|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.39 |
| Max. Negotiated Rate |
$331.53 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: BCBS Trust/PPO |
$304.24
|
| Rate for Payer: BCN Commercial |
$304.24
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.17
|
| Rate for Payer: UHC Core |
$307.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.28
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
OP
|
$573.24
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.06 |
| Max. Negotiated Rate |
$515.92 |
| Rate for Payer: Aetna Commercial |
$487.25
|
| Rate for Payer: Aetna Medicare |
$149.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.14
|
| Rate for Payer: BCBS Complete |
$106.11
|
| Rate for Payer: BCBS MAPPO |
$143.31
|
| Rate for Payer: BCBS Trust/PPO |
$471.26
|
| Rate for Payer: BCN Commercial |
$471.26
|
| Rate for Payer: BCN Medicare Advantage |
$143.31
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Commercial |
$492.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.31
|
| Rate for Payer: Healthscope Commercial |
$515.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.93
|
| Rate for Payer: Mclaren Medicaid |
$101.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.48
|
| Rate for Payer: Meridian Medicaid |
$106.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.25
|
| Rate for Payer: Nomi Health Commercial |
$470.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.93
|
| Rate for Payer: PACE Senior Care Partners |
$136.14
|
| Rate for Payer: PACE SWMI |
$143.31
|
| Rate for Payer: PHP Commercial |
$487.25
|
| Rate for Payer: PHP Medicare Advantage |
$143.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.72
|
| Rate for Payer: Priority Health Medicare |
$144.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.98
|
| Rate for Payer: Railroad Medicare Medicare |
$143.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.45
|
| Rate for Payer: UHC Core |
$478.66
|
| Rate for Payer: UHC Exchange |
$143.31
|
| Rate for Payer: UHC Medicaid |
$101.06
|
| Rate for Payer: UHC Medicare Advantage |
$143.31
|
| Rate for Payer: UHCCP Medicaid |
$101.06
|
| Rate for Payer: VA VA |
$143.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.93
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
IP
|
$573.24
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.98 |
| Max. Negotiated Rate |
$515.92 |
| Rate for Payer: Aetna Commercial |
$487.25
|
| Rate for Payer: BCBS Trust/PPO |
$473.44
|
| Rate for Payer: BCN Commercial |
$473.44
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Commercial |
$492.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Healthscope Commercial |
$515.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.25
|
| Rate for Payer: Nomi Health Commercial |
$470.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.93
|
| Rate for Payer: PHP Commercial |
$487.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.45
|
| Rate for Payer: UHC Core |
$478.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.93
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
IP
|
$650.76
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.93 |
| Max. Negotiated Rate |
$585.68 |
| Rate for Payer: Aetna Commercial |
$553.15
|
| Rate for Payer: BCBS Trust/PPO |
$537.46
|
| Rate for Payer: BCN Commercial |
$537.46
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cofinity Commercial |
$559.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.61
|
| Rate for Payer: Healthscope Commercial |
$585.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Nomi Health Commercial |
$533.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.07
|
| Rate for Payer: PHP Commercial |
$553.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$566.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.67
|
| Rate for Payer: UHC Core |
$543.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.07
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
OP
|
$650.76
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.73 |
| Max. Negotiated Rate |
$585.68 |
| Rate for Payer: Aetna Commercial |
$553.15
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.36
|
| Rate for Payer: BCBS Complete |
$120.46
|
| Rate for Payer: BCBS MAPPO |
$162.69
|
| Rate for Payer: BCBS Trust/PPO |
$534.99
|
| Rate for Payer: BCN Commercial |
$534.99
|
| Rate for Payer: BCN Medicare Advantage |
$162.69
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cofinity Commercial |
$559.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.69
|
| Rate for Payer: Healthscope Commercial |
$585.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.07
|
| Rate for Payer: Mclaren Medicaid |
$114.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.82
|
| Rate for Payer: Meridian Medicaid |
$120.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Nomi Health Commercial |
$533.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.07
|
| Rate for Payer: PACE Senior Care Partners |
$154.56
|
| Rate for Payer: PACE SWMI |
$162.69
|
| Rate for Payer: PHP Commercial |
$553.15
|
| Rate for Payer: PHP Medicare Advantage |
$162.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$566.16
