|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$469.23 |
| Max. Negotiated Rate |
$1,778.15 |
| Rate for Payer: Aetna Commercial |
$1,679.36
|
| Rate for Payer: Aetna Medicare |
$513.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$617.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$617.41
|
| Rate for Payer: BCBS Complete |
$971.08
|
| Rate for Payer: BCBS MAPPO |
$493.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,624.24
|
| Rate for Payer: BCN Commercial |
$1,536.12
|
| Rate for Payer: BCN Medicare Advantage |
$493.93
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,699.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.93
|
| Rate for Payer: Healthscope Commercial |
$1,778.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.79
|
| Rate for Payer: Mclaren Medicaid |
$924.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$518.63
|
| Rate for Payer: Meridian Medicaid |
$971.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| Rate for Payer: PACE Senior Care Partners |
$469.23
|
| Rate for Payer: PACE SWMI |
$493.93
|
| Rate for Payer: PHP Commercial |
$1,679.36
|
| Rate for Payer: PHP Medicare Advantage |
$493.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$924.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,718.88
|
| Rate for Payer: Priority Health Medicare |
$498.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,323.73
|
| Rate for Payer: Railroad Medicare Medicare |
$493.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.63
|
| Rate for Payer: UHC Core |
$1,649.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.93
|
| Rate for Payer: UHC Exchange |
$493.93
|
| Rate for Payer: UHC Medicare Advantage |
$493.93
|
| Rate for Payer: UHCCP Medicaid |
$924.77
|
| Rate for Payer: VA VA |
$493.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.79
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
IP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,284.22 |
| Max. Negotiated Rate |
$1,778.15 |
| Rate for Payer: Aetna Commercial |
$1,679.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.78
|
| Rate for Payer: BCN Commercial |
$1,526.84
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,699.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Healthscope Commercial |
$1,778.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| Rate for Payer: PHP Commercial |
$1,679.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,718.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,323.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.63
|
| Rate for Payer: UHC Core |
$1,649.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.79
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$417.33 |
| Max. Negotiated Rate |
$4,339.88 |
| Rate for Payer: Aetna Commercial |
$1,493.60
|
| Rate for Payer: Aetna Medicare |
$456.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.12
|
| Rate for Payer: BCBS Complete |
$4,339.88
|
| Rate for Payer: BCBS MAPPO |
$439.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.58
|
| Rate for Payer: BCN Commercial |
$1,366.21
|
| Rate for Payer: BCN Medicare Advantage |
$439.30
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,511.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.30
|
| Rate for Payer: Healthscope Commercial |
$1,581.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.88
|
| Rate for Payer: Mclaren Medicaid |
$4,132.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.26
|
| Rate for Payer: Meridian Medicaid |
$4,339.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: PACE Senior Care Partners |
$417.33
|
| Rate for Payer: PACE SWMI |
$439.30
|
| Rate for Payer: PHP Commercial |
$1,493.60
|
| Rate for Payer: PHP Medicare Advantage |
$439.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,132.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,528.75
|
| Rate for Payer: Priority Health Medicare |
$443.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,177.31
|
| Rate for Payer: Railroad Medicare Medicare |
$439.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,546.32
|
| Rate for Payer: UHC Core |
$1,467.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.30
|
| Rate for Payer: UHC Exchange |
$439.30
|
| Rate for Payer: UHC Medicare Advantage |
$439.30
|
| Rate for Payer: UHCCP Medicaid |
$4,132.95
|
| Rate for Payer: VA VA |
$439.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.88
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,142.17 |
| Max. Negotiated Rate |
$1,581.46 |
| Rate for Payer: Aetna Commercial |
$1,493.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.39
|
| Rate for Payer: BCN Commercial |
$1,357.95
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,511.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Healthscope Commercial |
$1,581.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: PHP Commercial |
$1,493.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,528.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,177.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,546.32
|
| Rate for Payer: UHC Core |
