$22,032.00 |
| Rate for Payer: Aetna Commercial |
$20,808.00
|
| Rate for Payer: BCBS Trust/PPO |
$18,918.14
|
| Rate for Payer: BCN Commercial |
$18,918.14
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$21,052.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Healthscope Commercial |
$22,032.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,360.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PHP Commercial |
$20,808.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,297.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,930.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,542.40
|
| Rate for Payer: UHC Core |
$20,440.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,360.00
|
|
|
HC TRANSCATH INSERT/REPLACE PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$24,480.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,814.00 |
| Max. Negotiated Rate |
$22,032.00 |
| Rate for Payer: Aetna Commercial |
$20,808.00
|
| Rate for Payer: Aetna Medicare |
$6,364.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,650.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,650.00
|
| Rate for Payer: BCBS Complete |
$13,421.26
|
| Rate for Payer: BCBS MAPPO |
$6,120.00
|
| Rate for Payer: BCBS Trust/PPO |
$19,033.20
|
| Rate for Payer: BCN Commercial |
$19,033.20
|
| Rate for Payer: BCN Medicare Advantage |
$6,120.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$21,052.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,120.00
|
| Rate for Payer: Healthscope Commercial |
$22,032.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,360.00
|
| Rate for Payer: Mclaren Medicaid |
$12,782.15
|
| Rate for Payer: Meridian Medicaid |
$13,421.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,426.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,038.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PACE Senior Care Partners |
$5,814.00
|
| Rate for Payer: PACE SWMI |
$6,120.00
|
| Rate for Payer: PHP Commercial |
$20,808.00
|
| Rate for Payer: PHP Medicare Advantage |
$6,120.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,782.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,297.60
|
| Rate for Payer: Priority Health Medicare |
$6,120.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,930.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,542.40
|
| Rate for Payer: UHC Core |
$20,440.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,120.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,303.60
|
| Rate for Payer: VA VA |
$6,120.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,360.00
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
IP
|
$42,373.86
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$25,843.82 |
| Max. Negotiated Rate |
$38,136.47 |
| Rate for Payer: Aetna Commercial |
$36,017.78
|
| Rate for Payer: BCBS Trust/PPO |
$32,746.52
|
| Rate for Payer: BCN Commercial |
$32,746.52
|
| Rate for Payer: Cash Price |
$33,899.09
|
| Rate for Payer: Cofinity Commercial |
$36,441.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,899.09
|
| Rate for Payer: Healthscope Commercial |
$38,136.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,780.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,017.78
|
| Rate for Payer: PHP Commercial |
$36,017.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,661.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,865.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25,843.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,289.00
|
| Rate for Payer: UHC Core |
$35,382.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,780.40
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
OP
|
$42,373.86
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,063.79 |
| Max. Negotiated Rate |
$38,136.47 |
| Rate for Payer: Aetna Commercial |
$36,017.78
|
| Rate for Payer: Aetna Medicare |
$11,017.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,241.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,241.83
|
| Rate for Payer: BCBS Complete |
$16,949.54
|
| Rate for Payer: BCBS MAPPO |
$10,593.46
|
| Rate for Payer: BCBS Trust/PPO |
$32,945.68
|
| Rate for Payer: BCN Commercial |
$32,945.68
|
| Rate for Payer: BCN Medicare Advantage |
$10,593.46
|
| Rate for Payer: Cash Price |
$33,899.09
|
| Rate for Payer: Cofinity Commercial |
$36,441.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,899.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,593.46
|
| Rate for Payer: Healthscope Commercial |
$38,136.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,780.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,123.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,182.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,017.78
|
| Rate for Payer: PACE Senior Care Partners |
$10,063.79
|
| Rate for Payer: PACE SWMI |
$10,593.46
|
| Rate for Payer: PHP Commercial |
$36,017.78
|
| Rate for Payer: PHP Medicare Advantage |
$10,593.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,661.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,865.26
|
| Rate for Payer: Priority Health Medicare |
$10,593.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25,843.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10,593.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,289.00
