|
HC SCISSORS
|
Facility
|
IP
|
$18.02
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.88
|
| Rate for Payer: BCN Commercial |
$14.88
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$15.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.32
|
| Rate for Payer: Nomi Health Commercial |
$14.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.86
|
| Rate for Payer: UHC Core |
$15.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$9.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$8.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.49
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.97
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.52
|
| Rate for Payer: PACE SWMI |
$8.97
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Medicare |
$9.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: UHC Exchange |
$8.97
|
| Rate for Payer: UHC Medicaid |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.97
|
| Rate for Payer: UHCCP Medicaid |
$6.32
|
| Rate for Payer: VA VA |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC SCL70 SCLERODERMA AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200161
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.13 |
| Max. Negotiated Rate |
$2,410.20 |
| Rate for Payer: Aetna Commercial |
$2,276.30
|
| Rate for Payer: Aetna Medicare |
$696.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$836.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$836.88
|
| Rate for Payer: BCBS Complete |
$495.70
|
| Rate for Payer: BCBS MAPPO |
$669.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,201.58
|
| Rate for Payer: BCN Commercial |
$2,201.58
|
| Rate for Payer: BCN Medicare Advantage |
$669.50
|
| Rate for Payer: Cash Price |
$2,142.40
|
| Rate for Payer: Cofinity Commercial |
$2,303.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,142.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.50
|
| Rate for Payer: Healthscope Commercial |
$2,410.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,008.50
|
| Rate for Payer: Mclaren Medicaid |
$472.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$702.98
|
| Rate for Payer: Meridian Medicaid |
$495.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$769.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$736.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,276.30
|
| Rate for Payer: Nomi Health Commercial |
$2,195.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,008.50
|
| Rate for Payer: PACE Senior Care Partners |
$636.02
|
| Rate for Payer: PACE SWMI |
$669.50
|
| Rate for Payer: PHP Commercial |
$2,276.30
|
| Rate for Payer: PHP Medicare Advantage |
$669.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,329.86
|
| Rate for Payer: Priority Health Medicare |
$676.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,863.89
|
| Rate for Payer: Railroad Medicare Medicare |
$669.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,356.64
|
| Rate for Payer: UHC Core |
$2,236.13
|
| Rate for Payer: UHC Exchange |
$669.50
|
| Rate for Payer: UHC Medicaid |
$472.13
|
| Rate for Payer: UHC Medicare Advantage |
$669.50
|
| Rate for Payer: UHCCP Medicaid |
$472.13
|
| Rate for Payer: VA VA |
$669.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,008.50
|
|
|
HC SCLEROTHERAPY OF FLUID COLLECTION
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
36100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,863.89 |
| Max. Negotiated Rate |
$2,410.20 |
| Rate for Payer: Aetna Commercial |
$2,276.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,211.76
|
| Rate for Payer: BCN Commercial |
$2,211.76
|
| Rate for Payer: Cash Price |
$2,142.40
|
| Rate for Payer: Cofinity Commercial |
$2,303.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,142.40
|
| Rate for Payer: Healthscope Commercial |
$2,410.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,008.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,276.30
|
| Rate for Payer: Nomi Health Commercial |
$2,195.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,008.50
|
| Rate for Payer: PHP Commercial |
$2,276.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,329.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,863.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,356.64
|
| Rate for Payer: UHC Core |
$2,236.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,008.50
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
IP
|
$80.16
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$55.79 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Aetna Commercial |
$68.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.20
|
| Rate for Payer: BCN Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cofinity Commercial |
$68.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.13
|
| Rate for Payer: Healthscope Commercial |
$72.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.14
|
| Rate for Payer: Nomi Health Commercial |
$65.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.12
|
| Rate for Payer: PHP Commercial |
$68.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.54
|
| Rate for Payer: UHC Core |
$66.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.12
|
|
|
HC SCREENING PAP SMEAR, OBTAIN PREP TO LAB
|
Facility
|
OP
|
$80.16
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
31100043