$1,467.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.88
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,666.35
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,083.13 |
| Max. Negotiated Rate |
$1,499.72 |
| Rate for Payer: Aetna Commercial |
$1,416.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.24
|
| Rate for Payer: BCN Commercial |
$1,287.76
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,433.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Healthscope Commercial |
$1,499.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,249.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: PHP Commercial |
$1,416.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,449.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.39
|
| Rate for Payer: UHC Core |
$1,391.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,249.76
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,666.35
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$381.30 |
| Max. Negotiated Rate |
$1,499.72 |
| Rate for Payer: Aetna Commercial |
$1,416.40
|
| Rate for Payer: Aetna Medicare |
$433.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.73
|
| Rate for Payer: BCBS Complete |
$400.39
|
| Rate for Payer: BCBS MAPPO |
$416.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.91
|
| Rate for Payer: BCN Commercial |
$1,295.59
|
| Rate for Payer: BCN Medicare Advantage |
$416.59
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,433.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.59
|
| Rate for Payer: Healthscope Commercial |
$1,499.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,249.76
|
| Rate for Payer: Mclaren Medicaid |
$381.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.42
|
| Rate for Payer: Meridian Medicaid |
$400.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: PACE Senior Care Partners |
$395.76
|
| Rate for Payer: PACE SWMI |
$416.59
|
| Rate for Payer: PHP Commercial |
$1,416.40
|
| Rate for Payer: PHP Medicare Advantage |
$416.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,449.72
|
| Rate for Payer: Priority Health Medicare |
$420.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.45
|
| Rate for Payer: Railroad Medicare Medicare |
$416.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.39
|
| Rate for Payer: UHC Core |
$1,391.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.59
|
| Rate for Payer: UHC Exchange |
$416.59
|
| Rate for Payer: UHC Medicare Advantage |
$416.59
|
| Rate for Payer: UHCCP Medicaid |
$381.30
|
| Rate for Payer: VA VA |
$416.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,249.76
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,219.18
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$284.65 |
| Max. Negotiated Rate |
$1,097.26 |
| Rate for Payer: Aetna Commercial |
$1,036.30
|
| Rate for Payer: Aetna Medicare |
$316.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$380.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$380.99
|
| Rate for Payer: BCBS Complete |
$298.90
|
| Rate for Payer: BCBS MAPPO |
$304.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.29
|
| Rate for Payer: BCN Commercial |
$947.91
|
| Rate for Payer: BCN Medicare Advantage |
$304.80
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,048.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.80
|
| Rate for Payer: Healthscope Commercial |
$1,097.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.38
|
| Rate for Payer: Mclaren Medicaid |
$284.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.03
|
| Rate for Payer: Meridian Medicaid |
$298.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$999.73
|
| Rate for Payer: PACE Senior Care Partners |
$289.56
|
| Rate for Payer: PACE SWMI |
$304.80
|
| Rate for Payer: PHP Commercial |
$1,036.30
|
| Rate for Payer: PHP Medicare Advantage |
$304.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,060.69
|
| Rate for Payer: Priority Health Medicare |
$307.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.85
|
| Rate for Payer: Railroad Medicare Medicare |
$304.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.88
|
| Rate for Payer: UHC Core |
$1,018.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.80
|
| Rate for Payer: UHC Exchange |
$304.80
|
| Rate for Payer: UHC Medicare Advantage |
$304.80
|
| Rate for Payer: UHCCP Medicaid |
$284.65
|
| Rate for Payer: VA VA |
$304.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.38
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,219.18
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.47 |
| Max. Negotiated Rate |
$1,097.26 |
| Rate for Payer: Aetna Commercial |
$1,036.30
|
| Rate for Payer: BCBS Trust/PPO |
$995.22
|
| Rate for Payer: BCN Commercial |
$942.18
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,048.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Healthscope Commercial |
$1,097.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$999.73
|
| Rate for Payer: PHP Commercial |
$1,036.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,060.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.88