|
| Rate for Payer: UHC Core |
$35,382.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,593.46
|
| Rate for Payer: UHC Medicare Advantage |
$10,911.27
|
| Rate for Payer: VA VA |
$10,593.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,780.40
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$3,814.80
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,326.65 |
| Max. Negotiated Rate |
$3,433.32 |
| Rate for Payer: Aetna Commercial |
$3,242.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,948.08
|
| Rate for Payer: BCN Commercial |
$2,948.08
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cofinity Commercial |
$3,280.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.84
|
| Rate for Payer: Healthscope Commercial |
$3,433.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,861.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,242.58
|
| Rate for Payer: PHP Commercial |
$3,242.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,670.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,318.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,326.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,357.02
|
| Rate for Payer: UHC Core |
$3,185.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,861.10
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$3,814.80
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$906.02 |
| Max. Negotiated Rate |
$3,433.32 |
| Rate for Payer: Aetna Commercial |
$3,242.58
|
| Rate for Payer: Aetna Medicare |
$991.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,192.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,192.12
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$953.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,966.01
|
| Rate for Payer: BCN Commercial |
$2,966.01
|
| Rate for Payer: BCN Medicare Advantage |
$953.70
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cash Price |
$3,051.84
|
| Rate for Payer: Cofinity Commercial |
$3,280.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,051.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.70
|
| Rate for Payer: Healthscope Commercial |
$3,433.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,861.10
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,001.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,096.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,242.58
|
| Rate for Payer: PACE Senior Care Partners |
$906.02
|
| Rate for Payer: PACE SWMI |
$953.70
|
| Rate for Payer: PHP Commercial |
$3,242.58
|
| Rate for Payer: PHP Medicare Advantage |
$953.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,670.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,318.88
|
| Rate for Payer: Priority Health Medicare |
$953.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,326.65
|
| Rate for Payer: Railroad Medicare Medicare |
$953.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,357.02
|
| Rate for Payer: UHC Core |
$3,185.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$953.70
|
| Rate for Payer: UHC Medicare Advantage |
$982.31
|
| Rate for Payer: VA VA |
$953.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,861.10
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
IP
|
$552.31
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$336.85 |
| Max. Negotiated Rate |
$497.08 |
| Rate for Payer: Aetna Commercial |
$469.46
|
| Rate for Payer: BCBS Trust/PPO |
$426.83
|
| Rate for Payer: BCN Commercial |
$426.83
|
| Rate for Payer: Cash Price |
$441.85
|
| Rate for Payer: Cofinity Commercial |
$474.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.85
|
| Rate for Payer: Healthscope Commercial |
$497.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.46
|
| Rate for Payer: PHP Commercial |
$469.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.03
|
| Rate for Payer: UHC Core |
$461.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.23
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
OP
|
$552.31
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$497.08 |
| Rate for Payer: Aetna Commercial |
$469.46
|
| Rate for Payer: Aetna Medicare |
$143.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.60
|
| Rate for Payer: BCBS Complete |
$220.92
|
| Rate for Payer: BCBS MAPPO |
$138.08
|
| Rate for Payer: BCBS Trust/PPO |
$429.42
|
| Rate for Payer: BCN Commercial |
$429.42
|
| Rate for Payer: BCN Medicare Advantage |
$138.08
|
| Rate for Payer: Cash Price |
$441.85
|
| Rate for Payer: Cofinity Commercial |
$474.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.08
|
| Rate for Payer: Healthscope Commercial |
$497.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$469.46
|
| Rate for Payer: PACE Senior Care Partners |
$131.17
|
| Rate for Payer: PACE SWMI |
$138.08
|
| Rate for Payer: PHP Commercial |
$469.46
|
| Rate for Payer: PHP Medicare Advantage |
$138.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.51
|
| Rate for Payer: Priority Health Medicare |
$138.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.85
|
| Rate for Payer: Railroad Medicare Medicare |
$138.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.03
|
