|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$505.80 |
| Rate for Payer: Aetna Commercial |
$477.70
|
| Rate for Payer: BCBS Trust/PPO |
$458.76
|
| Rate for Payer: BCN Commercial |
$434.31
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$483.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.60
|
| Rate for Payer: Healthscope Commercial |
$505.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.70
|
| Rate for Payer: Nomi Health Commercial |
$460.84
|
| Rate for Payer: PHP Commercial |
$477.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.30
|
| Rate for Payer: Priority Health HMO/PPO |
$488.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.56
|
| Rate for Payer: UHC Core |
$469.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.50
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$505.80 |
| Rate for Payer: Aetna Commercial |
$477.70
|
| Rate for Payer: Aetna Medicare |
$146.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.62
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$140.50
|
| Rate for Payer: BCBS Trust/PPO |
$462.02
|
| Rate for Payer: BCN Commercial |
$436.96
|
| Rate for Payer: BCN Medicare Advantage |
$140.50
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$483.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.50
|
| Rate for Payer: Healthscope Commercial |
$505.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.50
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.52
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.70
|
| Rate for Payer: Nomi Health Commercial |
$460.84
|
| Rate for Payer: PACE Senior Care Partners |
$133.48
|
| Rate for Payer: PACE SWMI |
$140.50
|
| Rate for Payer: PHP Commercial |
$477.70
|
| Rate for Payer: PHP Medicare Advantage |
$140.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.30
|
| Rate for Payer: Priority Health HMO/PPO |
$488.94
|
| Rate for Payer: Priority Health Medicare |
$141.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.54
|
| Rate for Payer: Railroad Medicare Medicare |
$140.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.56
|
| Rate for Payer: UHC Core |
$469.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.50
|
| Rate for Payer: UHC Exchange |
$140.50
|
| Rate for Payer: UHC Medicare Advantage |
$140.50
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$140.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.50
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.75 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Aetna Commercial |
$542.30
|
| Rate for Payer: Aetna Medicare |
$165.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$199.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$199.38
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$159.50
|
| Rate for Payer: BCBS Trust/PPO |
$524.50
|
| Rate for Payer: BCN Commercial |
$496.04
|
| Rate for Payer: BCN Medicare Advantage |
$159.50
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$548.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.50
|
| Rate for Payer: Healthscope Commercial |
$574.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.50
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.48
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.30
|
| Rate for Payer: Nomi Health Commercial |
$523.16
|
| Rate for Payer: PACE Senior Care Partners |
$151.52
|
| Rate for Payer: PACE SWMI |
$159.50
|
| Rate for Payer: PHP Commercial |
$542.30
|
| Rate for Payer: PHP Medicare Advantage |
$159.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health HMO/PPO |
$555.06
|
| Rate for Payer: Priority Health Medicare |
$161.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.46
|
| Rate for Payer: Railroad Medicare Medicare |
$159.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.44
|
| Rate for Payer: UHC Core |
$532.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.50
|
| Rate for Payer: UHC Exchange |
$159.50
|
| Rate for Payer: UHC Medicare Advantage |
$159.50
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$159.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.50
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.70 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Aetna Commercial |
$542.30
|
| Rate for Payer: BCBS Trust/PPO |
$520.80
|
| Rate for Payer: BCN Commercial |
$493.05
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$548.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.40
|
| Rate for Payer: Healthscope Commercial |
$574.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.30
|
| Rate for Payer: Nomi Health Commercial |
$523.16
|
| Rate for Payer: PHP Commercial |
$542.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health HMO/PPO |
$555.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.44
|
| Rate for Payer: UHC Core |
$532.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.50
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.76 |
| Max. Negotiated Rate |
$245.42 |
| Rate for Payer: Aetna Commercial |
$231.79
|
| Rate for Payer: Aetna Medicare |
$70.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.22
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$68.17
|
| Rate for Payer: BCBS Trust/PPO |
$224.18
|
| Rate for Payer: BCN Commercial |
$212.02
|
| Rate for Payer: BCN Medicare Advantage |
$68.17
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$234.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.17
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.52
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.58
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PACE Senior Care Partners |
$64.76
|
| Rate for Payer: PACE SWMI |
$68.17
|
| Rate for Payer: PHP Commercial |
$231.79
|
| Rate for Payer: PHP Medicare Advantage |
$68.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO |
$237.24
|
| Rate for Payer: Priority Health Medicare |
$68.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.70
|
| Rate for Payer: Railroad Medicare Medicare |
$68.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.97
|
| Rate for Payer: UHC Core |
$227.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.17
|
| Rate for Payer: UHC Exchange |
$68.17
|
| Rate for Payer: UHC Medicare Advantage |
$68.17
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$68.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.52
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.25 |
| Max. Negotiated Rate |
$245.42 |
| Rate for Payer: Aetna Commercial |
$231.79
|