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Aetna Commercial |
$68.14
|
| Rate for Payer: Aetna Medicare |
$20.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.05
|
| Rate for Payer: BCBS Complete |
$14.84
|
| Rate for Payer: BCBS MAPPO |
$20.04
|
| Rate for Payer: BCBS Trust/PPO |
$65.90
|
| Rate for Payer: BCCCP Commercial |
$17.38
|
| Rate for Payer: BCN Commercial |
$65.90
|
| Rate for Payer: BCN Medicare Advantage |
$20.04
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cash Price |
$64.13
|
| Rate for Payer: Cofinity Commercial |
$68.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$72.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.12
|
| Rate for Payer: Mclaren Medicaid |
$14.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.04
|
| Rate for Payer: Meridian Medicaid |
$14.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.14
|
| Rate for Payer: Nomi Health Commercial |
$65.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.12
|
| Rate for Payer: PACE Senior Care Partners |
$19.04
|
| Rate for Payer: PACE SWMI |
$20.04
|
| Rate for Payer: PHP Commercial |
$68.14
|
| Rate for Payer: PHP Medicare Advantage |
$20.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.74
|
| Rate for Payer: Priority Health Medicare |
$20.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.79
|
| Rate for Payer: Railroad Medicare Medicare |
$20.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.54
|
| Rate for Payer: UHC Core |
$66.93
|
| Rate for Payer: UHC Exchange |
$20.04
|
| Rate for Payer: UHC Medicaid |
$14.13
|
| Rate for Payer: UHC Medicare Advantage |
$20.04
|
| Rate for Payer: UHCCP Medicaid |
$14.13
|
| Rate for Payer: VA VA |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.12
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
IP
|
$105.27
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$94.74 |
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: BCBS Trust/PPO |
$86.94
|
| Rate for Payer: BCN Commercial |
$86.94
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$94.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Nomi Health Commercial |
$86.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: PHP Commercial |
$89.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.64
|
| Rate for Payer: UHC Core |
$87.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.95
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
OP
|
$105.27
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$94.74 |
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: Aetna Medicare |
$27.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.90
|
| Rate for Payer: BCBS Complete |
$19.49
|
| Rate for Payer: BCBS MAPPO |
$26.32
|
| Rate for Payer: BCBS Trust/PPO |
$86.54
|
| Rate for Payer: BCCCP Commercial |
$49.44
|
| Rate for Payer: BCN Commercial |
$86.54
|
| Rate for Payer: BCN Medicare Advantage |
$26.32
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$94.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.95
|
| Rate for Payer: Mclaren Medicaid |
$18.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.63
|
| Rate for Payer: Meridian Medicaid |
$19.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Nomi Health Commercial |
$86.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: PACE Senior Care Partners |
$25.00
|
| Rate for Payer: PACE SWMI |
$26.32
|
| Rate for Payer: PHP Commercial |
$89.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.58
|
| Rate for Payer: Priority Health Medicare |
$26.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.27
|
| Rate for Payer: Railroad Medicare Medicare |
$26.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.64
|
| Rate for Payer: UHC Core |
$87.90
|
| Rate for Payer: UHC Exchange |
$26.32
|
| Rate for Payer: UHC Medicaid |
$18.56
|
| Rate for Payer: UHC Medicare Advantage |
$26.32
|
| Rate for Payer: UHCCP Medicaid |
$18.56
|
| Rate for Payer: VA VA |
$26.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.95
|
|
|
HC SDL MSLT/MWT
|
Facility
|
OP
|
$2,623.63
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$462.55 |
| Max. Negotiated Rate |
$2,361.27 |
| Rate for Payer: Aetna Commercial |
$2,230.09
|
| Rate for Payer: Aetna Medicare |
$682.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$819.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$819.88
|
| Rate for Payer: BCBS Complete |
$485.63
|
| Rate for Payer: BCBS MAPPO |
$655.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,156.89
|
| Rate for Payer: BCN Commercial |
$2,156.89
|
| Rate for Payer: BCN Medicare Advantage |
$655.91
|
| Rate for Payer: Cash Price |
$2,098.90
|
| Rate for Payer: Cofinity Commercial |
$2,256.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,098.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.91
|
| Rate for Payer: Healthscope Commercial |
$2,361.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,967.72
|
| Rate for Payer: Mclaren Medicaid |
$462.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.70
|
| Rate for Payer: Meridian Medicaid |
$485.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$754.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,230.09
|
| Rate for Payer: Nomi Health Commercial |
$2,151.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,967.72
|
| Rate for Payer: PACE Senior Care Partners |
$623.11
|