| Rate for Payer: UHC Core |
$461.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.08
|
| Rate for Payer: UHC Medicare Advantage |
$142.22
|
| Rate for Payer: VA VA |
$138.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.23
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
IP
|
$1,586.54
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$967.63 |
| Max. Negotiated Rate |
$1,427.89 |
| Rate for Payer: Aetna Commercial |
$1,348.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.08
|
| Rate for Payer: BCN Commercial |
$1,226.08
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cofinity Commercial |
$1,364.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.23
|
| Rate for Payer: Healthscope Commercial |
$1,427.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,189.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.56
|
| Rate for Payer: PHP Commercial |
$1,348.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,380.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$967.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,396.16
|
| Rate for Payer: UHC Core |
$1,324.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,189.90
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
OP
|
$1,586.54
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$1,427.89 |
| Rate for Payer: Aetna Commercial |
$1,348.56
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$495.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$495.79
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$396.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.53
|
| Rate for Payer: BCN Commercial |
$1,233.53
|
| Rate for Payer: BCN Medicare Advantage |
$396.64
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cash Price |
$1,269.23
|
| Rate for Payer: Cofinity Commercial |
$1,364.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.64
|
| Rate for Payer: Healthscope Commercial |
$1,427.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,189.90
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$416.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$456.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.56
|
| Rate for Payer: PACE Senior Care Partners |
$376.80
|
| Rate for Payer: PACE SWMI |
$396.64
|
| Rate for Payer: PHP Commercial |
$1,348.56
|
| Rate for Payer: PHP Medicare Advantage |
$396.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,380.29
|
| Rate for Payer: Priority Health Medicare |
$396.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$967.63
|
| Rate for Payer: Railroad Medicare Medicare |
$396.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,396.16
|
| Rate for Payer: UHC Core |
$1,324.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.64
|
| Rate for Payer: UHC Medicare Advantage |
$408.53
|
| Rate for Payer: VA VA |
$396.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,189.90
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
IP
|
$599.45
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$365.60 |
| Max. Negotiated Rate |
$539.50 |
| Rate for Payer: Aetna Commercial |
$509.53
|
| Rate for Payer: BCBS Trust/PPO |
$463.25
|
| Rate for Payer: BCN Commercial |
$463.25
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cofinity Commercial |
$515.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.56
|
| Rate for Payer: Healthscope Commercial |
$539.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$449.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$509.53
|
| Rate for Payer: PHP Commercial |
$509.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.52
|
| Rate for Payer: UHC Core |
$500.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$449.59
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
OP
|
$599.45
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$539.50 |
| Rate for Payer: Aetna Commercial |
$509.53
|
| Rate for Payer: Aetna Medicare |
$155.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.33
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$149.86
|
| Rate for Payer: BCBS Trust/PPO |
$466.07
|
| Rate for Payer: BCN Commercial |
$466.07
|
| Rate for Payer: BCN Medicare Advantage |
$149.86
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cash Price |
$479.56
|
| Rate for Payer: Cofinity Commercial |
$515.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.86
|
| Rate for Payer: Healthscope Commercial |
$539.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$449.59
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$509.53
|
| Rate for Payer: PACE Senior Care Partners |
$142.37
|
| Rate for Payer: PACE SWMI |
$149.86
|
| Rate for Payer: PHP Commercial |
$509.53
|
| Rate for Payer: PHP Medicare Advantage |
$149.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.52
|
| Rate for Payer: Priority Health Medicare |
$149.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.60
|
| Rate for Payer: Railroad Medicare Medicare |
$149.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.52
|
| Rate for Payer: UHC Core |
$500.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.86
|
| Rate for Payer: UHC Medicare Advantage |
$154.36
|
| Rate for Payer: VA VA |
$149.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$449.59
|
|
