|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
IP
|
$1,755.98
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,141.39 |
| Max. Negotiated Rate |
$1,580.38 |
| Rate for Payer: Aetna Commercial |
$1,492.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,433.41
|
| Rate for Payer: BCN Commercial |
$1,357.02
|
| Rate for Payer: Cash Price |
$1,404.78
|
| Rate for Payer: Cofinity Commercial |
$1,510.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.78
|
| Rate for Payer: Healthscope Commercial |
$1,580.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,316.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,492.58
|
| Rate for Payer: Nomi Health Commercial |
$1,439.90
|
| Rate for Payer: PHP Commercial |
$1,492.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.39
|
| Rate for Payer: Priority Health HMO/PPO |
$1,527.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,176.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,545.26
|
| Rate for Payer: UHC Core |
$1,466.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,316.98
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
IP
|
$2,107.08
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,369.60 |
| Max. Negotiated Rate |
$1,896.37 |
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,720.01
|
| Rate for Payer: BCN Commercial |
$1,628.35
|
| Rate for Payer: Cash Price |
$1,685.66
|
| Rate for Payer: Cofinity Commercial |
$1,812.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,685.66
|
| Rate for Payer: Healthscope Commercial |
$1,896.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,580.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.02
|
| Rate for Payer: Nomi Health Commercial |
$1,727.81
|
| Rate for Payer: PHP Commercial |
$1,791.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,833.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,411.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.23
|
| Rate for Payer: UHC Core |
$1,759.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,580.31
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
OP
|
$2,107.08
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.43 |
| Max. Negotiated Rate |
$1,896.37 |
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: Aetna Medicare |
$547.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$658.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$658.46
|
| Rate for Payer: BCBS Complete |
$842.83
|
| Rate for Payer: BCBS MAPPO |
$526.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.23
|
| Rate for Payer: BCN Commercial |
$1,638.25
|
| Rate for Payer: BCN Medicare Advantage |
$526.77
|
| Rate for Payer: Cash Price |
$1,685.66
|
| Rate for Payer: Cofinity Commercial |
$1,812.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,685.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.77
|
| Rate for Payer: Healthscope Commercial |
$1,896.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,580.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$605.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.02
|
| Rate for Payer: Nomi Health Commercial |
$1,727.81
|
| Rate for Payer: PACE Senior Care Partners |
$500.43
|
| Rate for Payer: PACE SWMI |
$526.77
|
| Rate for Payer: PHP Commercial |
$1,791.02
|
| Rate for Payer: PHP Medicare Advantage |
$526.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,833.16
|
| Rate for Payer: Priority Health Medicare |
$532.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,411.74
|
| Rate for Payer: Railroad Medicare Medicare |
$526.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.23
|
| Rate for Payer: UHC Core |
$1,759.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$526.77
|
| Rate for Payer: UHC Exchange |
$526.77
|
| Rate for Payer: UHC Medicare Advantage |
$526.77
|
| Rate for Payer: VA VA |
$526.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,580.31
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
OP
|
$2,918.68
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$693.19 |
| Max. Negotiated Rate |
$2,626.81 |
| Rate for Payer: Aetna Commercial |
$2,480.88
|
| Rate for Payer: Aetna Medicare |
$758.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$912.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$912.09
|
| Rate for Payer: BCBS Complete |
$1,167.47
|
| Rate for Payer: BCBS MAPPO |
$729.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,399.45
|
| Rate for Payer: BCN Commercial |
$2,269.27
|
| Rate for Payer: BCN Medicare Advantage |
$729.67
|
| Rate for Payer: Cash Price |
$2,334.94
|
| Rate for Payer: Cofinity Commercial |
$2,510.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,334.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.67
|
| Rate for Payer: Healthscope Commercial |
$2,626.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,189.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$766.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$839.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,480.88
|
| Rate for Payer: Nomi Health Commercial |
$2,393.32
|
| Rate for Payer: PACE Senior Care Partners |
$693.19
|
| Rate for Payer: PACE SWMI |
$729.67
|
| Rate for Payer: PHP Commercial |
$2,480.88
|
| Rate for Payer: PHP Medicare Advantage |
$729.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.14
|
| Rate for Payer: Priority Health HMO/PPO |
$2,539.25
|
