|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$11,185.55
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,972.01 |
| Max. Negotiated Rate |
$10,067.00 |
| Rate for Payer: Aetna Commercial |
$9,507.72
|
| Rate for Payer: Aetna Medicare |
$2,908.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,495.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,495.48
|
| Rate for Payer: BCBS Complete |
$2,070.45
|
| Rate for Payer: BCBS MAPPO |
$2,796.39
|
| Rate for Payer: BCBS Trust/PPO |
$9,195.64
|
| Rate for Payer: BCN Commercial |
$9,195.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,796.39
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cofinity Commercial |
$9,619.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,948.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,796.39
|
| Rate for Payer: Healthscope Commercial |
$10,067.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,389.16
|
| Rate for Payer: Mclaren Medicaid |
$1,972.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,936.21
|
| Rate for Payer: Meridian Medicaid |
$2,070.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,215.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,076.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,507.72
|
| Rate for Payer: Nomi Health Commercial |
$9,172.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,389.16
|
| Rate for Payer: PACE Senior Care Partners |
$2,656.57
|
| Rate for Payer: PACE SWMI |
$2,796.39
|
| Rate for Payer: PHP Commercial |
$9,507.72
|
| Rate for Payer: PHP Medicare Advantage |
$2,796.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,972.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,731.43
|
| Rate for Payer: Priority Health Medicare |
$2,824.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,785.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2,796.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,843.28
|
| Rate for Payer: UHC Core |
$9,339.93
|
| Rate for Payer: UHC Exchange |
$2,796.39
|
| Rate for Payer: UHC Medicaid |
$1,972.01
|
| Rate for Payer: UHC Medicare Advantage |
$2,796.39
|
| Rate for Payer: UHCCP Medicaid |
$1,972.01
|
| Rate for Payer: VA VA |
$2,796.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,389.16
|
|
|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$11,185.55
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,785.14 |
| Max. Negotiated Rate |
$10,067.00 |
| Rate for Payer: Aetna Commercial |
$9,507.72
|
| Rate for Payer: BCBS Trust/PPO |
$9,238.15
|
| Rate for Payer: BCN Commercial |
$9,238.15
|
| Rate for Payer: Cash Price |
$8,948.44
|
| Rate for Payer: Cofinity Commercial |
$9,619.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,948.44
|
| Rate for Payer: Healthscope Commercial |
$10,067.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,507.72
|
| Rate for Payer: Nomi Health Commercial |
$9,172.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,389.16
|
| Rate for Payer: PHP Commercial |
$9,507.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,731.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,785.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,843.28
|
| Rate for Payer: UHC Core |
$9,339.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,389.16
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
OP
|
$13,546.53
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,388.25 |
| Max. Negotiated Rate |
$12,191.88 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: Aetna Medicare |
$3,522.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,233.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,233.29
|
| Rate for Payer: BCBS Complete |
$2,507.46
|
| Rate for Payer: BCBS MAPPO |
$3,386.63
|
| Rate for Payer: BCBS Trust/PPO |
$11,136.60
|
| Rate for Payer: BCN Commercial |
$11,136.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,386.63
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,386.63
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,159.90
|
| Rate for Payer: Mclaren Medicaid |
$2,388.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,555.96
|
| Rate for Payer: Meridian Medicaid |
$2,507.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,894.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,725.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PACE Senior Care Partners |
$3,217.30
|
| Rate for Payer: PACE SWMI |
$3,386.63
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| Rate for Payer: PHP Medicare Advantage |
$3,386.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,388.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,785.48
|
| Rate for Payer: Priority Health Medicare |
$3,420.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,428.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3,386.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,920.95
|
| Rate for Payer: UHC Core |
$11,311.35
|
| Rate for Payer: UHC Exchange |
$3,386.63
|
| Rate for Payer: UHC Medicaid |
$2,388.25
|
| Rate for Payer: UHC Medicare Advantage |
$3,386.63
|
| Rate for Payer: UHCCP Medicaid |
$2,388.25
|
| Rate for Payer: VA VA |
$3,386.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,159.90
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
IP
|
$13,546.53
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,428.38 |
| Max. Negotiated Rate |
$12,191.88 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: BCBS Trust/PPO |
$11,188.08
|
| Rate for Payer: BCN Commercial |
$11,188.08
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,159.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,785.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,428.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,920.95
|
| Rate for Payer: UHC Core |
$11,311.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,159.90
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$13,546.53
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,428.38 |