|
| Rate for Payer: Priority Health Medicare |
$164.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.93
|
| Rate for Payer: Railroad Medicare Medicare |
$162.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.67
|
| Rate for Payer: UHC Core |
$543.38
|
| Rate for Payer: UHC Exchange |
$162.69
|
| Rate for Payer: UHC Medicaid |
$114.73
|
| Rate for Payer: UHC Medicare Advantage |
$162.69
|
| Rate for Payer: UHCCP Medicaid |
$114.73
|
| Rate for Payer: VA VA |
$162.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.07
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$278.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.59 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: BCBS Trust/PPO |
$229.72
|
| Rate for Payer: BCN Commercial |
$229.72
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.76
|
| Rate for Payer: UHC Core |
$232.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$278.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna Medicare |
$72.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.92
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$69.53
|
| Rate for Payer: BCBS Trust/PPO |
$228.66
|
| Rate for Payer: BCN Commercial |
$228.66
|
| Rate for Payer: BCN Medicare Advantage |
$69.53
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Mclaren Medicaid |
$49.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.01
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PACE Senior Care Partners |
$66.06
|
| Rate for Payer: PACE SWMI |
$69.53
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: PHP Medicare Advantage |
$69.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.98
|
| Rate for Payer: Priority Health Medicare |
$70.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: Railroad Medicare Medicare |
$69.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.76
|
| Rate for Payer: UHC Core |
$232.25
|
| Rate for Payer: UHC Exchange |
$69.53
|
| Rate for Payer: UHC Medicaid |
$49.04
|
| Rate for Payer: UHC Medicare Advantage |
$69.53
|
| Rate for Payer: UHCCP Medicaid |
$49.04
|
| Rate for Payer: VA VA |
$69.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: BCBS Trust/PPO |
$123.93
|
| Rate for Payer: BCN Commercial |
$123.93
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.04
|
| Rate for Payer: UHC Core |
$125.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$150.05
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna Medicare |
$39.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.89
|
| Rate for Payer: BCBS Complete |
$27.77
|
| Rate for Payer: BCBS MAPPO |
$37.51
|
| Rate for Payer: BCBS Trust/PPO |
$123.36
|
| Rate for Payer: BCN Commercial |
$123.36
|
| Rate for Payer: BCN Medicare Advantage |
$37.51
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Mclaren Medicaid |
$26.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.39
|
| Rate for Payer: Meridian Medicaid |
$27.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PACE Senior Care Partners |
$35.64
|
| Rate for Payer: PACE SWMI |
$37.51
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: PHP Medicare Advantage |
$37.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.54
|
| Rate for Payer: Priority Health Medicare |
$37.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.43
|
| Rate for Payer: Railroad Medicare Medicare |
$37.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.04
|
| Rate for Payer: UHC Core |
$125.29
|
| Rate for Payer: UHC Exchange |
$37.51
|
| Rate for Payer: UHC Medicaid |
$26.45
|
| Rate for Payer: UHC Medicare Advantage |
$37.51
|
| Rate for Payer: UHCCP Medicaid |
$26.45
|
| Rate for Payer: VA VA |
$37.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$567.61
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.06 |
| Max. Negotiated Rate |
$510.85 |
| Rate for Payer: Aetna Commercial |
$482.47
|
| Rate for Payer: BCBS Trust/PPO |
$468.79
|
| Rate for Payer: BCN Commercial |
$468.79
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.09
|
| Rate for Payer: Healthscope Commercial |
$510.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.47
|
| Rate for Payer: Nomi Health Commercial |
$465.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.71
|
| Rate for Payer: PHP Commercial |
$482.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$493.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.50
|
| Rate for Payer: UHC Core |
$473.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.71
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$567.61
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.07 |
| Max. Negotiated Rate |
$510.85 |
| Rate for Payer: Aetna Commercial |
$482.47
|
| Rate for Payer: Aetna Medicare |
$147.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.38
|
| Rate for Payer: BCBS Complete |
$105.06
|
| Rate for Payer: BCBS MAPPO |
$141.90
|
| Rate for Payer: BCBS Trust/PPO |
$466.63
|
| Rate for Payer: BCN Commercial |
$466.63
|
| Rate for Payer: BCN Medicare Advantage |
$141.90
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.90
|
| Rate for Payer: Healthscope Commercial |
$510.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.71
|
| Rate for Payer: Mclaren Medicaid |