| Rate for Payer: PACE SWMI |
$655.91
|
| Rate for Payer: PHP Commercial |
$2,230.09
|
| Rate for Payer: PHP Medicare Advantage |
$655.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,282.56
|
| Rate for Payer: Priority Health Medicare |
$662.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,826.05
|
| Rate for Payer: Railroad Medicare Medicare |
$655.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,308.79
|
| Rate for Payer: UHC Core |
$2,190.73
|
| Rate for Payer: UHC Exchange |
$655.91
|
| Rate for Payer: UHC Medicaid |
$462.55
|
| Rate for Payer: UHC Medicare Advantage |
$655.91
|
| Rate for Payer: UHCCP Medicaid |
$462.55
|
| Rate for Payer: VA VA |
$655.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,967.72
|
|
|
HC SDL MSLT/MWT
|
Facility
|
IP
|
$2,623.63
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,826.05 |
| Max. Negotiated Rate |
$2,361.27 |
| Rate for Payer: Aetna Commercial |
$2,230.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.86
|
| Rate for Payer: BCN Commercial |
$2,166.86
|
| Rate for Payer: Cash Price |
$2,098.90
|
| Rate for Payer: Cofinity Commercial |
$2,256.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,098.90
|
| Rate for Payer: Healthscope Commercial |
$2,361.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,967.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,230.09
|
| Rate for Payer: Nomi Health Commercial |
$2,151.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,967.72
|
| Rate for Payer: PHP Commercial |
$2,230.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,282.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,826.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,308.79
|
| Rate for Payer: UHC Core |
$2,190.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,967.72
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
OP
|
$3,631.60
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$640.25 |
| Max. Negotiated Rate |
$3,268.44 |
| Rate for Payer: Aetna Commercial |
$3,086.86
|
| Rate for Payer: Aetna Medicare |
$944.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,134.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,134.88
|
| Rate for Payer: BCBS Complete |
$672.21
|
| Rate for Payer: BCBS MAPPO |
$907.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,985.54
|
| Rate for Payer: BCN Commercial |
$2,985.54
|
| Rate for Payer: BCN Medicare Advantage |
$907.90
|
| Rate for Payer: Cash Price |
$2,905.28
|
| Rate for Payer: Cofinity Commercial |
$3,123.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,905.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.90
|
| Rate for Payer: Healthscope Commercial |
$3,268.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,723.70
|
| Rate for Payer: Mclaren Medicaid |
$640.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$953.29
|
| Rate for Payer: Meridian Medicaid |
$672.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,044.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$998.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,086.86
|
| Rate for Payer: Nomi Health Commercial |
$2,977.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,723.70
|
| Rate for Payer: PACE Senior Care Partners |
$862.50
|
| Rate for Payer: PACE SWMI |
$907.90
|
| Rate for Payer: PHP Commercial |
$3,086.86
|
| Rate for Payer: PHP Medicare Advantage |
$907.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,159.49
|
| Rate for Payer: Priority Health Medicare |
$916.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,527.59
|
| Rate for Payer: Railroad Medicare Medicare |
$907.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,195.81
|
| Rate for Payer: UHC Core |
$3,032.39
|
| Rate for Payer: UHC Exchange |
$907.90
|
| Rate for Payer: UHC Medicaid |
$640.25
|
| Rate for Payer: UHC Medicare Advantage |
$907.90
|
| Rate for Payer: UHCCP Medicaid |
$640.25
|
| Rate for Payer: VA VA |
$907.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,723.70
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
IP
|
$3,631.60
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,527.59 |
| Max. Negotiated Rate |
$3,268.44 |
| Rate for Payer: Aetna Commercial |
$3,086.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,999.34
|
| Rate for Payer: BCN Commercial |
$2,999.34
|
| Rate for Payer: Cash Price |
$2,905.28
|
| Rate for Payer: Cofinity Commercial |
$3,123.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,905.28
|
| Rate for Payer: Healthscope Commercial |
$3,268.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,723.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,086.86
|
| Rate for Payer: Nomi Health Commercial |
$2,977.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,723.70
|
| Rate for Payer: PHP Commercial |
$3,086.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,159.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,527.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,195.81
|
| Rate for Payer: UHC Core |
$3,032.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,723.70
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
IP
|
$4,014.94
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,794.40 |
| Max. Negotiated Rate |
$3,613.45 |
| Rate for Payer: Aetna Commercial |
$3,412.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,315.94
|
