|
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 |
$1,499.71 |
| 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 |
$1,499.71
|
| 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 |
$305.07
|
| 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 |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.69
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| 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 |
$290.52
|
| 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 |
$290.52
|
| 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 |
$162.05 |
| 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 |
$170.16
|
| 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 |
$162.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.22
|
| Rate for Payer: Meridian Medicaid |
$170.16
|
| 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 |
$162.05
|
| 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 |
$162.05
|
| 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
|
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 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 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 |
$29.80
|
| 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 |
$65.47
|
| Rate for Payer: Mclaren Medicaid |
$28.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.92
|
| Rate for Payer: Meridian Medicaid |
$29.80
|
| 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 |
$28.38
|
| 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 |
$28.38
|
| Rate for Payer: VA VA |
$21.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.47
|
|
|
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 |
$65.47
|
| 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 |
$65.47
|
|
|
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 |
$921.66
|
| Rate for Payer: BCBS MAPPO |
$617.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.37
|
| Rate for Payer: BCN Commercial |
$1,920.22
|
| Rate for Payer: BCN Medicare Advantage |
$617.43
|
| 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 |
$617.43
|
| Rate for Payer: Healthscope Commercial |
$2,222.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,852.31
|
| Rate for Payer: Mclaren Medicaid |
$877.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$648.31
|
| Rate for Payer: Meridian Medicaid |
$921.66
|
| 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 |
$617.43
|
| Rate for Payer: PHP Commercial |
$2,099.28
|
| Rate for Payer: PHP Medicare Advantage |
$617.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$877.71
|
| 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 |
$617.43
|
| 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 |
$617.43
|
| Rate for Payer: UHC Exchange |
$617.43
|
| Rate for Payer: UHC Medicare Advantage |
$617.43
|
| Rate for Payer: UHCCP Medicaid |
$877.71
|
| Rate for Payer: VA VA |
$617.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,852.31
|
|
|
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 |
$1,852.31
|
| 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 |
$1,852.31
|
|
|
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 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 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 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-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$358.94
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Medicare |
$93.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.17
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$89.73
|
| Rate for Payer: BCBS Trust/PPO |
$295.08
|
| Rate for Payer: BCN Commercial |
$279.08
|
| Rate for Payer: BCN Medicare Advantage |
$89.73
|
| Rate for Payer: Cash Price |
$287.15
|
| 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: Health Alliance Plan Medicare Advantage |
$89.73
|
| Rate for Payer: Healthscope Commercial |
$323.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.20
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.22
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.10
|
| Rate for Payer: Nomi Health Commercial |
$294.33
|
| Rate for Payer: PACE Senior Care Partners |
$85.25
|
| Rate for Payer: PACE SWMI |
$89.73
|
| Rate for Payer: PHP Commercial |
$305.10
|
| Rate for Payer: PHP Medicare Advantage |
$89.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.31
|
| Rate for Payer: Priority Health HMO/PPO |
$312.28
|
| Rate for Payer: Priority Health Medicare |
$90.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.49
|
| Rate for Payer: Railroad Medicare Medicare |
$89.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.87
|
| Rate for Payer: UHC Core |
$299.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.73
|
| Rate for Payer: UHC Exchange |
$89.73
|
| Rate for Payer: UHC Medicare Advantage |
$89.73
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$89.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.20
|
|
|
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
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$3,955.19
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,570.87 |
| Max. Negotiated Rate |
$3,559.67 |
| Rate for Payer: Aetna Commercial |
$3,361.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,228.62
|
| Rate for Payer: BCN Commercial |
$3,056.57
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Cofinity Commercial |
$3,401.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.15
|
| Rate for Payer: Healthscope Commercial |