$100.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.00
|
| Rate for Payer: Meridian Medicaid |
$105.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.47
|
| Rate for Payer: Nomi Health Commercial |
$465.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.71
|
| Rate for Payer: PACE Senior Care Partners |
$134.81
|
| Rate for Payer: PACE SWMI |
$141.90
|
| Rate for Payer: PHP Commercial |
$482.47
|
| Rate for Payer: PHP Medicare Advantage |
$141.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$493.82
|
| Rate for Payer: Priority Health Medicare |
$143.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.06
|
| Rate for Payer: Railroad Medicare Medicare |
$141.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.50
|
| Rate for Payer: UHC Core |
$473.95
|
| Rate for Payer: UHC Exchange |
$141.90
|
| Rate for Payer: UHC Medicaid |
$100.07
|
| Rate for Payer: UHC Medicare Advantage |
$141.90
|
| Rate for Payer: UHCCP Medicaid |
$100.07
|
| Rate for Payer: VA VA |
$141.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.71
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,726.24 |
| Max. Negotiated Rate |
$4,818.42 |
| Rate for Payer: Aetna Commercial |
$4,550.73
|
| Rate for Payer: BCBS Trust/PPO |
$4,421.70
|
| Rate for Payer: BCN Commercial |
$4,421.70
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cofinity Commercial |
$4,604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.04
|
| Rate for Payer: Healthscope Commercial |
$4,818.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.73
|
| Rate for Payer: Nomi Health Commercial |
$4,390.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.35
|
| Rate for Payer: PHP Commercial |
$4,550.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,657.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,726.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,711.34
|
| Rate for Payer: UHC Core |
$4,470.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.35
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$943.87 |
| Max. Negotiated Rate |
$4,818.42 |
| Rate for Payer: Aetna Commercial |
$4,550.73
|
| Rate for Payer: Aetna Medicare |
$1,391.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,673.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,673.06
|
| Rate for Payer: BCBS Complete |
$990.99
|
| Rate for Payer: BCBS MAPPO |
$1,338.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,401.36
|
| Rate for Payer: BCN Commercial |
$4,401.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,338.45
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cofinity Commercial |
$4,604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,338.45
|
| Rate for Payer: Healthscope Commercial |
$4,818.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.35
|
| Rate for Payer: Mclaren Medicaid |
$943.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,405.37
|
| Rate for Payer: Meridian Medicaid |
$990.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,539.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,472.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.73
|
| Rate for Payer: Nomi Health Commercial |
$4,390.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.35
|
| Rate for Payer: PACE Senior Care Partners |
$1,271.53
|
| Rate for Payer: PACE SWMI |
$1,338.45
|
| Rate for Payer: PHP Commercial |
$4,550.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,338.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$943.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,657.81
|
| Rate for Payer: Priority Health Medicare |
$1,351.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,726.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,338.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,711.34
|
| Rate for Payer: UHC Core |
$4,470.42
|
| Rate for Payer: UHC Exchange |
$1,338.45
|
| Rate for Payer: UHC Medicaid |
$943.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,338.45
|
| Rate for Payer: UHCCP Medicaid |
$943.87
|
| Rate for Payer: VA VA |
$1,338.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.35
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,741.45
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$307.02 |
| Max. Negotiated Rate |
$1,567.31 |
| Rate for Payer: Aetna Commercial |
$1,480.23
|
| Rate for Payer: Aetna Medicare |
$452.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$544.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$544.20
|
| Rate for Payer: BCBS Complete |
$322.34
|
| Rate for Payer: BCBS MAPPO |
$435.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,431.65
|
| Rate for Payer: BCN Commercial |
$1,431.65
|
| Rate for Payer: BCN Medicare Advantage |
$435.36
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cofinity Commercial |
$1,497.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.36
|
| Rate for Payer: Healthscope Commercial |
$1,567.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,306.09
|
| Rate for Payer: Mclaren Medicaid |
$307.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$457.13
|
| Rate for Payer: Meridian Medicaid |
