|
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 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 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 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 |
$634.16
|
| 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 |
$634.16
|
|
|
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 |
$634.16
|
| 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 |
$634.16
|
|
|
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 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 |
$280.72
|
| Rate for Payer: BCBS Trust/PPO |
$923.10
|
| Rate for Payer: BCN Commercial |
$873.02
|
| Rate for Payer: BCN Medicare Advantage |
$280.72
|
| 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 |
$280.72
|
| 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 |
$280.72
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: PHP Medicare Advantage |
$280.72
|
| 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 |
$280.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.12
|
| Rate for Payer: UHC Core |
$937.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.72
|
| Rate for Payer: UHC Exchange |
$280.72
|
| Rate for Payer: UHC Medicare Advantage |
$280.72
|
| Rate for Payer: VA VA |
$280.72
|
| 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
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$265.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.99
|
| Rate for Payer: BCBS Complete |
$408.31
|
| Rate for Payer: BCBS MAPPO |
$255.20
|
| Rate for Payer: BCBS Trust/PPO |
$839.18
|
| Rate for Payer: BCN Commercial |
$793.66
|
| Rate for Payer: BCN Medicare Advantage |
$255.20
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.20
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Senior Care Partners |
$242.44
|
| Rate for Payer: PACE SWMI |
$255.20
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$255.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Medicare |
$257.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: Railroad Medicare Medicare |
$255.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.20
|
| Rate for Payer: UHC Exchange |
$255.20
|
| Rate for Payer: UHC Medicare Advantage |
$255.20
|
| Rate for Payer: VA VA |
$255.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.58
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: BCBS Trust/PPO |
$833.26
|
| Rate for Payer: BCN Commercial |
$788.86
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.58
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
IP
|
$930.40
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$604.76 |
| Max. Negotiated Rate |
$837.36 |
| Rate for Payer: Aetna Commercial |
$790.84
|
| Rate for Payer: BCBS Trust/PPO |
$759.49
|
| Rate for Payer: BCN Commercial |
$719.01
|
| Rate for Payer: Cash Price |
$744.32
|
| Rate for Payer: Cofinity Commercial |
$800.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.32
|
| Rate for Payer: Healthscope Commercial |
$837.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.84
|
| Rate for Payer: Nomi Health Commercial |
$762.93
|
| Rate for Payer: PHP Commercial |
$790.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.76
|
| Rate for Payer: Priority Health HMO/PPO |
$809.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$623.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.75
|
| Rate for Payer: UHC Core |
$776.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.80
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
OP
|
$930.40
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.97 |
| Max. Negotiated Rate |
$837.36 |
| Rate for Payer: Aetna Commercial |
$790.84
|
| Rate for Payer: Aetna Medicare |
$241.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.75
|
| Rate for Payer: BCBS Complete |
$372.16
|
| Rate for Payer: BCBS MAPPO |
$232.60
|
| Rate for Payer: BCBS Trust/PPO |
$764.88
|
| Rate for Payer: BCN Commercial |
$723.39
|
| Rate for Payer: BCN Medicare Advantage |
$232.60
|
| Rate for Payer: Cash Price |
$744.32
|
| Rate for Payer: Cofinity Commercial |
$800.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.60
|
| Rate for Payer: Healthscope Commercial |
$837.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.84
|
| Rate for Payer: Nomi Health Commercial |
$762.93
|
| Rate for Payer: PACE Senior Care Partners |
$220.97
|
| Rate for Payer: PACE SWMI |
$232.60
|
| Rate for Payer: PHP Commercial |
$790.84
|
| Rate for Payer: PHP Medicare Advantage |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.76
|
| Rate for Payer: Priority Health HMO/PPO |
$809.45
|
| Rate for Payer: Priority Health Medicare |
$234.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$623.37
|
| Rate for Payer: Railroad Medicare Medicare |
$232.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.75
|
| Rate for Payer: UHC Core |
$776.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.60
|
| Rate for Payer: UHC Exchange |
$232.60
|
| Rate for Payer: UHC Medicare Advantage |
$232.60
|
| Rate for Payer: VA VA |
$232.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.80
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
IP
|
$6,639.46
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,315.65 |
| Max. Negotiated Rate |
$5,975.51 |
| Rate for Payer: Aetna Commercial |
$5,643.54
|
| Rate for Payer: BCBS Trust/PPO |
$5,419.79
|
| Rate for Payer: BCN Commercial |
$5,130.97
|
| Rate for Payer: Cash Price |
$5,311.57
|
| Rate for Payer: Cofinity Commercial |
$5,709.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.57
|
| Rate for Payer: Healthscope Commercial |
