|
HC VEDOLIZUMAB
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.94
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$126.73
|
| Rate for Payer: BCN Commercial |
$126.73
|
| Rate for Payer: BCN Medicare Advantage |
$40.75
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.25
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PACE Senior Care Partners |
$38.71
|
| Rate for Payer: PACE SWMI |
$40.75
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: PHP Medicare Advantage |
$40.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Medicare |
$40.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.41
|
| Rate for Payer: Railroad Medicare Medicare |
$40.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.44
|
| Rate for Payer: UHC Core |
$136.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.75
|
| Rate for Payer: UHC Medicare Advantage |
$41.97
|
| Rate for Payer: VA VA |
$40.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.25
|
|
|
HC VEDOLIZUMAB, ANTIBODY
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna Medicare |
$33.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.31
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS MAPPO |
$32.25
|
| Rate for Payer: BCBS Trust/PPO |
$100.30
|
| Rate for Payer: BCN Commercial |
$100.30
|
| Rate for Payer: BCN Medicare Advantage |
$32.25
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.25
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.75
|
| Rate for Payer: Mclaren Medicaid |
$10.42
|
| Rate for Payer: Meridian Medicaid |
$10.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PACE Senior Care Partners |
$30.64
|
| Rate for Payer: PACE SWMI |
$32.25
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: PHP Medicare Advantage |
$32.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.23
|
| Rate for Payer: Priority Health Medicare |
$32.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.68
|
| Rate for Payer: Railroad Medicare Medicare |
$32.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.52
|
| Rate for Payer: UHC Core |
$107.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.25
|
| Rate for Payer: UHC Medicare Advantage |
$33.22
|
| Rate for Payer: VA VA |
$32.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.75
|
|
|
HC VEDOLIZUMAB, ANTIBODY
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: BCBS Trust/PPO |
$99.69
|
| Rate for Payer: BCN Commercial |
$99.69
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.52
|
| Rate for Payer: UHC Core |
$107.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.75
|
|
|
HC VEDOLIZUMAB CMPT
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna Medicare |
$33.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.00
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$99.52
|
| Rate for Payer: BCN Commercial |
$99.52
|
| Rate for Payer: BCN Medicare Advantage |
$32.00
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.80
|
| Rate for Payer: PACE Senior Care Partners |
$30.40
|
| Rate for Payer: PACE SWMI |
$32.00
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: PHP Medicare Advantage |
$32.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.36
|
| Rate for Payer: Priority Health Medicare |
$32.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.07
|
| Rate for Payer: Railroad Medicare Medicare |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.64
|
| Rate for Payer: UHC Core |
$106.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.00
|
| Rate for Payer: UHC Medicare Advantage |
$32.96
|
| Rate for Payer: VA VA |
$32.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
|
|
HC VEDOLIZUMAB CMPT
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.07 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: BCBS Trust/PPO |
$98.92
|
| Rate for Payer: BCN Commercial |
$98.92
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.80
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.64
|
| Rate for Payer: UHC Core |
$106.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: Aetna Medicare |
$63.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.25
|
| Rate for Payer: BCBS Complete |
$29.89
|
| Rate for Payer: BCBS MAPPO |
$61.00
|
| Rate for Payer: BCBS Trust/PPO |
$189.71
|
| Rate for Payer: BCN Commercial |
$189.71
|
| Rate for Payer: BCN Medicare Advantage |
$61.00
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.00
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.00
|
| Rate for Payer: Mclaren Medicaid |
$28.46
|
| Rate for Payer: Meridian Medicaid |
$29.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PACE Senior Care Partners |
$57.95
|
| Rate for Payer: PACE SWMI |
$61.00
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: PHP Medicare Advantage |
$61.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.28
|
| Rate for Payer: Priority Health Medicare |
$61.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.82
|
| Rate for Payer: Railroad Medicare Medicare |
$61.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.72
|
| Rate for Payer: UHC Core |
$203.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.00
|
| Rate for Payer: UHC Medicare Advantage |
$62.83
|
| Rate for Payer: VA VA |
$61.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.00
|
|
|
HC VEDOLIZUMAB, S
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
30100706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$148.82 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: BCBS Trust/PPO |
$188.56
|
| Rate for Payer: BCN Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.20
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.72
|
| Rate for Payer: UHC Core |