$322.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$500.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$478.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.23
|
| Rate for Payer: Nomi Health Commercial |
$1,427.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,306.09
|
| Rate for Payer: PACE Senior Care Partners |
$413.59
|
| Rate for Payer: PACE SWMI |
$435.36
|
| Rate for Payer: PHP Commercial |
$1,480.23
|
| Rate for Payer: PHP Medicare Advantage |
$435.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,515.06
|
| Rate for Payer: Priority Health Medicare |
$439.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,212.05
|
| Rate for Payer: Railroad Medicare Medicare |
$435.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,532.48
|
| Rate for Payer: UHC Core |
$1,454.11
|
| Rate for Payer: UHC Exchange |
$435.36
|
| Rate for Payer: UHC Medicaid |
$307.02
|
| Rate for Payer: UHC Medicare Advantage |
$435.36
|
| Rate for Payer: UHCCP Medicaid |
$307.02
|
| Rate for Payer: VA VA |
$435.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,306.09
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,741.45
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,212.05 |
| Max. Negotiated Rate |
$1,567.31 |
| Rate for Payer: Aetna Commercial |
$1,480.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.26
|
| Rate for Payer: BCN Commercial |
$1,438.26
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cofinity Commercial |
$1,497.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.16
|
| Rate for Payer: Healthscope Commercial |
$1,567.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,306.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.23
|
| Rate for Payer: Nomi Health Commercial |
$1,427.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,306.09
|
| Rate for Payer: PHP Commercial |
$1,480.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,515.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,212.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,532.48
|
| Rate for Payer: UHC Core |
$1,454.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,306.09
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,217.27
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$1,095.54 |
| Rate for Payer: Aetna Commercial |
$1,034.68
|
| Rate for Payer: Aetna Medicare |
$316.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$380.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$380.40
|
| Rate for Payer: BCBS Complete |
$225.32
|
| Rate for Payer: BCBS MAPPO |
$304.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,000.72
|
| Rate for Payer: BCN Commercial |
$1,000.72
|
| Rate for Payer: BCN Medicare Advantage |
$304.32
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cofinity Commercial |
$1,046.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.32
|
| Rate for Payer: Healthscope Commercial |
$1,095.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$912.95
|
| Rate for Payer: Mclaren Medicaid |
$214.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.53
|
| Rate for Payer: Meridian Medicaid |
$225.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$334.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.68
|
| Rate for Payer: Nomi Health Commercial |
$998.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.95
|
| Rate for Payer: PACE Senior Care Partners |
$289.10
|
| Rate for Payer: PACE SWMI |
$304.32
|
| Rate for Payer: PHP Commercial |
$1,034.68
|
| Rate for Payer: PHP Medicare Advantage |
$304.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,059.02
|
| Rate for Payer: Priority Health Medicare |
$307.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$847.22
|
| Rate for Payer: Railroad Medicare Medicare |
$304.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,071.20
|
| Rate for Payer: UHC Core |
$1,016.42
|
| Rate for Payer: UHC Exchange |
$304.32
|
| Rate for Payer: UHC Medicaid |
$214.60
|
| Rate for Payer: UHC Medicare Advantage |
$304.32
|
| Rate for Payer: UHCCP Medicaid |
$214.60
|
| Rate for Payer: VA VA |
$304.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$912.95
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$1,217.27
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$847.22 |
| Max. Negotiated Rate |
$1,095.54 |
| Rate for Payer: Aetna Commercial |
$1,034.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,005.34
|
| Rate for Payer: BCN Commercial |
$1,005.34
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cofinity Commercial |
$1,046.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.82
|
| Rate for Payer: Healthscope Commercial |
$1,095.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$912.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.68
|
| Rate for Payer: Nomi Health Commercial |
$998.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.95
|
| Rate for Payer: PHP Commercial |
$1,034.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,059.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$847.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,071.20
|
| Rate for Payer: UHC Core |
$1,016.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$912.95
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$742.85