$5,975.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,979.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.54
|
| Rate for Payer: Nomi Health Commercial |
$5,444.36
|
| Rate for Payer: PHP Commercial |
$5,643.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,315.65
|
| Rate for Payer: Priority Health HMO/PPO |
$5,776.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,448.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,842.72
|
| Rate for Payer: UHC Core |
$5,543.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,979.60
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
OP
|
$6,639.46
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,576.87 |
| Max. Negotiated Rate |
$5,975.51 |
| Rate for Payer: Aetna Commercial |
$5,643.54
|
| Rate for Payer: Aetna Medicare |
$1,726.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,074.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,074.83
|
| Rate for Payer: BCBS Complete |
$2,655.78
|
| Rate for Payer: BCBS MAPPO |
$1,659.86
|
| Rate for Payer: BCBS Trust/PPO |
$5,458.30
|
| Rate for Payer: BCN Commercial |
$5,162.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,659.86
|
| Rate for Payer: Cash Price |
$5,311.57
|
| Rate for Payer: Cofinity Commercial |
$5,709.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,659.86
|
| Rate for Payer: Healthscope Commercial |
$5,975.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,979.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,742.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,908.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.54
|
| Rate for Payer: Nomi Health Commercial |
$5,444.36
|
| Rate for Payer: PACE Senior Care Partners |
$1,576.87
|
| Rate for Payer: PACE SWMI |
$1,659.86
|
| Rate for Payer: PHP Commercial |
$5,643.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,659.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,315.65
|
| Rate for Payer: Priority Health HMO/PPO |
$5,776.33
|
| Rate for Payer: Priority Health Medicare |
$1,676.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,448.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,659.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,842.72
|
| Rate for Payer: UHC Core |
$5,543.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,659.86
|
| Rate for Payer: UHC Exchange |
$1,659.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,659.86
|
| Rate for Payer: VA VA |
$1,659.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,979.60
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
OP
|
$5,517.84
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,310.49 |
| Max. Negotiated Rate |
$4,966.06 |
| Rate for Payer: Aetna Commercial |
$4,690.16
|
| Rate for Payer: Aetna Medicare |
$1,434.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,724.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,724.32
|
| Rate for Payer: BCBS Complete |
$2,207.14
|
| Rate for Payer: BCBS MAPPO |
$1,379.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,536.22
|
| Rate for Payer: BCN Commercial |
$4,290.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.46
|
| Rate for Payer: Cash Price |
$4,414.27
|
| Rate for Payer: Cofinity Commercial |
$4,745.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,414.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.46
|
| Rate for Payer: Healthscope Commercial |
$4,966.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,138.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,586.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,690.16
|
| Rate for Payer: Nomi Health Commercial |
$4,524.63
|
| Rate for Payer: PACE Senior Care Partners |
$1,310.49
|
| Rate for Payer: PACE SWMI |
$1,379.46
|
| Rate for Payer: PHP Commercial |
$4,690.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.60
|
| Rate for Payer: Priority Health HMO/PPO |
$4,800.52
|
| Rate for Payer: Priority Health Medicare |
$1,393.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,696.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,379.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,855.70
|
| Rate for Payer: UHC Core |
$4,607.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,379.46
|
| Rate for Payer: UHC Exchange |
$1,379.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,379.46
|
| Rate for Payer: VA VA |
$1,379.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,138.38
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
IP
|
$5,517.84
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,586.60 |
| Max. Negotiated Rate |
$4,966.06 |
| Rate for Payer: Aetna Commercial |
$4,690.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,504.21
|
| Rate for Payer: BCN Commercial |
$4,264.19
|
| Rate for Payer: Cash Price |
$4,414.27
|
| Rate for Payer: Cofinity Commercial |
$4,745.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,414.27
|
| Rate for Payer: Healthscope Commercial |
$4,966.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,690.16
|
| Rate for Payer: Nomi Health Commercial |
$4,524.63
|
| Rate for Payer: PHP Commercial |
$4,690.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.60
|
| Rate for Payer: Priority Health HMO/PPO |
$4,800.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,696.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,855.70
|
| Rate for Payer: UHC Core |
$4,607.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,138.38
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
IP
|
$3,348.21
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,176.34 |
| Max. Negotiated Rate |
$3,013.39 |
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,733.14