|
| Rate for Payer: UHC Core |
$1,018.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.38
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,666.35
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$381.30 |
| Max. Negotiated Rate |
$1,499.72 |
| Rate for Payer: Aetna Commercial |
$1,416.40
|
| Rate for Payer: Aetna Medicare |
$433.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.73
|
| Rate for Payer: BCBS Complete |
$400.39
|
| Rate for Payer: BCBS MAPPO |
$416.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.91
|
| Rate for Payer: BCN Commercial |
$1,295.59
|
| Rate for Payer: BCN Medicare Advantage |
$416.59
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,433.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.59
|
| Rate for Payer: Healthscope Commercial |
$1,499.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,249.76
|
| Rate for Payer: Mclaren Medicaid |
$381.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.42
|
| Rate for Payer: Meridian Medicaid |
$400.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: PACE Senior Care Partners |
$395.76
|
| Rate for Payer: PACE SWMI |
$416.59
|
| Rate for Payer: PHP Commercial |
$1,416.40
|
| Rate for Payer: PHP Medicare Advantage |
$416.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,449.72
|
| Rate for Payer: Priority Health Medicare |
$420.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.45
|
| Rate for Payer: Railroad Medicare Medicare |
$416.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.39
|
| Rate for Payer: UHC Core |
$1,391.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.59
|
| Rate for Payer: UHC Exchange |
$416.59
|
| Rate for Payer: UHC Medicare Advantage |
$416.59
|
| Rate for Payer: UHCCP Medicaid |
$381.30
|
| Rate for Payer: VA VA |
$416.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,249.76
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,666.35
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,083.13 |
| Max. Negotiated Rate |
$1,499.72 |
| Rate for Payer: Aetna Commercial |
$1,416.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.24
|
| Rate for Payer: BCN Commercial |
$1,287.76
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,433.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Healthscope Commercial |
$1,499.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,249.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: PHP Commercial |
$1,416.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,449.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.39
|
| Rate for Payer: UHC Core |
$1,391.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,249.76
|
|
|
HC NM VOID CYSTO
|
Facility
|
OP
|
$1,069.28
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Aetna Commercial |
$908.89
|
| Rate for Payer: Aetna Medicare |
$278.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$334.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$334.15
|
| Rate for Payer: BCBS Complete |
$298.90
|
| Rate for Payer: BCBS MAPPO |
$267.32
|
| Rate for Payer: BCBS Trust/PPO |
$879.06
|
| Rate for Payer: BCN Commercial |
$831.37
|
| Rate for Payer: BCN Medicare Advantage |
$267.32
|
| Rate for Payer: Cash Price |
$855.42
|
| Rate for Payer: Cash Price |
$855.42
|
| Rate for Payer: Cofinity Commercial |
$919.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.32
|
| Rate for Payer: Healthscope Commercial |
$962.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$801.96
|
| Rate for Payer: Mclaren Medicaid |
$284.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.69
|
| Rate for Payer: Meridian Medicaid |
$298.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.89
|
| Rate for Payer: Nomi Health Commercial |
$876.81
|
| Rate for Payer: PACE Senior Care Partners |
$253.95
|
| Rate for Payer: PACE SWMI |
$267.32
|
| Rate for Payer: PHP Commercial |
$908.89
|
| Rate for Payer: PHP Medicare Advantage |
$267.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.03
|
| Rate for Payer: Priority Health HMO/PPO |
$930.27
|
| Rate for Payer: Priority Health Medicare |
$269.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$716.42
|
| Rate for Payer: Railroad Medicare Medicare |
$267.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$940.97
|
| Rate for Payer: UHC Core |
$892.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.32
|
| Rate for Payer: UHC Exchange |
$267.32
|
| Rate for Payer: UHC Medicare Advantage |
$267.32
|
| Rate for Payer: UHCCP Medicaid |
$284.65
|
| Rate for Payer: VA VA |
$267.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$801.96
|
|
|
HC NM VOID CYSTO
|
Facility
|
IP
|
$1,069.28
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$695.03 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Aetna Commercial |
$908.89
|
| Rate for Payer: BCBS Trust/PPO |
$872.85
|
| Rate for Payer: BCN Commercial |
$826.34
|
| Rate for Payer: Cash Price |
$855.42
|
| Rate for Payer: Cofinity Commercial |
$919.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.42
|
| Rate for Payer: Healthscope Commercial |