| Max. Negotiated Rate |
$12,191.88 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: BCBS Trust/PPO |
$11,188.08
|
| Rate for Payer: BCN Commercial |
$11,188.08
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,159.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,785.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,428.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,920.95
|
| Rate for Payer: UHC Core |
$11,311.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,159.90
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$13,546.53
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,388.25 |
| Max. Negotiated Rate |
$12,191.88 |
| Rate for Payer: Aetna Commercial |
$11,514.55
|
| Rate for Payer: Aetna Medicare |
$3,522.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,233.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,233.29
|
| Rate for Payer: BCBS Complete |
$2,507.46
|
| Rate for Payer: BCBS MAPPO |
$3,386.63
|
| Rate for Payer: BCBS Trust/PPO |
$11,136.60
|
| Rate for Payer: BCN Commercial |
$11,136.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,386.63
|
| Rate for Payer: Cash Price |
$10,837.22
|
| Rate for Payer: Cofinity Commercial |
$11,650.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,837.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,386.63
|
| Rate for Payer: Healthscope Commercial |
$12,191.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,159.90
|
| Rate for Payer: Mclaren Medicaid |
$2,388.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,555.96
|
| Rate for Payer: Meridian Medicaid |
$2,507.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,894.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,725.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,514.55
|
| Rate for Payer: Nomi Health Commercial |
$11,108.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,159.90
|
| Rate for Payer: PACE Senior Care Partners |
$3,217.30
|
| Rate for Payer: PACE SWMI |
$3,386.63
|
| Rate for Payer: PHP Commercial |
$11,514.55
|
| Rate for Payer: PHP Medicare Advantage |
$3,386.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,388.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,785.48
|
| Rate for Payer: Priority Health Medicare |
$3,420.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,428.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3,386.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,920.95
|
| Rate for Payer: UHC Core |
$11,311.35
|
| Rate for Payer: UHC Exchange |
$3,386.63
|
| Rate for Payer: UHC Medicaid |
$2,388.25
|
| Rate for Payer: UHC Medicare Advantage |
$3,386.63
|
| Rate for Payer: UHCCP Medicaid |
$2,388.25
|
| Rate for Payer: VA VA |
$3,386.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,159.90
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
IP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,173.68 |
| Max. Negotiated Rate |
$1,517.69 |
| Rate for Payer: Aetna Commercial |
$1,433.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.73
|
| Rate for Payer: BCN Commercial |
$1,392.73
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,450.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,517.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,264.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Nomi Health Commercial |
$1,382.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.74
|
| Rate for Payer: PHP Commercial |
$1,433.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,467.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,173.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,483.96
|
| Rate for Payer: UHC Core |
$1,408.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,264.74
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
OP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.30 |
| Max. Negotiated Rate |
$1,517.69 |
| Rate for Payer: Aetna Commercial |
$1,433.37
|
| Rate for Payer: Aetna Medicare |
$438.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$526.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$526.98
|
| Rate for Payer: BCBS Complete |
$312.14
|
| Rate for Payer: BCBS MAPPO |
$421.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,386.32
|
| Rate for Payer: BCN Commercial |
$1,386.32
|
| Rate for Payer: BCN Medicare Advantage |
$421.58
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,450.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.58
|
| Rate for Payer: Healthscope Commercial |
$1,517.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,264.74
|
| Rate for Payer: Mclaren Medicaid |
$297.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.66
|
| Rate for Payer: Meridian Medicaid |
$312.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$484.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$463.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Nomi Health Commercial |
$1,382.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,264.74
|
| Rate for Payer: PACE Senior Care Partners |
$400.50
|
| Rate for Payer: PACE SWMI |
$421.58
|
| Rate for Payer: PHP Commercial |
$1,433.37
|
| Rate for Payer: PHP Medicare Advantage |
$421.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,467.10
|
| Rate for Payer: Priority Health Medicare |
$425.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,173.68
|
| Rate for Payer: Railroad Medicare Medicare |
$421.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,483.96
|
| Rate for Payer: UHC Core |
$1,408.08
|
| Rate for Payer: UHC Exchange |
$421.58
|
| Rate for Payer: UHC Medicaid |
$297.30
|
| Rate for Payer: UHC Medicare Advantage |
$421.58
|
| Rate for Payer: UHCCP Medicaid |
$297.30
|
| Rate for Payer: VA VA |
$421.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,264.74
|
|
|
HC SELENIUM LEVEL
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC SELENIUM LEVEL
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS MAPPO |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.27