|
| Rate for Payer: BCN Commercial |
$2,587.50
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: Nomi Health Commercial |
$2,745.53
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,912.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,243.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,946.42
|
| Rate for Payer: UHC Core |
$2,795.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
OP
|
$3,348.21
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.20 |
| Max. Negotiated Rate |
$3,013.39 |
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: Aetna Medicare |
$870.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,046.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,046.32
|
| Rate for Payer: BCBS Complete |
$1,523.78
|
| Rate for Payer: BCBS MAPPO |
$837.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,752.56
|
| Rate for Payer: BCN Commercial |
$2,603.23
|
| Rate for Payer: BCN Medicare Advantage |
$837.05
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$837.05
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Mclaren Medicaid |
$1,451.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$878.91
|
| Rate for Payer: Meridian Medicaid |
$1,523.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$962.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: Nomi Health Commercial |
$2,745.53
|
| Rate for Payer: PACE Senior Care Partners |
$795.20
|
| Rate for Payer: PACE SWMI |
$837.05
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: PHP Medicare Advantage |
$837.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,451.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,912.94
|
| Rate for Payer: Priority Health Medicare |
$845.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,243.30
|
| Rate for Payer: Railroad Medicare Medicare |
$837.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,946.42
|
| Rate for Payer: UHC Core |
$2,795.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$837.05
|
| Rate for Payer: UHC Exchange |
$837.05
|
| Rate for Payer: UHC Medicare Advantage |
$837.05
|
| Rate for Payer: UHCCP Medicaid |
$1,451.13
|
| Rate for Payer: VA VA |
$837.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE NEPHROURETERAL CATHETER
|
Facility
|
IP
|
$3,348.21
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
36100505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,176.34 |
| Max. Negotiated Rate |
$3,013.39 |
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,733.14
|
| Rate for Payer: BCN Commercial |
$2,587.50
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: Nomi Health Commercial |
$2,745.53
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,912.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,243.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,946.42
|
| Rate for Payer: UHC Core |
$2,795.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE NEPHROURETERAL CATHETER
|
Facility
|
OP
|
$3,348.21
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
36100505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.20 |
| Max. Negotiated Rate |
$3,013.39 |
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: Aetna Medicare |
$870.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,046.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,046.32
|
| Rate for Payer: BCBS Complete |
$2,565.51
|
| Rate for Payer: BCBS MAPPO |
$837.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,752.56
|
| Rate for Payer: BCN Commercial |
$2,603.23
|
| Rate for Payer: BCN Medicare Advantage |
$837.05
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$837.05
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Mclaren Medicaid |
$2,443.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$878.91
|
| Rate for Payer: Meridian Medicaid |
$2,565.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$962.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: Nomi Health Commercial |
$2,745.53
|
| Rate for Payer: PACE Senior Care Partners |
$795.20
|
| Rate for Payer: PACE SWMI |
$837.05
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: PHP Medicare Advantage |
$837.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,443.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,912.94
|
| Rate for Payer: Priority Health Medicare |
$845.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,243.30
|
| Rate for Payer: Railroad Medicare Medicare |
$837.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,946.42
|
| Rate for Payer: UHC Core |
$2,795.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$837.05
|
| Rate for Payer: UHC Exchange |
$837.05
|
| Rate for Payer: UHC Medicare Advantage |
$837.05
|
| Rate for Payer: UHCCP Medicaid |
$2,443.18
|
| Rate for Payer: VA VA |
$837.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 1ST ORDER
|
Facility
|
IP
|
$8,589.97
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
36100474
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,583.48 |
| Max. Negotiated Rate |
$7,730.97 |
| Rate for Payer: Aetna Commercial |
$7,301.47
|
| Rate for Payer: BCBS Trust/PPO |
$7,011.99
|
| Rate for Payer: BCN Commercial |
$6,638.33
|
| Rate for Payer: Cash Price |
$6,871.98
|
| Rate for Payer: Cofinity Commercial |
$7,387.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,871.98
|
| Rate for Payer: Healthscope Commercial |
$7,730.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,442.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,301.47
|
| Rate for Payer: Nomi Health Commercial |
$7,043.78
|
| Rate for Payer: PHP Commercial |
$7,301.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,583.48