| Rate for Payer: Priority Health Medicare |
$736.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,955.52
|
| Rate for Payer: Railroad Medicare Medicare |
$729.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,568.44
|
| Rate for Payer: UHC Core |
$2,437.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$729.67
|
| Rate for Payer: UHC Exchange |
$729.67
|
| Rate for Payer: UHC Medicare Advantage |
$729.67
|
| Rate for Payer: VA VA |
$729.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,189.01
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
IP
|
$2,918.68
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,897.14 |
| Max. Negotiated Rate |
$2,626.81 |
| Rate for Payer: Aetna Commercial |
$2,480.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,382.52
|
| Rate for Payer: BCN Commercial |
$2,255.56
|
| Rate for Payer: Cash Price |
$2,334.94
|
| Rate for Payer: Cofinity Commercial |
$2,510.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,334.94
|
| Rate for Payer: Healthscope Commercial |
$2,626.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,189.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,480.88
|
| Rate for Payer: Nomi Health Commercial |
$2,393.32
|
| Rate for Payer: PHP Commercial |
$2,480.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.14
|
| Rate for Payer: Priority Health HMO/PPO |
$2,539.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,955.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,568.44
|
| Rate for Payer: UHC Core |
$2,437.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,189.01
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
OP
|
$1,448.79
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$1,303.91 |
| Rate for Payer: Aetna Commercial |
$1,231.47
|
| Rate for Payer: Aetna Medicare |
$376.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.75
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$362.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.05
|
| Rate for Payer: BCN Commercial |
$1,126.43
|
| Rate for Payer: BCN Medicare Advantage |
$362.20
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cofinity Commercial |
$1,245.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.20
|
| Rate for Payer: Healthscope Commercial |
$1,303.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.59
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.31
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.47
|
| Rate for Payer: Nomi Health Commercial |
$1,188.01
|
| Rate for Payer: PACE Senior Care Partners |
$344.09
|
| Rate for Payer: PACE SWMI |
$362.20
|
| Rate for Payer: PHP Commercial |
$1,231.47
|
| Rate for Payer: PHP Medicare Advantage |
$362.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,260.45
|
| Rate for Payer: Priority Health Medicare |
$365.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.69
|
| Rate for Payer: Railroad Medicare Medicare |
$362.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.94
|
| Rate for Payer: UHC Core |
$1,209.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.20
|
| Rate for Payer: UHC Exchange |
$362.20
|
| Rate for Payer: UHC Medicare Advantage |
$362.20
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$362.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.59
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
IP
|
$1,448.79
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$941.71 |
| Max. Negotiated Rate |
$1,303.91 |
| Rate for Payer: Aetna Commercial |
$1,231.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.65
|
| Rate for Payer: BCN Commercial |
$1,119.62
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cofinity Commercial |
$1,245.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.03
|
| Rate for Payer: Healthscope Commercial |
$1,303.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.47
|
| Rate for Payer: Nomi Health Commercial |
$1,188.01
|
| Rate for Payer: PHP Commercial |
$1,231.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,260.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.94
|
| Rate for Payer: UHC Core |
$1,209.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.59
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
OP
|
$1,693.72
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$402.26 |
| Max. Negotiated Rate |
$1,524.35 |
| Rate for Payer: Aetna Commercial |
$1,439.66
|
| Rate for Payer: Aetna Medicare |
$440.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$529.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$529.29
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$423.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.41
|
| Rate for Payer: BCN Commercial |
$1,316.87
|
| Rate for Payer: BCN Medicare Advantage |
$423.43
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cofinity Commercial |
$1,456.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.43
|
| Rate for Payer: Healthscope Commercial |
$1,524.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,270.29
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.60
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$486.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.66
|
| Rate for Payer: Nomi Health Commercial |
$1,388.85
|
| Rate for Payer: PACE Senior Care Partners |
$402.26
|
| Rate for Payer: PACE SWMI |
$423.43
|
| Rate for Payer: PHP Commercial |
$1,439.66
|