$203.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.00
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
IP
|
$1,001.24
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$610.66 |
| Max. Negotiated Rate |
$901.12 |
| Rate for Payer: Aetna Commercial |
$851.05
|
| Rate for Payer: BCBS Trust/PPO |
$773.76
|
| Rate for Payer: BCN Commercial |
$773.76
|
| Rate for Payer: Cash Price |
$800.99
|
| Rate for Payer: Cofinity Commercial |
$861.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.99
|
| Rate for Payer: Healthscope Commercial |
$901.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$851.05
|
| Rate for Payer: PHP Commercial |
$851.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$881.09
|
| Rate for Payer: UHC Core |
$836.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.93
|
|
|
HC VEEG 12-26 HR UNMONITORED
|
Facility
|
OP
|
$1,001.24
|
|
|
Service Code
|
CPT 95714
|
| Hospital Charge Code |
74000027
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$901.12 |
| Rate for Payer: Aetna Commercial |
$851.05
|
| Rate for Payer: Aetna Medicare |
$260.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.89
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$250.31
|
| Rate for Payer: BCBS Trust/PPO |
$778.46
|
| Rate for Payer: BCN Commercial |
$778.46
|
| Rate for Payer: BCN Medicare Advantage |
$250.31
|
| Rate for Payer: Cash Price |
$800.99
|
| Rate for Payer: Cash Price |
$800.99
|
| Rate for Payer: Cofinity Commercial |
$861.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.31
|
| Rate for Payer: Healthscope Commercial |
$901.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.93
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$851.05
|
| Rate for Payer: PACE Senior Care Partners |
$237.79
|
| Rate for Payer: PACE SWMI |
$250.31
|
| Rate for Payer: PHP Commercial |
$851.05
|
| Rate for Payer: PHP Medicare Advantage |
$250.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.08
|
| Rate for Payer: Priority Health Medicare |
$250.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.66
|
| Rate for Payer: Railroad Medicare Medicare |
$250.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$881.09
|
| Rate for Payer: UHC Core |
$836.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.31
|
| Rate for Payer: UHC Medicare Advantage |
$257.82
|
| Rate for Payer: VA VA |
$250.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.93
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
IP
|
$2,394.08
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,460.15 |
| Max. Negotiated Rate |
$2,154.67 |
| Rate for Payer: Aetna Commercial |
$2,034.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.15
|
| Rate for Payer: BCN Commercial |
$1,850.15
|
| Rate for Payer: Cash Price |
$1,915.26
|
| Rate for Payer: Cofinity Commercial |
$2,058.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,915.26
|
| Rate for Payer: Healthscope Commercial |
$2,154.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,795.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,034.97
|
| Rate for Payer: PHP Commercial |
$2,034.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,082.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,460.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,106.79
|
| Rate for Payer: UHC Core |
$1,999.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,795.56
|
|
|
HC VEEG 2-12 HR CONT MNTR
|
Facility
|
OP
|
$2,394.08
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
74000023
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$2,154.67 |
| Rate for Payer: Aetna Commercial |
$2,034.97
|
| Rate for Payer: Aetna Medicare |
$622.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$748.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$748.15
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$598.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,861.40
|
| Rate for Payer: BCN Commercial |
$1,861.40
|
| Rate for Payer: BCN Medicare Advantage |
$598.52
|
| Rate for Payer: Cash Price |
$1,915.26
|
| Rate for Payer: Cash Price |
$1,915.26
|
| Rate for Payer: Cofinity Commercial |
$2,058.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,915.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.52
|
| Rate for Payer: Healthscope Commercial |
$2,154.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,795.56
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$628.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$688.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,034.97
|
| Rate for Payer: PACE Senior Care Partners |
$568.59
|
| Rate for Payer: PACE SWMI |
$598.52
|
| Rate for Payer: PHP Commercial |
$2,034.97
|
| Rate for Payer: PHP Medicare Advantage |
$598.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,082.85
|
| Rate for Payer: Priority Health Medicare |
$598.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,460.15
|
| Rate for Payer: Railroad Medicare Medicare |
$598.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,106.79
|
| Rate for Payer: UHC Core |
$1,999.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.52
|
| Rate for Payer: UHC Medicare Advantage |
$616.48
|
| Rate for Payer: VA VA |
$598.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,795.56
|
|
|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
OP
|
$1,051.86
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$946.67 |
| Rate for Payer: Aetna Commercial |
$894.08
|
| Rate for Payer: Aetna Medicare |
$273.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$328.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$328.71
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$262.96
|
| Rate for Payer: BCBS Trust/PPO |