$3,559.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,966.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,361.91
|
| Rate for Payer: Nomi Health Commercial |
$3,243.26
|
| Rate for Payer: PHP Commercial |
$3,361.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,570.87
|
| Rate for Payer: Priority Health HMO/PPO |
$3,441.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,649.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,480.57
|
| Rate for Payer: UHC Core |
$3,302.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,966.39
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$3,955.19
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.36 |
| Max. Negotiated Rate |
$3,559.67 |
| Rate for Payer: Aetna Commercial |
$3,361.91
|
| Rate for Payer: Aetna Medicare |
$1,028.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,236.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,236.00
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$988.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,251.56
|
| Rate for Payer: BCN Commercial |
$3,075.16
|
| Rate for Payer: BCN Medicare Advantage |
$988.80
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Cash Price |
$3,164.15
|
| Rate for Payer: Cofinity Commercial |
$3,401.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$988.80
|
| Rate for Payer: Healthscope Commercial |
$3,559.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,966.39
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,038.24
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,137.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,361.91
|
| Rate for Payer: Nomi Health Commercial |
$3,243.26
|
| Rate for Payer: PACE Senior Care Partners |
$939.36
|
| Rate for Payer: PACE SWMI |
$988.80
|
| Rate for Payer: PHP Commercial |
$3,361.91
|
| Rate for Payer: PHP Medicare Advantage |
$988.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,570.87
|
| Rate for Payer: Priority Health HMO/PPO |
$3,441.02
|
| Rate for Payer: Priority Health Medicare |
$998.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,649.98
|
| Rate for Payer: Railroad Medicare Medicare |
$988.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,480.57
|
| Rate for Payer: UHC Core |
$3,302.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$988.80
|
| Rate for Payer: UHC Exchange |
$988.80
|
| Rate for Payer: UHC Medicare Advantage |
$988.80
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$988.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,966.39
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,547.08
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,205.60 |
| Max. Negotiated Rate |
$8,592.37 |
| Rate for Payer: Aetna Commercial |
$8,115.02
|
| Rate for Payer: BCBS Trust/PPO |
$7,793.28
|
| Rate for Payer: BCN Commercial |
$7,377.98
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cofinity Commercial |
$8,210.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,637.66
|
| Rate for Payer: Healthscope Commercial |
$8,592.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,160.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,115.02
|
| Rate for Payer: Nomi Health Commercial |
$7,828.61
|
| Rate for Payer: PHP Commercial |
$8,115.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,205.60
|
| Rate for Payer: Priority Health HMO/PPO |
$8,305.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,396.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,401.43
|
| Rate for Payer: UHC Core |
$7,971.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,160.31
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,547.08
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,267.43 |
| Max. Negotiated Rate |
$8,592.37 |
| Rate for Payer: Aetna Commercial |
$8,115.02
|
| Rate for Payer: Aetna Medicare |
$2,482.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,983.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,983.46
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$2,386.77
|
| Rate for Payer: BCBS Trust/PPO |
$7,848.65
|
| Rate for Payer: BCN Commercial |
$7,422.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,386.77
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cash Price |
$7,637.66
|
| Rate for Payer: Cofinity Commercial |
$8,210.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,637.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,386.77
|
| Rate for Payer: Healthscope Commercial |
$8,592.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,160.31
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,506.11
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,744.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,115.02
|
| Rate for Payer: Nomi Health Commercial |
$7,828.61
|
| Rate for Payer: PACE Senior Care Partners |
$2,267.43
|
| Rate for Payer: PACE SWMI |
$2,386.77
|
| Rate for Payer: PHP Commercial |
$8,115.02
|
| Rate for Payer: PHP Medicare Advantage |
$2,386.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,205.60
|
| Rate for Payer: Priority Health HMO/PPO |
$8,305.96
|
| Rate for Payer: Priority Health Medicare |
$2,410.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,396.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,386.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,401.43
|
| Rate for Payer: UHC Core |
$7,971.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,386.77
|
| Rate for Payer: UHC Exchange |
$2,386.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,386.77