| Rate for Payer: PHP Medicare Advantage |
$423.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.92
|
| Rate for Payer: Priority Health HMO/PPO |
$1,473.54
|
| Rate for Payer: Priority Health Medicare |
$427.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,134.79
|
| Rate for Payer: Railroad Medicare Medicare |
$423.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,490.47
|
| Rate for Payer: UHC Core |
$1,414.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.43
|
| Rate for Payer: UHC Exchange |
$423.43
|
| Rate for Payer: UHC Medicare Advantage |
$423.43
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$423.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,270.29
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
IP
|
$1,693.72
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,100.92 |
| Max. Negotiated Rate |
$1,524.35 |
| Rate for Payer: Aetna Commercial |
$1,439.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,382.58
|
| Rate for Payer: BCN Commercial |
$1,308.91
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cofinity Commercial |
$1,456.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.98
|
| Rate for Payer: Healthscope Commercial |
$1,524.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,270.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.66
|
| Rate for Payer: Nomi Health Commercial |
$1,388.85
|
| Rate for Payer: PHP Commercial |
$1,439.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.92
|
| Rate for Payer: Priority Health HMO/PPO |
$1,473.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,134.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,490.47
|
| Rate for Payer: UHC Core |
$1,414.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,270.29
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
IP
|
$2,390.22
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,553.64 |
| Max. Negotiated Rate |
$2,151.20 |
| Rate for Payer: Aetna Commercial |
$2,031.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,951.14
|
| Rate for Payer: BCN Commercial |
$1,847.16
|
| Rate for Payer: Cash Price |
$1,912.18
|
| Rate for Payer: Cofinity Commercial |
$2,055.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.18
|
| Rate for Payer: Healthscope Commercial |
$2,151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,792.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,031.69
|
| Rate for Payer: Nomi Health Commercial |
$1,959.98
|
| Rate for Payer: PHP Commercial |
$2,031.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,553.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2,079.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,601.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,103.39
|
| Rate for Payer: UHC Core |
$1,995.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,792.66
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
OP
|
$2,390.22
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.70 |
| Max. Negotiated Rate |
$2,151.20 |
| Rate for Payer: Aetna Commercial |
$2,031.69
|
| Rate for Payer: Aetna Medicare |
$621.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.94
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$597.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,965.00
|
| Rate for Payer: BCN Commercial |
$1,858.40
|
| Rate for Payer: BCN Medicare Advantage |
$597.55
|
| Rate for Payer: Cash Price |
$1,912.18
|
| Rate for Payer: Cash Price |
$1,912.18
|
| Rate for Payer: Cofinity Commercial |
$2,055.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.55
|
| Rate for Payer: Healthscope Commercial |
$2,151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,792.66
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.43
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$687.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,031.69
|
| Rate for Payer: Nomi Health Commercial |
$1,959.98
|
| Rate for Payer: PACE Senior Care Partners |
$567.68
|
| Rate for Payer: PACE SWMI |
$597.55
|
| Rate for Payer: PHP Commercial |
$2,031.69
|
| Rate for Payer: PHP Medicare Advantage |
$597.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,553.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2,079.49
|
| Rate for Payer: Priority Health Medicare |
$603.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,601.45
|
| Rate for Payer: Railroad Medicare Medicare |
$597.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,103.39
|
| Rate for Payer: UHC Core |
$1,995.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.55
|
| Rate for Payer: UHC Exchange |
$597.55
|
| Rate for Payer: UHC Medicare Advantage |
$597.55
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$597.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,792.66
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
OP
|
$1,962.98
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$466.21 |
| Max. Negotiated Rate |
$1,766.68 |
| Rate for Payer: Aetna Commercial |
$1,668.53
|
| Rate for Payer: Aetna Medicare |
$510.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.43
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$490.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,613.77
|
| Rate for Payer: BCN Commercial |
$1,526.22
|
| Rate for Payer: BCN Medicare Advantage |
$490.75
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cofinity Commercial |
$1,688.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.75