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$517.02 |
| Max. Negotiated Rate |
$668.57 |
| Rate for Payer: Aetna Commercial |
$631.42
|
| Rate for Payer: BCBS Trust/PPO |
$613.52
|
| Rate for Payer: BCN Commercial |
$613.52
|
| Rate for Payer: Cash Price |
$594.28
|
| Rate for Payer: Cofinity Commercial |
$638.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.28
|
| Rate for Payer: Healthscope Commercial |
$668.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.42
|
| Rate for Payer: Nomi Health Commercial |
$609.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.14
|
| Rate for Payer: PHP Commercial |
$631.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$646.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.71
|
| Rate for Payer: UHC Core |
$620.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.14
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$742.85
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.96 |
| Max. Negotiated Rate |
$668.57 |
| Rate for Payer: Aetna Commercial |
$631.42
|
| Rate for Payer: Aetna Medicare |
$193.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$232.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$232.14
|
| Rate for Payer: BCBS Complete |
$137.50
|
| Rate for Payer: BCBS MAPPO |
$185.71
|
| Rate for Payer: BCBS Trust/PPO |
$610.70
|
| Rate for Payer: BCN Commercial |
$610.70
|
| Rate for Payer: BCN Medicare Advantage |
$185.71
|
| Rate for Payer: Cash Price |
$594.28
|
| Rate for Payer: Cofinity Commercial |
$638.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.71
|
| Rate for Payer: Healthscope Commercial |
$668.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.14
|
| Rate for Payer: Mclaren Medicaid |
$130.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.00
|
| Rate for Payer: Meridian Medicaid |
$137.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$204.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.42
|
| Rate for Payer: Nomi Health Commercial |
$609.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.14
|
| Rate for Payer: PACE Senior Care Partners |
$176.43
|
| Rate for Payer: PACE SWMI |
$185.71
|
| Rate for Payer: PHP Commercial |
$631.42
|
| Rate for Payer: PHP Medicare Advantage |
$185.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$646.28
|
| Rate for Payer: Priority Health Medicare |
$187.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.02
|
| Rate for Payer: Railroad Medicare Medicare |
$185.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.71
|
| Rate for Payer: UHC Core |
$620.28
|
| Rate for Payer: UHC Exchange |
$185.71
|
| Rate for Payer: UHC Medicaid |
$130.96
|
| Rate for Payer: UHC Medicare Advantage |
$185.71
|
| Rate for Payer: UHCCP Medicaid |
$130.96
|
| Rate for Payer: VA VA |
$185.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.14
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,427.69
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.60 |
| Max. Negotiated Rate |
$3,984.92 |
| Rate for Payer: Aetna Commercial |
$3,763.54
|
| Rate for Payer: Aetna Medicare |
$1,151.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,383.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,383.65
|
| Rate for Payer: BCBS Complete |
$819.57
|
| Rate for Payer: BCBS MAPPO |
$1,106.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,640.00
|
| Rate for Payer: BCN Commercial |
$3,640.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,106.92
|
| Rate for Payer: Cash Price |
$3,542.15
|
| Rate for Payer: Cofinity Commercial |
$3,807.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,106.92
|
| Rate for Payer: Healthscope Commercial |
$3,984.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,320.77
|
| Rate for Payer: Mclaren Medicaid |
$780.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,162.27
|
| Rate for Payer: Meridian Medicaid |
$819.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,272.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,217.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,763.54
|
| Rate for Payer: Nomi Health Commercial |
$3,630.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,320.77
|
| Rate for Payer: PACE Senior Care Partners |
$1,051.58
|
| Rate for Payer: PACE SWMI |
$1,106.92
|
| Rate for Payer: PHP Commercial |
$3,763.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,106.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,852.09
|
| Rate for Payer: Priority Health Medicare |
$1,117.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,081.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,106.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,896.37
|
| Rate for Payer: UHC Core |
$3,697.12
|
| Rate for Payer: UHC Exchange |
$1,106.92
|
| Rate for Payer: UHC Medicaid |
$780.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,106.92
|
| Rate for Payer: UHCCP Medicaid |
$780.60
|
| Rate for Payer: VA VA |
$1,106.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,320.77
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,427.69
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,081.67 |
| Max. Negotiated Rate |
$3,984.92 |
| Rate for Payer: Aetna Commercial |