| Rate for Payer: BCBS Trust/PPO |
$222.60
|
| Rate for Payer: BCN Commercial |
$210.73
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$234.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PHP Commercial |
$231.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO |
$237.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.97
|
| Rate for Payer: UHC Core |
$227.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.52
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.97
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$36.78
|
| Rate for Payer: BCBS Trust/PPO |
$120.94
|
| Rate for Payer: BCN Commercial |
$114.38
|
| Rate for Payer: BCN Medicare Advantage |
$36.78
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.78
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Senior Care Partners |
$34.94
|
| Rate for Payer: PACE SWMI |
$36.78
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$36.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Medicare |
$37.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: Railroad Medicare Medicare |
$36.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.78
|
| Rate for Payer: UHC Exchange |
$36.78
|
| Rate for Payer: UHC Medicare Advantage |
$36.78
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$36.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: BCBS Trust/PPO |
$120.09
|
| Rate for Payer: BCN Commercial |
$113.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$556.48
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna Commercial |
$473.01
|
| Rate for Payer: Aetna Medicare |
$144.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.90
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$139.12
|
| Rate for Payer: BCBS Trust/PPO |
$457.48
|
| Rate for Payer: BCN Commercial |
$432.66
|
| Rate for Payer: BCN Medicare Advantage |
$139.12
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cofinity Commercial |
$478.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$500.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$417.36
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.08
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: Nomi Health Commercial |
$456.31
|
| Rate for Payer: PACE Senior Care Partners |
$132.16
|
| Rate for Payer: PACE SWMI |
$139.12
|
| Rate for Payer: PHP Commercial |
$473.01
|
| Rate for Payer: PHP Medicare Advantage |
$139.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: Priority Health HMO/PPO |
$484.14
|
| Rate for Payer: Priority Health Medicare |
$140.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.84
|
| Rate for Payer: Railroad Medicare Medicare |
$139.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.70
|
| Rate for Payer: UHC Core |
$464.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.12
|
| Rate for Payer: UHC Exchange |
$139.12
|
| Rate for Payer: UHC Medicare Advantage |
$139.12
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$417.36
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$556.48
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.71 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna Commercial |
$473.01
|
| Rate for Payer: BCBS Trust/PPO |
$454.25
|
| Rate for Payer: BCN Commercial |
$430.05
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cofinity Commercial |
$478.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.18
|
| Rate for Payer: Healthscope Commercial |
$500.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$417.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: Nomi Health Commercial |
$456.31
|
| Rate for Payer: PHP Commercial |
$473.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: Priority Health HMO/PPO |
$484.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.70
|
| Rate for Payer: UHC Core |
$464.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$417.36
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,248.82
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$969.25 |
| Max. Negotiated Rate |
$4,723.94 |
| Rate for Payer: Aetna Commercial |
$4,461.50
|
| Rate for Payer: Aetna Medicare |
$1,364.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,640.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,640.26
|
| Rate for Payer: BCBS Complete |
$1,017.78
|
| Rate for Payer: BCBS MAPPO |
$1,312.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,315.05
|
| Rate for Payer: BCN Commercial |
$4,080.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.20
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cofinity Commercial |
$4,513.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,199.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.20
|
| Rate for Payer: Healthscope Commercial |
$4,723.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,936.62
|
| Rate for Payer: Mclaren Medicaid |
$969.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,377.82
|
| Rate for Payer: Meridian Medicaid |
$1,017.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,509.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,461.50
|
| Rate for Payer: Nomi Health Commercial |
$4,304.03
|
| Rate for Payer: PACE Senior Care Partners |
$1,246.59
|
| Rate for Payer: PACE SWMI |
$1,312.20
|
| Rate for Payer: PHP Commercial |
$4,461.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$969.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.73
|
| Rate for Payer: Priority Health HMO/PPO |
$4,566.47
|
| Rate for Payer: Priority Health Medicare |
$1,325.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,516.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,312.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,618.96
|
| Rate for Payer: UHC Core |
$4,382.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,312.20
|
| Rate for Payer: UHC Exchange |
$1,312.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.20
|
| Rate for Payer: UHCCP Medicaid |
$969.25
|
| Rate for Payer: VA VA |
$1,312.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,936.62
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,248.82
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,411.73 |
| Max. Negotiated Rate |
$4,723.94 |
| Rate for Payer: Aetna Commercial |
$4,461.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,284.61
|
| Rate for Payer: BCN Commercial |
$4,056.29
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cofinity Commercial |
$4,513.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,199.06
|
| Rate for Payer: Healthscope Commercial |