|
| Rate for Payer: Healthscope Commercial |
$1,766.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.23
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.28
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.53
|
| Rate for Payer: Nomi Health Commercial |
$1,609.64
|
| Rate for Payer: PACE Senior Care Partners |
$466.21
|
| Rate for Payer: PACE SWMI |
$490.75
|
| Rate for Payer: PHP Commercial |
$1,668.53
|
| Rate for Payer: PHP Medicare Advantage |
$490.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,707.79
|
| Rate for Payer: Priority Health Medicare |
$495.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.20
|
| Rate for Payer: Railroad Medicare Medicare |
$490.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.42
|
| Rate for Payer: UHC Core |
$1,639.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.75
|
| Rate for Payer: UHC Exchange |
$490.75
|
| Rate for Payer: UHC Medicare Advantage |
$490.75
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$490.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.23
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
IP
|
$1,962.98
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,275.94 |
| Max. Negotiated Rate |
$1,766.68 |
| Rate for Payer: Aetna Commercial |
$1,668.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,602.38
|
| Rate for Payer: BCN Commercial |
$1,516.99
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cofinity Commercial |
$1,688.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.38
|
| Rate for Payer: Healthscope Commercial |
$1,766.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.53
|
| Rate for Payer: Nomi Health Commercial |
$1,609.64
|
| Rate for Payer: PHP Commercial |
$1,668.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,707.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.42
|
| Rate for Payer: UHC Core |
$1,639.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.23
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$696.15 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: BCBS Trust/PPO |
$874.26
|
| Rate for Payer: BCN Commercial |
$827.67
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO |
$931.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$717.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$254.36 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$278.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$334.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$334.69
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS MAPPO |
$267.75
|
| Rate for Payer: BCBS Trust/PPO |
$880.47
|
| Rate for Payer: BCN Commercial |
$832.70
|
| Rate for Payer: BCN Medicare Advantage |
$267.75
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: PACE Senior Care Partners |
$254.36
|
| Rate for Payer: PACE SWMI |
$267.75
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: PHP Medicare Advantage |
$267.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO |
$931.77
|
| Rate for Payer: Priority Health Medicare |
$270.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$717.57
|
| Rate for Payer: Railroad Medicare Medicare |
$267.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.75
|
| Rate for Payer: UHC Exchange |
$267.75
|
| Rate for Payer: UHC Medicare Advantage |
$267.75
|
| Rate for Payer: VA VA |
$267.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
OP
|
$7,265.88
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,725.65 |
| Max. Negotiated Rate |
$6,539.29 |
| Rate for Payer: Aetna Commercial |
$6,176.00
|
| Rate for Payer: Aetna Medicare |
$1,889.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,270.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,270.59
|
| Rate for Payer: BCBS Complete |
$2,906.35
|
| Rate for Payer: BCBS MAPPO |
$1,816.47
|
| Rate for Payer: BCBS Trust/PPO |
$5,973.28
|
| Rate for Payer: BCN Commercial |
$5,649.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,816.47
|
| Rate for Payer: Cash Price |
$5,812.70
|
| Rate for Payer: Cofinity Commercial |
$6,248.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,812.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,816.47
|
| Rate for Payer: Healthscope Commercial |
$6,539.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,449.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,907.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,088.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,176.00
|
| Rate for Payer: Nomi Health Commercial |
$5,958.02
|
| Rate for Payer: PACE Senior Care Partners |
$1,725.65
|
| Rate for Payer: PACE SWMI |
$1,816.47
|
| Rate for Payer: PHP Commercial |
$6,176.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,816.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,722.82
|
| Rate for Payer: Priority Health HMO/PPO |
$6,321.32
|
| Rate for Payer: Priority Health Medicare |
$1,834.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,868.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,816.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,393.97
|
| Rate for Payer: UHC Core |
$6,067.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,816.47
|
| Rate for Payer: UHC Exchange |
$1,816.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,816.47
|
| Rate for Payer: VA VA |
$1,816.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,449.41