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$2,386.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,160.31
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna Commercial |
$299.57
|
| Rate for Payer: Aetna Medicare |
$91.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.14
|
| Rate for Payer: BCBS Complete |
$152.73
|
| Rate for Payer: BCBS MAPPO |
$88.11
|
| Rate for Payer: BCBS Trust/PPO |
$289.74
|
| Rate for Payer: BCN Commercial |
$274.02
|
| Rate for Payer: BCN Medicare Advantage |
$88.11
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$303.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.11
|
| Rate for Payer: Healthscope Commercial |
$317.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.33
|
| Rate for Payer: Mclaren Medicaid |
$145.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.52
|
| Rate for Payer: Meridian Medicaid |
$152.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: Nomi Health Commercial |
$289.00
|
| Rate for Payer: PACE Senior Care Partners |
$83.70
|
| Rate for Payer: PACE SWMI |
$88.11
|
| Rate for Payer: PHP Commercial |
$299.57
|
| Rate for Payer: PHP Medicare Advantage |
$88.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: Priority Health HMO/PPO |
$306.62
|
| Rate for Payer: Priority Health Medicare |
$88.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.13
|
| Rate for Payer: Railroad Medicare Medicare |
$88.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.15
|
| Rate for Payer: UHC Core |
$294.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.11
|
| Rate for Payer: UHC Exchange |
$88.11
|
| Rate for Payer: UHC Medicare Advantage |
$88.11
|
| Rate for Payer: UHCCP Medicaid |
$145.45
|
| Rate for Payer: VA VA |
$88.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.33
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$352.44
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$229.09 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna Commercial |
$299.57
|
| Rate for Payer: BCBS Trust/PPO |
$287.70
|
| Rate for Payer: BCN Commercial |
$272.37
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Cofinity Commercial |
$303.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.95
|
| Rate for Payer: Healthscope Commercial |
$317.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.57
|
| Rate for Payer: Nomi Health Commercial |
$289.00
|
| Rate for Payer: PHP Commercial |
$299.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.09
|
| Rate for Payer: Priority Health HMO/PPO |
$306.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.15
|
| Rate for Payer: UHC Core |
$294.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.33
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$786.62 |
| Max. Negotiated Rate |
$2,980.87 |
| Rate for Payer: Aetna Commercial |
$2,815.27
|
| Rate for Payer: Aetna Medicare |
$861.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,035.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,035.03
|
| Rate for Payer: BCBS Complete |
$1,324.83
|
| Rate for Payer: BCBS MAPPO |
$828.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,722.86
|
| Rate for Payer: BCN Commercial |
$2,575.14
|
| Rate for Payer: BCN Medicare Advantage |
$828.02
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,848.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.02
|
| Rate for Payer: Healthscope Commercial |
$2,980.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,484.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$869.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$952.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: Nomi Health Commercial |
$2,715.91
|
| Rate for Payer: PACE Senior Care Partners |
$786.62
|
| Rate for Payer: PACE SWMI |
$828.02
|
| Rate for Payer: PHP Commercial |
$2,815.27
|
| Rate for Payer: PHP Medicare Advantage |
$828.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,881.51
|
| Rate for Payer: Priority Health Medicare |
$836.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,219.09
|
| Rate for Payer: Railroad Medicare Medicare |
$828.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,914.63
|
| Rate for Payer: UHC Core |
$2,765.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$828.02
|
| Rate for Payer: UHC Exchange |
$828.02
|
| Rate for Payer: UHC Medicare Advantage |
$828.02
|
| Rate for Payer: VA VA |
$828.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,484.06
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,312.08
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,152.85 |
| Max. Negotiated Rate |
$2,980.87 |
| Rate for Payer: Aetna Commercial |
$2,815.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,703.65
|
| Rate for Payer: BCN Commercial |
$2,559.58
|
| Rate for Payer: Cash Price |
$2,649.66
|
| Rate for Payer: Cofinity Commercial |
$2,848.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,649.66
|
| Rate for Payer: Healthscope Commercial |
$2,980.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,484.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.27
|
| Rate for Payer: Nomi Health Commercial |
$2,715.91
|
| Rate for Payer: PHP Commercial |
$2,815.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,152.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,881.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,219.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,914.63
|
| Rate for Payer: UHC Core |
$2,765.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,484.06
|
|