| Rate for Payer: BCN Commercial |
$3,315.94
|
| Rate for Payer: Cash Price |
$3,211.95
|
| Rate for Payer: Cofinity Commercial |
$3,452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,211.95
|
| Rate for Payer: Healthscope Commercial |
$3,613.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,011.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,412.70
|
| Rate for Payer: Nomi Health Commercial |
$3,292.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,011.20
|
| Rate for Payer: PHP Commercial |
$3,412.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,493.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,794.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,533.15
|
| Rate for Payer: UHC Core |
$3,352.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,011.20
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
OP
|
$4,014.94
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$707.83 |
| Max. Negotiated Rate |
$3,613.45 |
| Rate for Payer: Aetna Commercial |
$3,412.70
|
| Rate for Payer: Aetna Medicare |
$1,043.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,254.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,254.67
|
| Rate for Payer: BCBS Complete |
$743.17
|
| Rate for Payer: BCBS MAPPO |
$1,003.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,300.68
|
| Rate for Payer: BCN Commercial |
$3,300.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.74
|
| Rate for Payer: Cash Price |
$3,211.95
|
| Rate for Payer: Cofinity Commercial |
$3,452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,211.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.74
|
| Rate for Payer: Healthscope Commercial |
$3,613.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,011.20
|
| Rate for Payer: Mclaren Medicaid |
$707.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.92
|
| Rate for Payer: Meridian Medicaid |
$743.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,154.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,104.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,412.70
|
| Rate for Payer: Nomi Health Commercial |
$3,292.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,011.20
|
| Rate for Payer: PACE Senior Care Partners |
$953.55
|
| Rate for Payer: PACE SWMI |
$1,003.74
|
| Rate for Payer: PHP Commercial |
$3,412.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$707.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,493.00
|
| Rate for Payer: Priority Health Medicare |
$1,013.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,794.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,003.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,533.15
|
| Rate for Payer: UHC Core |
$3,352.47
|
| Rate for Payer: UHC Exchange |
$1,003.74
|
| Rate for Payer: UHC Medicaid |
$707.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.74
|
| Rate for Payer: UHCCP Medicaid |
$707.83
|
| Rate for Payer: VA VA |
$1,003.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,011.20
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
IP
|
$749.58
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$521.71 |
| Max. Negotiated Rate |
$674.62 |
| Rate for Payer: Aetna Commercial |
$637.14
|
| Rate for Payer: BCBS Trust/PPO |
$619.08
|
| Rate for Payer: BCN Commercial |
$619.08
|
| Rate for Payer: Cash Price |
$599.66
|
| Rate for Payer: Cofinity Commercial |
$644.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.66
|
| Rate for Payer: Healthscope Commercial |
$674.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$562.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.14
|
| Rate for Payer: Nomi Health Commercial |
$614.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.18
|
| Rate for Payer: PHP Commercial |
$637.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$652.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$659.63
|
| Rate for Payer: UHC Core |
$625.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$562.18
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
OP
|
$749.58
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$132.15 |
| Max. Negotiated Rate |
$674.62 |
| Rate for Payer: Aetna Commercial |
$637.14
|
| Rate for Payer: Aetna Medicare |
$194.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.24
|
| Rate for Payer: BCBS Complete |
$138.75
|
| Rate for Payer: BCBS MAPPO |
$187.40
|
| Rate for Payer: BCBS Trust/PPO |
$616.23
|
| Rate for Payer: BCN Commercial |
$616.23
|
| Rate for Payer: BCN Medicare Advantage |
$187.40
|
| Rate for Payer: Cash Price |
$599.66
|
| Rate for Payer: Cofinity Commercial |
$644.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.40
|
| Rate for Payer: Healthscope Commercial |
$674.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$562.18
|
| Rate for Payer: Mclaren Medicaid |
$132.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.76
|
| Rate for Payer: Meridian Medicaid |
$138.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.14
|
| Rate for Payer: Nomi Health Commercial |
$614.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.18
|
| Rate for Payer: PACE Senior Care Partners |
$178.03
|
| Rate for Payer: PACE SWMI |
$187.40
|
| Rate for Payer: PHP Commercial |
$637.14
|
| Rate for Payer: PHP Medicare Advantage |
$187.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$652.13
|
| Rate for Payer: Priority Health Medicare |