$817.82
|
| Rate for Payer: BCN Commercial |
$817.82
|
| Rate for Payer: BCN Medicare Advantage |
$262.96
|
| Rate for Payer: Cash Price |
$841.49
|
| Rate for Payer: Cash Price |
$841.49
|
| Rate for Payer: Cofinity Commercial |
$904.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.96
|
| Rate for Payer: Healthscope Commercial |
$946.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$788.90
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.08
|
| Rate for Payer: PACE Senior Care Partners |
$249.82
|
| Rate for Payer: PACE SWMI |
$262.96
|
| Rate for Payer: PHP Commercial |
$894.08
|
| Rate for Payer: PHP Medicare Advantage |
$262.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$915.12
|
| Rate for Payer: Priority Health Medicare |
$262.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.53
|
| Rate for Payer: Railroad Medicare Medicare |
$262.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.64
|
| Rate for Payer: UHC Core |
$878.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.96
|
| Rate for Payer: UHC Medicare Advantage |
$270.85
|
| Rate for Payer: VA VA |
$262.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$788.90
|
|
|
HC VEEG 2-12 HR INTMT MNTR
|
Facility
|
IP
|
$1,051.86
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
74000022
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$641.53 |
| Max. Negotiated Rate |
$946.67 |
| Rate for Payer: Aetna Commercial |
$894.08
|
| Rate for Payer: BCBS Trust/PPO |
$812.88
|
| Rate for Payer: BCN Commercial |
$812.88
|
| Rate for Payer: Cash Price |
$841.49
|
| Rate for Payer: Cofinity Commercial |
$904.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.49
|
| Rate for Payer: Healthscope Commercial |
$946.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$788.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$894.08
|
| Rate for Payer: PHP Commercial |
$894.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$736.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$915.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.64
|
| Rate for Payer: UHC Core |
$878.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$788.90
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
OP
|
$1,921.04
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$1,728.94 |
| Rate for Payer: Aetna Commercial |
$1,632.88
|
| Rate for Payer: Aetna Medicare |
$499.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.32
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$480.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,493.61
|
| Rate for Payer: BCN Commercial |
$1,493.61
|
| Rate for Payer: BCN Medicare Advantage |
$480.26
|
| Rate for Payer: Cash Price |
$1,536.83
|
| Rate for Payer: Cash Price |
$1,536.83
|
| Rate for Payer: Cofinity Commercial |
$1,652.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,536.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.26
|
| Rate for Payer: Healthscope Commercial |
$1,728.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,440.78
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,632.88
|
| Rate for Payer: PACE Senior Care Partners |
$456.25
|
| Rate for Payer: PACE SWMI |
$480.26
|
| Rate for Payer: PHP Commercial |
$1,632.88
|
| Rate for Payer: PHP Medicare Advantage |
$480.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,671.30
|
| Rate for Payer: Priority Health Medicare |
$480.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,171.64
|
| Rate for Payer: Railroad Medicare Medicare |
$480.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,690.52
|
| Rate for Payer: UHC Core |
$1,604.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.26
|
| Rate for Payer: UHC Medicare Advantage |
$494.67
|
| Rate for Payer: VA VA |
$480.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,440.78
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
IP
|
$1,921.04
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
74000026
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,171.64 |
| Max. Negotiated Rate |
$1,728.94 |
| Rate for Payer: Aetna Commercial |
$1,632.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,484.58
|
| Rate for Payer: BCN Commercial |
$1,484.58
|
| Rate for Payer: Cash Price |
$1,536.83
|
| Rate for Payer: Cofinity Commercial |
$1,652.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,536.83
|
| Rate for Payer: Healthscope Commercial |
$1,728.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,440.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,632.88
|
| Rate for Payer: PHP Commercial |
$1,632.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,671.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,171.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,690.52
|
| Rate for Payer: UHC Core |
$1,604.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,440.78
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
OP
|
$4,462.92
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$685.87 |
| Max. Negotiated Rate |
$4,016.63 |
| Rate for Payer: Aetna Commercial |
$3,793.48
|
| Rate for Payer: Aetna Medicare |
$1,160.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,394.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,394.66
|
| Rate for Payer: BCBS Complete |
$720.16
|
| Rate for Payer: BCBS MAPPO |
$1,115.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,469.92
|
| Rate for Payer: BCN Commercial |
$3,469.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,115.73
|
| Rate for Payer: Cash Price |
$3,570.34
|
| Rate for Payer: Cash Price |
$3,570.34
|
| Rate for Payer: Cofinity Commercial |
$3,838.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,570.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,115.73