$962.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$801.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.89
|
| Rate for Payer: Nomi Health Commercial |
$876.81
|
| Rate for Payer: PHP Commercial |
$908.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.03
|
| Rate for Payer: Priority Health HMO/PPO |
$930.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$716.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$940.97
|
| Rate for Payer: UHC Core |
$892.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$801.96
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,939.87
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$158.77 |
| Max. Negotiated Rate |
$1,745.88 |
| Rate for Payer: Aetna Commercial |
$1,648.89
|
| Rate for Payer: Aetna Medicare |
$504.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$606.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$606.21
|
| Rate for Payer: BCBS Complete |
$166.72
|
| Rate for Payer: BCBS MAPPO |
$484.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.77
|
| Rate for Payer: BCN Commercial |
$1,508.25
|
| Rate for Payer: BCN Medicare Advantage |
$484.97
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: Cofinity Commercial |
$1,668.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.97
|
| Rate for Payer: Healthscope Commercial |
$1,745.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.90
|
| Rate for Payer: Mclaren Medicaid |
$158.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.22
|
| Rate for Payer: Meridian Medicaid |
$166.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.89
|
| Rate for Payer: Nomi Health Commercial |
$1,590.69
|
| Rate for Payer: PACE Senior Care Partners |
$460.72
|
| Rate for Payer: PACE SWMI |
$484.97
|
| Rate for Payer: PHP Commercial |
$1,648.89
|
| Rate for Payer: PHP Medicare Advantage |
$484.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.92
|
| Rate for Payer: Priority Health HMO/PPO |
$1,687.69
|
| Rate for Payer: Priority Health Medicare |
$489.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,299.71
|
| Rate for Payer: Railroad Medicare Medicare |
$484.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,707.09
|
| Rate for Payer: UHC Core |
$1,619.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.97
|
| Rate for Payer: UHC Exchange |
$484.97
|
| Rate for Payer: UHC Medicare Advantage |
$484.97
|
| Rate for Payer: UHCCP Medicaid |
$158.77
|
| Rate for Payer: VA VA |
$484.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.90
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,939.87
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,260.92 |
| Max. Negotiated Rate |
$1,745.88 |
| Rate for Payer: Aetna Commercial |
$1,648.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.52
|
| Rate for Payer: BCN Commercial |
$1,499.13
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: Cofinity Commercial |
$1,668.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.90
|
| Rate for Payer: Healthscope Commercial |
$1,745.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.89
|
| Rate for Payer: Nomi Health Commercial |
$1,590.69
|
| Rate for Payer: PHP Commercial |
$1,648.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.92
|
| Rate for Payer: Priority Health HMO/PPO |
$1,687.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,299.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,707.09
|
| Rate for Payer: UHC Core |
$1,619.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.90
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.32
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.68
|
| Rate for Payer: Railroad Medicare Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$87.30
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: Aetna Commercial |
$74.20
|
| Rate for Payer: Aetna Medicare |
$22.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.28
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$21.82
|
| Rate for Payer: BCBS Trust/PPO |
$71.77
|
| Rate for Payer: BCN Commercial |
$67.88
|
| Rate for Payer: BCN Medicare Advantage |
$21.82
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cofinity Commercial |
$75.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.82
|
| Rate for Payer: Healthscope Commercial |
$78.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.48
|
| Rate for Payer: Mclaren Medicaid |
$27.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.92
|
| Rate for Payer: Meridian Medicaid |
$29.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$71.59
|
| Rate for Payer: PACE Senior Care Partners |
$20.73
|
| Rate for Payer: PACE SWMI |
$21.82
|
| Rate for Payer: PHP Commercial |
$74.20
|
| Rate for Payer: PHP Medicare Advantage |
$21.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.74
|
| Rate for Payer: Priority Health HMO/PPO |
$75.95
|
| Rate for Payer: Priority Health Medicare |
$22.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.49
|
| Rate for Payer: Railroad Medicare Medicare |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.82
|
| Rate for Payer: UHC Core |
$72.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.82