$189.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.71
|
| Rate for Payer: Railroad Medicare Medicare |
$187.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$659.63
|
| Rate for Payer: UHC Core |
$625.90
|
| Rate for Payer: UHC Exchange |
$187.40
|
| Rate for Payer: UHC Medicaid |
$132.15
|
| Rate for Payer: UHC Medicare Advantage |
$187.40
|
| Rate for Payer: UHCCP Medicaid |
$132.15
|
| Rate for Payer: VA VA |
$187.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$562.18
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.15
|
| Rate for Payer: BCN Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.97
|
| Rate for Payer: BCBS Complete |
$2.95
|
| Rate for Payer: BCBS MAPPO |
$3.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Medicare Advantage |
$3.98
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Mclaren Medicaid |
$2.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.18
|
| Rate for Payer: Meridian Medicaid |
$2.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PACE Senior Care Partners |
$3.78
|
| Rate for Payer: PACE SWMI |
$3.98
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: PHP Medicare Advantage |
$3.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Medicare |
$4.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$3.98
|
| Rate for Payer: UHC Medicaid |
$2.81
|
| Rate for Payer: UHC Medicare Advantage |
$3.98
|
| Rate for Payer: UHCCP Medicaid |
$2.81
|
| Rate for Payer: VA VA |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
OP
|
$5,066.39
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$893.20 |
| Max. Negotiated Rate |
$4,559.75 |
| Rate for Payer: Aetna Commercial |
$4,306.43
|
| Rate for Payer: Aetna Medicare |
$1,317.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,583.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,583.25
|
| Rate for Payer: BCBS Complete |
$937.79
|
| Rate for Payer: BCBS MAPPO |
$1,266.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,165.08
|
| Rate for Payer: BCN Commercial |
$4,165.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.60
|
| Rate for Payer: Cash Price |
$4,053.11
|
| Rate for Payer: Cofinity Commercial |
$4,357.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.60
|
| Rate for Payer: Healthscope Commercial |
$4,559.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.79
|
| Rate for Payer: Mclaren Medicaid |
$893.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,329.93
|
| Rate for Payer: Meridian Medicaid |
$937.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,456.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,393.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,306.43
|
| Rate for Payer: Nomi Health Commercial |
$4,154.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.79
|
| Rate for Payer: PACE Senior Care Partners |
$1,203.27
|
| Rate for Payer: PACE SWMI |
$1,266.60
|
| Rate for Payer: PHP Commercial |
$4,306.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$893.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,407.76
|
| Rate for Payer: Priority Health Medicare |
$1,279.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,526.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,266.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,458.42
|
| Rate for Payer: UHC Core |
$4,230.44
|
| Rate for Payer: UHC Exchange |
$1,266.60
|
| Rate for Payer: UHC Medicaid |
$893.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.60
|
| Rate for Payer: UHCCP Medicaid |
$893.20
|
| Rate for Payer: VA VA |
$1,266.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.79
|
|
|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
IP
|
$5,066.39
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,526.21 |
| Max. Negotiated Rate |
$4,559.75 |
| Rate for Payer: Aetna Commercial |
$4,306.43
|
| Rate for Payer: BCBS Trust/PPO |
$4,184.33
|
| Rate for Payer: BCN Commercial |
$4,184.33
|
| Rate for Payer: Cash Price |
$4,053.11
|
| Rate for Payer: Cofinity Commercial |
$4,357.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.11
|
| Rate for Payer: Healthscope Commercial |
$4,559.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,306.43
|
| Rate for Payer: Nomi Health Commercial |
$4,154.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,799.79
|
| Rate for Payer: PHP Commercial |
$4,306.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,407.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,526.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,458.42
|
| Rate for Payer: UHC Core |
$4,230.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.79
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,079.42 |
| Max. Negotiated Rate |
$5,275.11 |
| Rate for Payer: Aetna Commercial |
$4,982.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,840.79
|
| Rate for Payer: BCN Commercial |
$4,840.79
|
| Rate for Payer: Cash Price |
$4,688.98
|
| Rate for Payer: Cofinity Commercial |
$5,040.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,688.98
|
| Rate for Payer: Healthscope Commercial |
$5,275.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,395.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,982.05
|
| Rate for Payer: Nomi Health Commercial |
$4,806.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,395.92
|
| Rate for Payer: PHP Commercial |