$3,763.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,656.83
|
| Rate for Payer: BCN Commercial |
$3,656.83
|
| Rate for Payer: Cash Price |
$3,542.15
|
| Rate for Payer: Cofinity Commercial |
$3,807.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.15
|
| Rate for Payer: Healthscope Commercial |
$3,984.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,320.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,763.54
|
| Rate for Payer: Nomi Health Commercial |
$3,630.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,320.77
|
| Rate for Payer: PHP Commercial |
$3,763.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,852.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,081.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,896.37
|
| Rate for Payer: UHC Core |
$3,697.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,320.77
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$461.05
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.89 |
| Max. Negotiated Rate |
$414.94 |
| Rate for Payer: Aetna Commercial |
$391.89
|
| Rate for Payer: BCBS Trust/PPO |
$380.78
|
| Rate for Payer: BCN Commercial |
$380.78
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cofinity Commercial |
$396.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.84
|
| Rate for Payer: Healthscope Commercial |
$414.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.89
|
| Rate for Payer: Nomi Health Commercial |
$378.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.79
|
| Rate for Payer: PHP Commercial |
$391.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$401.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.72
|
| Rate for Payer: UHC Core |
$384.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.79
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$461.05
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.28 |
| Max. Negotiated Rate |
$414.94 |
| Rate for Payer: Aetna Commercial |
$391.89
|
| Rate for Payer: Aetna Medicare |
$119.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$144.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$144.08
|
| Rate for Payer: BCBS Complete |
$85.34
|
| Rate for Payer: BCBS MAPPO |
$115.26
|
| Rate for Payer: BCBS Trust/PPO |
$379.03
|
| Rate for Payer: BCN Commercial |
$379.03
|
| Rate for Payer: BCN Medicare Advantage |
$115.26
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cofinity Commercial |
$396.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.26
|
| Rate for Payer: Healthscope Commercial |
$414.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.79
|
| Rate for Payer: Mclaren Medicaid |
$81.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.03
|
| Rate for Payer: Meridian Medicaid |
$85.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.89
|
| Rate for Payer: Nomi Health Commercial |
$378.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.79
|
| Rate for Payer: PACE Senior Care Partners |
$109.50
|
| Rate for Payer: PACE SWMI |
$115.26
|
| Rate for Payer: PHP Commercial |
$391.89
|
| Rate for Payer: PHP Medicare Advantage |
$115.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$401.11
|
| Rate for Payer: Priority Health Medicare |
$116.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.89
|
| Rate for Payer: Railroad Medicare Medicare |
$115.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.72
|
| Rate for Payer: UHC Core |
$384.98
|
| Rate for Payer: UHC Exchange |
$115.26
|
| Rate for Payer: UHC Medicaid |
$81.28
|
| Rate for Payer: UHC Medicare Advantage |
$115.26
|
| Rate for Payer: UHCCP Medicaid |
$81.28
|
| Rate for Payer: VA VA |
$115.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.79
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: BCBS Trust/PPO |
$63.98
|
| Rate for Payer: BCN Commercial |
$63.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.17
|
| Rate for Payer: UHC Core |
$64.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$20.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.21
|
| Rate for Payer: BCBS Complete |
$14.34
|
| Rate for Payer: BCBS MAPPO |
$19.37
|
| Rate for Payer: BCBS Trust/PPO |
$63.69
|
| Rate for Payer: BCN Commercial |
$63.69
|
| Rate for Payer: BCN Medicare Advantage |
$19.37
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Mclaren Medicaid |
$13.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.34
|
| Rate for Payer: Meridian Medicaid |
$14.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Senior Care Partners |
$18.40
|
| Rate for Payer: PACE SWMI |
$19.37
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$19.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.40
|
| Rate for Payer: Priority Health Medicare |
$19.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.92
|
| Rate for Payer: Railroad Medicare Medicare |
$19.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.17
|
| Rate for Payer: UHC Core |
$64.69
|
| Rate for Payer: UHC Exchange |
$19.37
|
| Rate for Payer: UHC Medicaid |
$13.66
|
| Rate for Payer: UHC Medicare Advantage |
$19.37
|
| Rate for Payer: UHCCP Medicaid |
$13.66
|
| Rate for Payer: VA VA |
$19.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