|
| Rate for Payer: Healthscope Commercial |
$4,016.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,347.19
|
| Rate for Payer: Mclaren Medicaid |
$685.87
|
| Rate for Payer: Meridian Medicaid |
$720.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,171.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,283.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,793.48
|
| Rate for Payer: PACE Senior Care Partners |
$1,059.94
|
| Rate for Payer: PACE SWMI |
$1,115.73
|
| Rate for Payer: PHP Commercial |
$3,793.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,115.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,124.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,882.74
|
| Rate for Payer: Priority Health Medicare |
$1,115.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,721.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,115.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,927.37
|
| Rate for Payer: UHC Core |
$3,726.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,115.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.20
|
| Rate for Payer: VA VA |
$1,115.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,347.19
|
|
|
HC VEEG EA 12-26 HR CONT MNTR
|
Facility
|
IP
|
$4,462.92
|
|
|
Service Code
|
CPT 95716
|
| Hospital Charge Code |
74000025
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,721.93 |
| Max. Negotiated Rate |
$4,016.63 |
| Rate for Payer: Aetna Commercial |
$3,793.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,448.94
|
| Rate for Payer: BCN Commercial |
$3,448.94
|
| Rate for Payer: Cash Price |
$3,570.34
|
| Rate for Payer: Cofinity Commercial |
$3,838.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,570.34
|
| Rate for Payer: Healthscope Commercial |
$4,016.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,347.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,793.48
|
| Rate for Payer: PHP Commercial |
$3,793.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,124.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,882.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,721.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,927.37
|
| Rate for Payer: UHC Core |
$3,726.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,347.19
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
IP
|
$2,374.30
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,448.09 |
| Max. Negotiated Rate |
$2,136.87 |
| Rate for Payer: Aetna Commercial |
$2,018.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.86
|
| Rate for Payer: BCN Commercial |
$1,834.86
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cofinity Commercial |
$2,041.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,899.44
|
| Rate for Payer: Healthscope Commercial |
$2,136.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,780.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,018.16
|
| Rate for Payer: PHP Commercial |
$2,018.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,065.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,448.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,089.38
|
| Rate for Payer: UHC Core |
$1,982.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,780.72
|
|
|
HC VEEG EA 12-26 HR INTMT MNTR
|
Facility
|
OP
|
$2,374.30
|
|
|
Service Code
|
CPT 95715
|
| Hospital Charge Code |
74000024
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$2,136.87 |
| Rate for Payer: Aetna Commercial |
$2,018.16
|
| Rate for Payer: Aetna Medicare |
$617.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$741.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$741.97
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$593.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.02
|
| Rate for Payer: BCN Commercial |
$1,846.02
|
| Rate for Payer: BCN Medicare Advantage |
$593.58
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cofinity Commercial |
$2,041.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,899.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.58
|
| Rate for Payer: Healthscope Commercial |
$2,136.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,780.72
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$623.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$682.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,018.16
|
| Rate for Payer: PACE Senior Care Partners |
$563.90
|
| Rate for Payer: PACE SWMI |
$593.58
|
| Rate for Payer: PHP Commercial |
$2,018.16
|
| Rate for Payer: PHP Medicare Advantage |
$593.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,065.64
|
| Rate for Payer: Priority Health Medicare |
$593.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,448.09
|
| Rate for Payer: Railroad Medicare Medicare |
$593.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,089.38
|
| Rate for Payer: UHC Core |
$1,982.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$593.58
|
| Rate for Payer: UHC Medicare Advantage |
$611.38
|
| Rate for Payer: VA VA |
$593.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,780.72
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
IP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$842.31 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,067.29
|
| Rate for Payer: BCN Commercial |
$1,067.29
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$842.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,215.34
|
| Rate for Payer: UHC Core |
$1,153.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.80
|
|
|
HC VEIN MAPPING BILATERAL LOWER
|
Facility
|
OP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: Aetna Medicare |