$4,982.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,099.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,079.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,157.88
|
| Rate for Payer: UHC Core |
$4,894.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,395.92
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,033.33 |
| Max. Negotiated Rate |
$5,275.11 |
| Rate for Payer: Aetna Commercial |
$4,982.05
|
| Rate for Payer: Aetna Medicare |
$1,523.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,831.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,831.63
|
| Rate for Payer: BCBS Complete |
$1,084.91
|
| Rate for Payer: BCBS MAPPO |
$1,465.31
|
| Rate for Payer: BCBS Trust/PPO |
$4,818.52
|
| Rate for Payer: BCN Commercial |
$4,818.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,465.31
|
| Rate for Payer: Cash Price |
$4,688.98
|
| Rate for Payer: Cofinity Commercial |
$5,040.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,688.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,465.31
|
| Rate for Payer: Healthscope Commercial |
$5,275.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,395.92
|
| Rate for Payer: Mclaren Medicaid |
$1,033.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,538.57
|
| Rate for Payer: Meridian Medicaid |
$1,084.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,685.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,611.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,982.05
|
| Rate for Payer: Nomi Health Commercial |
$4,806.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,395.92
|
| Rate for Payer: PACE Senior Care Partners |
$1,392.04
|
| Rate for Payer: PACE SWMI |
$1,465.31
|
| Rate for Payer: PHP Commercial |
$4,982.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,465.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,099.27
|
| Rate for Payer: Priority Health Medicare |
$1,479.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,079.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,465.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,157.88
|
| Rate for Payer: UHC Core |
$4,894.13
|
| Rate for Payer: UHC Exchange |
$1,465.31
|
| Rate for Payer: UHC Medicaid |
$1,033.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,465.31
|
| Rate for Payer: UHCCP Medicaid |
$1,033.33
|
| Rate for Payer: VA VA |
$1,465.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,395.92
|
|
|
HC SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$9,738.02
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,777.66 |
| Max. Negotiated Rate |
$8,764.22 |
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: BCBS Trust/PPO |
$8,042.63
|
| Rate for Payer: BCN Commercial |
$8,042.63
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,303.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,472.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,777.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,569.46
|
| Rate for Payer: UHC Core |
$8,131.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,303.52
|
|
|
HC SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$9,738.02
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,716.81 |
| Max. Negotiated Rate |
$8,764.22 |
| Rate for Payer: Aetna Commercial |
$8,277.32
|
| Rate for Payer: Aetna Medicare |
$2,531.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,043.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,043.13
|
| Rate for Payer: BCBS Complete |
$1,802.51
|
| Rate for Payer: BCBS MAPPO |
$2,434.51
|
| Rate for Payer: BCBS Trust/PPO |
$8,005.63
|
| Rate for Payer: BCN Commercial |
$8,005.63
|
| Rate for Payer: BCN Medicare Advantage |
$2,434.51
|
| Rate for Payer: Cash Price |
$7,790.42
|
| Rate for Payer: Cofinity Commercial |
$8,374.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,790.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,434.51
|
| Rate for Payer: Healthscope Commercial |
$8,764.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,303.52
|
| Rate for Payer: Mclaren Medicaid |
$1,716.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,556.23
|
| Rate for Payer: Meridian Medicaid |
$1,802.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,799.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,677.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,277.32
|
| Rate for Payer: Nomi Health Commercial |
$7,985.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.52
|
| Rate for Payer: PACE Senior Care Partners |
$2,312.78
|
| Rate for Payer: PACE SWMI |
$2,434.51
|
| Rate for Payer: PHP Commercial |
$8,277.32
|
| Rate for Payer: PHP Medicare Advantage |
$2,434.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,716.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,472.08
|
| Rate for Payer: Priority Health Medicare |
$2,458.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,777.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,434.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,569.46
|
| Rate for Payer: UHC Core |
$8,131.25
|
| Rate for Payer: UHC Exchange |
$2,434.51
|
| Rate for Payer: UHC Medicaid |
$1,716.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,434.51
|
| Rate for Payer: UHCCP Medicaid |
$1,716.81
|
| Rate for Payer: VA VA |
$2,434.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,303.52
|
|