|
| Rate for Payer: Priority Health HMO/PPO |
$7,473.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,755.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,559.17
|
| Rate for Payer: UHC Core |
$7,172.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,442.48
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 1ST ORDER
|
Facility
|
OP
|
$8,589.97
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
36100474
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,040.12 |
| Max. Negotiated Rate |
$7,730.97 |
| Rate for Payer: Aetna Commercial |
$7,301.47
|
| Rate for Payer: Aetna Medicare |
$2,233.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,684.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,684.37
|
| Rate for Payer: BCBS Complete |
$3,435.99
|
| Rate for Payer: BCBS MAPPO |
$2,147.49
|
| Rate for Payer: BCBS Trust/PPO |
$7,061.81
|
| Rate for Payer: BCN Commercial |
$6,678.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,147.49
|
| Rate for Payer: Cash Price |
$6,871.98
|
| Rate for Payer: Cofinity Commercial |
$7,387.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,871.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,147.49
|
| Rate for Payer: Healthscope Commercial |
$7,730.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,442.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,254.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,469.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,301.47
|
| Rate for Payer: Nomi Health Commercial |
$7,043.78
|
| Rate for Payer: PACE Senior Care Partners |
$2,040.12
|
| Rate for Payer: PACE SWMI |
$2,147.49
|
| Rate for Payer: PHP Commercial |
$7,301.47
|
| Rate for Payer: PHP Medicare Advantage |
$2,147.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,583.48
|
| Rate for Payer: Priority Health HMO/PPO |
$7,473.27
|
| Rate for Payer: Priority Health Medicare |
$2,168.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,755.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2,147.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,559.17
|
| Rate for Payer: UHC Core |
$7,172.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,147.49
|
| Rate for Payer: UHC Exchange |
$2,147.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,147.49
|
| Rate for Payer: VA VA |
$2,147.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,442.48
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 2ND ORDER
|
Facility
|
OP
|
$5,382.61
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
36100475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,278.37 |
| Max. Negotiated Rate |
$4,844.35 |
| Rate for Payer: Aetna Commercial |
$4,575.22
|
| Rate for Payer: Aetna Medicare |
$1,399.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,682.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,682.07
|
| Rate for Payer: BCBS Complete |
$2,153.04
|
| Rate for Payer: BCBS MAPPO |
$1,345.65
|
| Rate for Payer: BCBS Trust/PPO |
$4,425.04
|
| Rate for Payer: BCN Commercial |
$4,184.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,345.65
|
| Rate for Payer: Cash Price |
$4,306.09
|
| Rate for Payer: Cofinity Commercial |
$4,629.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,306.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,345.65
|
| Rate for Payer: Healthscope Commercial |
$4,844.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,036.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,412.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,547.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,575.22
|
| Rate for Payer: Nomi Health Commercial |
$4,413.74
|
| Rate for Payer: PACE Senior Care Partners |
$1,278.37
|
| Rate for Payer: PACE SWMI |
$1,345.65
|
| Rate for Payer: PHP Commercial |
$4,575.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,345.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.70
|
| Rate for Payer: Priority Health HMO/PPO |
$4,682.87
|
| Rate for Payer: Priority Health Medicare |
$1,359.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,606.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,345.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,736.70
|
| Rate for Payer: UHC Core |
$4,494.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,345.65
|
| Rate for Payer: UHC Exchange |
$1,345.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,345.65
|
| Rate for Payer: VA VA |
$1,345.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,036.96
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 2ND ORDER
|
Facility
|
IP
|
$5,382.61
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
36100475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,498.70 |
| Max. Negotiated Rate |
$4,844.35 |
| Rate for Payer: Aetna Commercial |
$4,575.22
|
| Rate for Payer: BCBS Trust/PPO |
$4,393.82
|
| Rate for Payer: BCN Commercial |
$4,159.68
|
| Rate for Payer: Cash Price |
$4,306.09
|
| Rate for Payer: Cofinity Commercial |
$4,629.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,306.09
|
| Rate for Payer: Healthscope Commercial |
$4,844.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,036.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,575.22
|
| Rate for Payer: Nomi Health Commercial |
$4,413.74
|
| Rate for Payer: PHP Commercial |
$4,575.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.70
|
| Rate for Payer: Priority Health HMO/PPO |
$4,682.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,606.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,736.70
|
| Rate for Payer: UHC Core |
$4,494.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,036.96
|
|