$359.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$431.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$431.58
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$345.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.78
|
| Rate for Payer: BCN Commercial |
$1,073.78
|
| Rate for Payer: BCN Medicare Advantage |
$345.27
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.27
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.80
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$362.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$397.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PACE Senior Care Partners |
$328.00
|
| Rate for Payer: PACE SWMI |
$345.27
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: PHP Medicare Advantage |
$345.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.53
|
| Rate for Payer: Priority Health Medicare |
$345.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$842.31
|
| Rate for Payer: Railroad Medicare Medicare |
$345.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,215.34
|
| Rate for Payer: UHC Core |
$1,153.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.27
|
| Rate for Payer: UHC Medicare Advantage |
$355.63
|
| Rate for Payer: VA VA |
$345.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.80
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
OP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: Aetna Medicare |
$359.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$431.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$431.58
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$345.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.78
|
| Rate for Payer: BCN Commercial |
$1,073.78
|
| Rate for Payer: BCN Medicare Advantage |
$345.27
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.27
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.80
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$362.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$397.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PACE Senior Care Partners |
$328.00
|
| Rate for Payer: PACE SWMI |
$345.27
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: PHP Medicare Advantage |
$345.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.53
|
| Rate for Payer: Priority Health Medicare |
$345.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$842.31
|
| Rate for Payer: Railroad Medicare Medicare |
$345.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,215.34
|
| Rate for Payer: UHC Core |
$1,153.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.27
|
| Rate for Payer: UHC Medicare Advantage |
$355.63
|
| Rate for Payer: VA VA |
$345.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.80
|
|
|
HC VEIN MAPPING BILATERAL UPPER
|
Facility
|
IP
|
$1,381.07
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$842.31 |
| Max. Negotiated Rate |
$1,242.96 |
| Rate for Payer: Aetna Commercial |
$1,173.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,067.29
|
| Rate for Payer: BCN Commercial |
$1,067.29
|
| Rate for Payer: Cash Price |
$1,104.86
|
| Rate for Payer: Cofinity Commercial |
$1,187.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.86
|
| Rate for Payer: Healthscope Commercial |
$1,242.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,173.91
|
| Rate for Payer: PHP Commercial |
$1,173.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$842.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,215.34
|
| Rate for Payer: UHC Core |
$1,153.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.80
|
|
|
HC VEIN MAPPING UNILAT LOWER EXTREMITY (R OR L)
|
Facility
|
OP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: Aetna Medicare |
$221.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.82
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$212.66
|
| Rate for Payer: BCBS Trust/PPO |
$661.36
|
| Rate for Payer: BCN Commercial |
$661.36
|
| Rate for Payer: BCN Medicare Advantage |
$212.66
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.66
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.96
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$223.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PACE Senior Care Partners |
$202.02
|
| Rate for Payer: PACE SWMI |
$212.66
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: PHP Medicare Advantage |
$212.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.04
|
| Rate for Payer: Priority Health Medicare |
$212.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$518.79
|
| Rate for Payer: Railroad Medicare Medicare |
$212.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.55
|
| Rate for Payer: UHC Core |
$710.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.66
|
| Rate for Payer: UHC Medicare Advantage |
$219.03
|
| Rate for Payer: VA VA |
$212.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.96
|
|
|
HC VEIN MAPPING UNILAT LOWER EXTREMITY (R OR L)
|
Facility
|
IP
|
$850.62
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$518.79 |
| Max. Negotiated Rate |
$765.56 |
| Rate for Payer: Aetna Commercial |
$723.03
|
| Rate for Payer: BCBS Trust/PPO |
$657.36
|
| Rate for Payer: BCN Commercial |
$657.36
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$731.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.50
|
| Rate for Payer: Healthscope Commercial |
$765.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$723.03
|
| Rate for Payer: PHP Commercial |
$723.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$518.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.55
|
| Rate for Payer: UHC Core |
$710.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.96
|
|