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
IP
|
$7,265.88
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,722.82 |
| Max. Negotiated Rate |
$6,539.29 |
| Rate for Payer: Aetna Commercial |
$6,176.00
|
| Rate for Payer: BCBS Trust/PPO |
$5,931.14
|
| Rate for Payer: BCN Commercial |
$5,615.07
|
| Rate for Payer: Cash Price |
$5,812.70
|
| Rate for Payer: Cofinity Commercial |
$6,248.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,812.70
|
| Rate for Payer: Healthscope Commercial |
$6,539.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,449.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,176.00
|
| Rate for Payer: Nomi Health Commercial |
$5,958.02
|
| Rate for Payer: PHP Commercial |
$6,176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,722.82
|
| Rate for Payer: Priority Health HMO/PPO |
$6,321.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,868.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,393.97
|
| Rate for Payer: UHC Core |
$6,067.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,449.41
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Aetna Commercial |
$867.00
|
| Rate for Payer: BCBS Trust/PPO |
$832.63
|
| Rate for Payer: BCN Commercial |
$788.26
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$877.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.00
|
| Rate for Payer: Healthscope Commercial |
$918.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.00
|
| Rate for Payer: Nomi Health Commercial |
$836.40
|
| Rate for Payer: PHP Commercial |
$867.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health HMO/PPO |
$887.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.60
|
| Rate for Payer: UHC Core |
$851.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.00
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Aetna Commercial |
$867.00
|
| Rate for Payer: Aetna Medicare |
$265.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.75
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: BCBS MAPPO |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$838.54
|
| Rate for Payer: BCN Commercial |
$793.05
|
| Rate for Payer: BCN Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$877.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.00
|
| Rate for Payer: Healthscope Commercial |
$918.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.00
|
| Rate for Payer: Nomi Health Commercial |
$836.40
|
| Rate for Payer: PACE Senior Care Partners |
$242.25
|
| Rate for Payer: PACE SWMI |
$255.00
|
| Rate for Payer: PHP Commercial |
$867.00
|
| Rate for Payer: PHP Medicare Advantage |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health HMO/PPO |
$887.40
|
| Rate for Payer: Priority Health Medicare |
$257.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.40
|
| Rate for Payer: Railroad Medicare Medicare |
$255.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.60
|
| Rate for Payer: UHC Core |
$851.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.00
|
| Rate for Payer: UHC Exchange |
$255.00
|
| Rate for Payer: UHC Medicare Advantage |
$255.00
|
| Rate for Payer: VA VA |
$255.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.00
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
IP
|
$845.54
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$760.99 |
| Rate for Payer: Aetna Commercial |
$718.71
|
| Rate for Payer: BCBS Trust/PPO |
$690.21
|
| Rate for Payer: BCN Commercial |
$653.43
|
| Rate for Payer: Cash Price |
$676.43
|
| Rate for Payer: Cofinity Commercial |
$727.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.43
|
| Rate for Payer: Healthscope Commercial |
$760.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.71
|
| Rate for Payer: Nomi Health Commercial |
$693.34
|
| Rate for Payer: PHP Commercial |
$718.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.60
|
| Rate for Payer: Priority Health HMO/PPO |
$735.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$566.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.08
|
| Rate for Payer: UHC Core |
$706.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.15
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
OP
|
$845.54
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.82 |
| Max. Negotiated Rate |
$760.99 |
| Rate for Payer: Aetna Commercial |
$718.71
|
| Rate for Payer: Aetna Medicare |
$219.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.23
|
| Rate for Payer: BCBS Complete |
$338.22
|
| Rate for Payer: BCBS MAPPO |
$211.38
|
| Rate for Payer: BCBS Trust/PPO |
$695.12
|
| Rate for Payer: BCN Commercial |
$657.41
|
| Rate for Payer: BCN Medicare Advantage |
$211.38
|
| Rate for Payer: Cash Price |
$676.43
|
| Rate for Payer: Cofinity Commercial |
$727.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.38
|
| Rate for Payer: Healthscope Commercial |
$760.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.71
|
| Rate for Payer: Nomi Health Commercial |
$693.34
|
| Rate for Payer: PACE Senior Care Partners |
$200.82
|
| Rate for Payer: PACE SWMI |
$211.38
|
| Rate for Payer: PHP Commercial |
$718.71
|
| Rate for Payer: PHP Medicare Advantage |
$211.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.60
|
| Rate for Payer: Priority Health HMO/PPO |
$735.62
|
| Rate for Payer: Priority Health Medicare |
$213.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$566.51
|