|
| Rate for Payer: UHC Exchange |
$21.82
|
| Rate for Payer: UHC Medicare Advantage |
$21.82
|
| Rate for Payer: UHCCP Medicaid |
$27.81
|
| Rate for Payer: VA VA |
$21.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.48
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$87.30
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: Aetna Commercial |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$71.26
|
| Rate for Payer: BCN Commercial |
$67.47
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cofinity Commercial |
$75.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.84
|
| Rate for Payer: Healthscope Commercial |
$78.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$71.59
|
| Rate for Payer: PHP Commercial |
$74.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.74
|
| Rate for Payer: Priority Health HMO/PPO |
$75.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.82
|
| Rate for Payer: UHC Core |
$72.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.48
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,469.74
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,605.33 |
| Max. Negotiated Rate |
$2,222.77 |
| Rate for Payer: Aetna Commercial |
$2,099.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,016.05
|
| Rate for Payer: BCN Commercial |
$1,908.62
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cofinity Commercial |
$2,123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.79
|
| Rate for Payer: Healthscope Commercial |
$2,222.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,852.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,099.28
|
| Rate for Payer: Nomi Health Commercial |
$2,025.19
|
| Rate for Payer: PHP Commercial |
$2,099.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.33
|
| Rate for Payer: Priority Health HMO/PPO |
$2,148.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,654.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,173.37
|
| Rate for Payer: UHC Core |
$2,062.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,852.30
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,469.74
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$586.56 |
| Max. Negotiated Rate |
$2,222.77 |
| Rate for Payer: Aetna Commercial |
$2,099.28
|
| Rate for Payer: Aetna Medicare |
$642.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$771.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$771.79
|
| Rate for Payer: BCBS Complete |
$903.02
|
| Rate for Payer: BCBS MAPPO |
$617.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.37
|
| Rate for Payer: BCN Commercial |
$1,920.22
|
| Rate for Payer: BCN Medicare Advantage |
$617.44
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cofinity Commercial |
$2,123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$617.44
|
| Rate for Payer: Healthscope Commercial |
$2,222.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,852.30
|
| Rate for Payer: Mclaren Medicaid |
$859.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$648.31
|
| Rate for Payer: Meridian Medicaid |
$903.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$710.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,099.28
|
| Rate for Payer: Nomi Health Commercial |
$2,025.19
|
| Rate for Payer: PACE Senior Care Partners |
$586.56
|
| Rate for Payer: PACE SWMI |
$617.44
|
| Rate for Payer: PHP Commercial |
$2,099.28
|
| Rate for Payer: PHP Medicare Advantage |
$617.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.33
|
| Rate for Payer: Priority Health HMO/PPO |
$2,148.67
|
| Rate for Payer: Priority Health Medicare |
$623.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,654.73
|
| Rate for Payer: Railroad Medicare Medicare |
$617.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,173.37
|
| Rate for Payer: UHC Core |
$2,062.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$617.44
|
| Rate for Payer: UHC Exchange |
$617.44
|
| Rate for Payer: UHC Medicare Advantage |
$617.44
|
| Rate for Payer: UHCCP Medicaid |
$859.97
|
| Rate for Payer: VA VA |
$617.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,852.30
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,132.67
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$736.24 |
| Max. Negotiated Rate |
$1,019.40 |
| Rate for Payer: Aetna Commercial |
$962.77
|
| Rate for Payer: BCBS Trust/PPO |
$924.60
|
| Rate for Payer: BCN Commercial |
$875.33
|
| Rate for Payer: Cash Price |
$906.14
|
| Rate for Payer: Cofinity Commercial |
$974.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$906.14
|
| Rate for Payer: Healthscope Commercial |
$1,019.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$849.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.77
|
| Rate for Payer: Nomi Health Commercial |
$928.79
|
| Rate for Payer: PHP Commercial |
$962.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.24
|
| Rate for Payer: Priority Health HMO/PPO |
$985.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.75
|
| Rate for Payer: UHC Core |
$945.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$849.50