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.93
|
| Rate for Payer: Meridian Medicaid |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.27
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Medicare |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: UHCCP Medicaid |
$9.35
|
| Rate for Payer: VA VA |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
OP
|
$0.53
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Aetna Medicare |
$0.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: BCBS MAPPO |
$0.13
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCN Commercial |
$0.44
|
| Rate for Payer: BCN Medicare Advantage |
$0.13
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.40
|
| Rate for Payer: Mclaren Medicaid |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.14
|
| Rate for Payer: Meridian Medicaid |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: PACE Senior Care Partners |
$0.13
|
| Rate for Payer: PACE SWMI |
$0.13
|
| Rate for Payer: PHP Commercial |
$0.45
|
| Rate for Payer: PHP Medicare Advantage |
$0.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.47
|
| Rate for Payer: UHC Core |
$0.44
|
| Rate for Payer: UHC Exchange |
$0.13
|
| Rate for Payer: UHC Medicaid |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.13
|
| Rate for Payer: UHCCP Medicaid |
$0.09
|
| Rate for Payer: VA VA |
$0.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.40
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
IP
|
$0.53
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCN Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: PHP Commercial |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.47
|
| Rate for Payer: UHC Core |
$0.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.40
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
OP
|
$57.53
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$51.78 |
| Rate for Payer: Aetna Commercial |
$48.90
|
| Rate for Payer: Aetna Medicare |
$14.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.98
|
| Rate for Payer: BCBS Complete |
$10.65
|
| Rate for Payer: BCBS MAPPO |
$14.38
|
| Rate for Payer: BCBS Trust/PPO |
$47.30
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: BCN Medicare Advantage |
$14.38
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$51.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$10.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.10
|
| Rate for Payer: Meridian Medicaid |
$10.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.90
|
| Rate for Payer: Nomi Health Commercial |
$47.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.15
|
| Rate for Payer: PACE Senior Care Partners |
$13.66
|
| Rate for Payer: PACE SWMI |
$14.38
|
| Rate for Payer: PHP Commercial |
$48.90
|
| Rate for Payer: PHP Medicare Advantage |
$14.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$14.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.04
|
| Rate for Payer: Railroad Medicare Medicare |
$14.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.63
|
| Rate for Payer: UHC Core |
$48.04
|
| Rate for Payer: UHC Exchange |
$14.38
|
| Rate for Payer: UHC Medicaid |
$10.14
|
| Rate for Payer: UHC Medicare Advantage |
$14.38
|
| Rate for Payer: UHCCP Medicaid |
$10.14
|
| Rate for Payer: VA VA |
$14.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.15
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
IP
|
$57.53
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$51.78 |
| Rate for Payer: Aetna Commercial |
$48.90
|
| Rate for Payer: BCBS Trust/PPO |
$47.51
|
| Rate for Payer: BCN Commercial |
$47.51
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.02
|
| Rate for Payer: Healthscope Commercial |
$51.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.90
|
| Rate for Payer: Nomi Health Commercial |
$47.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.15
|
| Rate for Payer: PHP Commercial |
$48.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.63
|
| Rate for Payer: UHC Core |
$48.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.15
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: BCBS Trust/PPO |
$97.10
|
| Rate for Payer: BCN Commercial |
$97.10
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.46
|
| Rate for Payer: UHC Core |
$98.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$30.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.74
|
| Rate for Payer: BCBS Complete |
$21.76
|
| Rate for Payer: BCBS MAPPO |
$29.39
|
| Rate for Payer: BCBS Trust/PPO |
$96.65
|
| Rate for Payer: BCN Commercial |
$96.65
|
| Rate for Payer: BCN Medicare Advantage |
$29.39
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.39
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Mclaren Medicaid |
$20.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.86
|
| Rate for Payer: Meridian Medicaid |
$21.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Senior Care Partners |
$27.92
|
| Rate for Payer: PACE SWMI |
$29.39
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$29.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.29
|
| Rate for Payer: Priority Health Medicare |
$29.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.83
|
| Rate for Payer: Railroad Medicare Medicare |
$29.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.46
|
| Rate for Payer: UHC Core |
$98.17
|
| Rate for Payer: UHC Exchange |
$29.39
|
| Rate for Payer: UHC Medicaid |
$20.73
|
| Rate for Payer: UHC Medicare Advantage |
$29.39
|
| Rate for Payer: UHCCP Medicaid |
$20.73
|
| Rate for Payer: VA VA |
$29.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.52
|
| Rate for Payer: BCBS Complete |
$14.52
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$64.49
|
| Rate for Payer: BCN Commercial |
$64.49
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.59
|
| Rate for Payer: Meridian Medicaid |