| Rate for Payer: Railroad Medicare Medicare |
$211.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.08
|
| Rate for Payer: UHC Core |
$706.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.38
|
| Rate for Payer: UHC Exchange |
$211.38
|
| Rate for Payer: UHC Medicare Advantage |
$211.38
|
| Rate for Payer: VA VA |
$211.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.15
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,122.86
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$1,010.57 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna Medicare |
$291.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.89
|
| Rate for Payer: BCBS Complete |
$449.14
|
| Rate for Payer: BCBS MAPPO |
$280.71
|
| Rate for Payer: BCBS Trust/PPO |
$923.10
|
| Rate for Payer: BCN Commercial |
$873.02
|
| Rate for Payer: BCN Medicare Advantage |
$280.71
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.71
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: PACE Senior Care Partners |
$266.68
|
| Rate for Payer: PACE SWMI |
$280.71
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: PHP Medicare Advantage |
$280.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health HMO/PPO |
$976.89
|
| Rate for Payer: Priority Health Medicare |
$283.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$752.32
|
| Rate for Payer: Railroad Medicare Medicare |
$280.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.12
|
| Rate for Payer: UHC Core |
$937.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.71
|
| Rate for Payer: UHC Exchange |
$280.71
|
| Rate for Payer: UHC Medicare Advantage |
$280.71
|
| Rate for Payer: VA VA |
$280.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.14
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,122.86
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$729.86 |
| Max. Negotiated Rate |
$1,010.57 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: BCBS Trust/PPO |
$916.59
|
| Rate for Payer: BCN Commercial |
$867.75
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health HMO/PPO |
$976.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$752.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.12
|
| Rate for Payer: UHC Core |
$937.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.14
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
OP
|
$10,446.83
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,481.12 |
| Max. Negotiated Rate |
$9,402.15 |
| Rate for Payer: Aetna Commercial |
$8,879.81
|
| Rate for Payer: Aetna Medicare |
$2,716.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,264.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,264.63
|
| Rate for Payer: BCBS Complete |
$4,178.73
|
| Rate for Payer: BCBS MAPPO |
$2,611.71
|
| Rate for Payer: BCBS Trust/PPO |
$8,588.34
|
| Rate for Payer: BCN Commercial |
$8,122.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,611.71
|
| Rate for Payer: Cash Price |
$8,357.46
|
| Rate for Payer: Cofinity Commercial |
$8,984.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,357.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,611.71
|
| Rate for Payer: Healthscope Commercial |
$9,402.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,835.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,742.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,003.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,879.81
|
| Rate for Payer: Nomi Health Commercial |
$8,566.40
|
| Rate for Payer: PACE Senior Care Partners |
$2,481.12
|
| Rate for Payer: PACE SWMI |
$2,611.71
|
| Rate for Payer: PHP Commercial |
$8,879.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,611.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,790.44
|
| Rate for Payer: Priority Health HMO/PPO |
$9,088.74
|
| Rate for Payer: Priority Health Medicare |
$2,637.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,999.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,611.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,193.21
|
| Rate for Payer: UHC Core |
$8,723.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,611.71
|
| Rate for Payer: UHC Exchange |
$2,611.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,611.71
|
| Rate for Payer: VA VA |
$2,611.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,835.12
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
IP
|
$10,446.83
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,790.44 |
| Max. Negotiated Rate |
$9,402.15 |
| Rate for Payer: Aetna Commercial |
$8,879.81
|
| Rate for Payer: BCBS Trust/PPO |
$8,527.75
|
| Rate for Payer: BCN Commercial |
$8,073.31
|
| Rate for Payer: Cash Price |
$8,357.46
|
| Rate for Payer: Cofinity Commercial |
$8,984.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,357.46
|
| Rate for Payer: Healthscope Commercial |
$9,402.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,835.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,879.81
|
| Rate for Payer: Nomi Health Commercial |
$8,566.40
|
| Rate for Payer: PHP Commercial |
$8,879.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,790.44
|
| Rate for Payer: Priority Health HMO/PPO |
$9,088.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,999.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,193.21
|
| Rate for Payer: UHC Core |
$8,723.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,835.12
|
|