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,132.67
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$269.01 |
| Max. Negotiated Rate |
$1,019.40 |
| Rate for Payer: Aetna Commercial |
$962.77
|
| Rate for Payer: Aetna Medicare |
$294.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$353.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$353.96
|
| Rate for Payer: BCBS Complete |
$453.07
|
| Rate for Payer: BCBS MAPPO |
$283.17
|
| Rate for Payer: BCBS Trust/PPO |
$931.17
|
| Rate for Payer: BCN Commercial |
$880.65
|
| Rate for Payer: BCN Medicare Advantage |
$283.17
|
| Rate for Payer: Cash Price |
$906.14
|
| Rate for Payer: Cofinity Commercial |
$974.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$906.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.17
|
| Rate for Payer: Healthscope Commercial |
$1,019.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$849.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$297.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.77
|
| Rate for Payer: Nomi Health Commercial |
$928.79
|
| Rate for Payer: PACE Senior Care Partners |
$269.01
|
| Rate for Payer: PACE SWMI |
$283.17
|
| Rate for Payer: PHP Commercial |
$962.77
|
| Rate for Payer: PHP Medicare Advantage |
$283.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.24
|
| Rate for Payer: Priority Health HMO/PPO |
$985.42
|
| Rate for Payer: Priority Health Medicare |
$286.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$283.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.75
|
| Rate for Payer: UHC Core |
$945.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.17
|
| Rate for Payer: UHC Exchange |
$283.17
|
| Rate for Payer: UHC Medicare Advantage |
$283.17
|
| Rate for Payer: VA VA |
$283.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$849.50
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$924.31
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$831.88 |
| Rate for Payer: Aetna Commercial |
$785.66
|
| Rate for Payer: Aetna Medicare |
$240.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.85
|
| Rate for Payer: BCBS Complete |
$369.72
|
| Rate for Payer: BCBS MAPPO |
$231.08
|
| Rate for Payer: BCBS Trust/PPO |
$759.88
|
| Rate for Payer: BCN Commercial |
$718.65
|
| Rate for Payer: BCN Medicare Advantage |
$231.08
|
| Rate for Payer: Cash Price |
$739.45
|
| Rate for Payer: Cofinity Commercial |
$794.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.08
|
| Rate for Payer: Healthscope Commercial |
$831.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.66
|
| Rate for Payer: Nomi Health Commercial |
$757.93
|
| Rate for Payer: PACE Senior Care Partners |
$219.52
|
| Rate for Payer: PACE SWMI |
$231.08
|
| Rate for Payer: PHP Commercial |
$785.66
|
| Rate for Payer: PHP Medicare Advantage |
$231.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.80
|
| Rate for Payer: Priority Health HMO/PPO |
$804.15
|
| Rate for Payer: Priority Health Medicare |
$233.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$619.29
|
| Rate for Payer: Railroad Medicare Medicare |
$231.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$813.39
|
| Rate for Payer: UHC Core |
$771.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.08
|
| Rate for Payer: UHC Exchange |
$231.08
|
| Rate for Payer: UHC Medicare Advantage |
$231.08
|
| Rate for Payer: VA VA |
$231.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.23
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$924.31
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$600.80 |
| Max. Negotiated Rate |
$831.88 |
| Rate for Payer: Aetna Commercial |
$785.66
|
| Rate for Payer: BCBS Trust/PPO |
$754.51
|
| Rate for Payer: BCN Commercial |
$714.31
|
| Rate for Payer: Cash Price |
$739.45
|
| Rate for Payer: Cofinity Commercial |
$794.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.45
|
| Rate for Payer: Healthscope Commercial |
$831.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.66
|
| Rate for Payer: Nomi Health Commercial |
$757.93
|
| Rate for Payer: PHP Commercial |
$785.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.80
|
| Rate for Payer: Priority Health HMO/PPO |
$804.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$619.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$813.39
|
| Rate for Payer: UHC Core |
$771.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.23
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$358.94
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$293.00
|
| Rate for Payer: BCN Commercial |
$277.39
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cofinity Commercial |
$308.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.15
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.10
|
| Rate for Payer: Nomi Health Commercial |
$294.33
|
| Rate for Payer: PHP Commercial |
$305.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.31
|
| Rate for Payer: Priority Health HMO/PPO |
$312.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.87
|
| Rate for Payer: UHC Core |
$299.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.20
|
|