$14.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Senior Care Partners |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$19.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.60
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.04
|
| Rate for Payer: UHC Core |
$65.51
|
| Rate for Payer: UHC Exchange |
$19.61
|
| Rate for Payer: UHC Medicaid |
$13.83
|
| Rate for Payer: UHC Medicare Advantage |
$19.61
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: VA VA |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: BCBS Trust/PPO |
$64.79
|
| Rate for Payer: BCN Commercial |
$64.79
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.04
|
| Rate for Payer: UHC Core |
$65.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$390.15
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$271.54 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: BCBS Trust/PPO |
$322.22
|
| Rate for Payer: BCN Commercial |
$322.22
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.33
|
| Rate for Payer: UHC Core |
$325.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.61
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
OP
|
$390.15
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna Medicare |
$101.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.92
|
| Rate for Payer: BCBS Complete |
$72.22
|
| Rate for Payer: BCBS MAPPO |
$97.54
|
| Rate for Payer: BCBS Trust/PPO |
$320.74
|
| Rate for Payer: BCN Commercial |
$320.74
|
| Rate for Payer: BCN Medicare Advantage |
$97.54
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.54
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.61
|
| Rate for Payer: Mclaren Medicaid |
$68.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.41
|
| Rate for Payer: Meridian Medicaid |
$72.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PACE Senior Care Partners |
$92.66
|
| Rate for Payer: PACE SWMI |
$97.54
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: PHP Medicare Advantage |
$97.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.43
|
| Rate for Payer: Priority Health Medicare |
$98.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.54
|
| Rate for Payer: Railroad Medicare Medicare |
$97.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.33
|
| Rate for Payer: UHC Core |
$325.78
|
| Rate for Payer: UHC Exchange |
$97.54
|
| Rate for Payer: UHC Medicaid |
$68.78
|
| Rate for Payer: UHC Medicare Advantage |
$97.54
|
| Rate for Payer: UHCCP Medicaid |
$68.78
|
| Rate for Payer: VA VA |
$97.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.61
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.95
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: BCBS Trust/PPO |
$14.82
|
| Rate for Payer: BCN Commercial |
$14.82
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Nomi Health Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.80
|
| Rate for Payer: UHC Core |
$14.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.46
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.95
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.61
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.46
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Meridian Medicaid |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Nomi Health Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: PACE Senior Care Partners |
$4.26
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.62
|
| Rate for Payer: Priority Health Medicare |
$4.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.49
|
| Rate for Payer: Railroad Medicare Medicare |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.80
|
| Rate for Payer: UHC Core |
$14.99
|
| Rate for Payer: UHC Exchange |
$4.49
|
| Rate for Payer: UHC Medicaid |
$3.16
|
| Rate for Payer: UHC Medicare Advantage |
$4.49
|
| Rate for Payer: UHCCP Medicaid |
$3.16
|
| Rate for Payer: VA VA |
$4.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.46
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$249.70
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.79 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: BCBS Trust/PPO |
$206.23
|
| Rate for Payer: BCN Commercial |
$206.23
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.74
|
| Rate for Payer: UHC Core |
$208.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$249.70
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$212.25
|
| Rate for Payer: Aetna Medicare |
$64.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.03
|
| Rate for Payer: BCBS Complete |
$46.22
|
| Rate for Payer: BCBS MAPPO |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$205.28
|
| Rate for Payer: BCN Commercial |
$205.28
|
| Rate for Payer: BCN Medicare Advantage |
$62.42
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$214.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.28
|
| Rate for Payer: Mclaren Medicaid |
$44.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.55
|
| Rate for Payer: Meridian Medicaid |
$46.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: PACE Senior Care Partners |
$59.30
|
| Rate for Payer: PACE SWMI |
$62.42
|
| Rate for Payer: PHP Commercial |
$212.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.24
|
| Rate for Payer: Priority Health Medicare |
$63.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.79
|
| Rate for Payer: Railroad Medicare Medicare |
$62.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.74
|
| Rate for Payer: UHC Core |
$208.50
|
| Rate for Payer: UHC Exchange |
$62.42
|
| Rate for Payer: UHC Medicaid |
$44.02
|
| Rate for Payer: UHC Medicare Advantage |
$62.42
|
| Rate for Payer: UHCCP Medicaid |
$44.02
|
| Rate for Payer: VA VA |
$62.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.28
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: BCBS Trust/PPO |
$76.48
|
| Rate for Payer: BCN Commercial |
$76.48
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.45
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