$4,723.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,936.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,461.50
|
| Rate for Payer: Nomi Health Commercial |
$4,304.03
|
| Rate for Payer: PHP Commercial |
$4,461.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.73
|
| Rate for Payer: Priority Health HMO/PPO |
$4,566.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,516.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,618.96
|
| Rate for Payer: UHC Core |
$4,382.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,936.62
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,707.30
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,109.74 |
| Max. Negotiated Rate |
$1,536.57 |
| Rate for Payer: Aetna Commercial |
$1,451.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.67
|
| Rate for Payer: BCN Commercial |
$1,319.40
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cofinity Commercial |
$1,468.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,365.84
|
| Rate for Payer: Healthscope Commercial |
$1,536.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,280.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,451.20
|
| Rate for Payer: Nomi Health Commercial |
$1,399.99
|
| Rate for Payer: PHP Commercial |
$1,451.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,109.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,485.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,143.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,502.42
|
| Rate for Payer: UHC Core |
$1,425.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,280.48
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,707.30
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$259.32 |
| Max. Negotiated Rate |
$1,536.57 |
| Rate for Payer: Aetna Commercial |
$1,451.20
|
| Rate for Payer: Aetna Medicare |
$443.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$533.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$533.53
|
| Rate for Payer: BCBS Complete |
$272.30
|
| Rate for Payer: BCBS MAPPO |
$426.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,403.57
|
| Rate for Payer: BCN Commercial |
$1,327.43
|
| Rate for Payer: BCN Medicare Advantage |
$426.82
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cofinity Commercial |
$1,468.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,365.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.82
|
| Rate for Payer: Healthscope Commercial |
$1,536.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,280.48
|
| Rate for Payer: Mclaren Medicaid |
$259.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$448.17
|
| Rate for Payer: Meridian Medicaid |
$272.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$490.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,451.20
|
| Rate for Payer: Nomi Health Commercial |
$1,399.99
|
| Rate for Payer: PACE Senior Care Partners |
$405.48
|
| Rate for Payer: PACE SWMI |
$426.82
|
| Rate for Payer: PHP Commercial |
$1,451.20
|
| Rate for Payer: PHP Medicare Advantage |
$426.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,109.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,485.35
|
| Rate for Payer: Priority Health Medicare |
$431.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,143.89
|
| Rate for Payer: Railroad Medicare Medicare |
$426.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,502.42
|
| Rate for Payer: UHC Core |
$1,425.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$426.82
|
| Rate for Payer: UHC Exchange |
$426.82
|
| Rate for Payer: UHC Medicare Advantage |
$426.82
|
| Rate for Payer: UHCCP Medicaid |
$259.32
|
| Rate for Payer: VA VA |
$426.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,280.48
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,193.40
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$259.32 |
| Max. Negotiated Rate |
$1,074.06 |
| Rate for Payer: Aetna Commercial |
$1,014.39
|
| Rate for Payer: Aetna Medicare |
$310.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.94
|
| Rate for Payer: BCBS Complete |
$272.30
|
| Rate for Payer: BCBS MAPPO |
$298.35
|
| Rate for Payer: BCBS Trust/PPO |
$981.09
|
| Rate for Payer: BCN Commercial |
$927.87
|
| Rate for Payer: BCN Medicare Advantage |
$298.35
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cofinity Commercial |
$1,026.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.35
|
| Rate for Payer: Healthscope Commercial |
$1,074.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$895.05
|
| Rate for Payer: Mclaren Medicaid |
$259.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.27
|
| Rate for Payer: Meridian Medicaid |
$272.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.39
|
| Rate for Payer: Nomi Health Commercial |
$978.59
|
| Rate for Payer: PACE Senior Care Partners |
$283.43
|
| Rate for Payer: PACE SWMI |
$298.35
|
| Rate for Payer: PHP Commercial |
$1,014.39
|
| Rate for Payer: PHP Medicare Advantage |
$298.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,038.26
|
| Rate for Payer: Priority Health Medicare |
$301.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$799.58
|
| Rate for Payer: Railroad Medicare Medicare |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,050.19
|
| Rate for Payer: UHC Core |
$996.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.35
|
| Rate for Payer: UHC Exchange |
$298.35
|
| Rate for Payer: UHC Medicare Advantage |
$298.35
|
| Rate for Payer: UHCCP Medicaid |
$259.32
|
| Rate for Payer: VA VA |
$298.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$895.05
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$1,193.40
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$775.71 |
| Max. Negotiated Rate |
$1,074.06 |
| Rate for Payer: Aetna Commercial |
$1,014.39
|
| Rate for Payer: BCBS Trust/PPO |
$974.17
|
| Rate for Payer: BCN Commercial |
$922.26
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cofinity Commercial |
$1,026.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.72
|
| Rate for Payer: Healthscope Commercial |
$1,074.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$895.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.39
|
| Rate for Payer: Nomi Health Commercial |
$978.59
|
| Rate for Payer: PHP Commercial |
$1,014.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,038.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$799.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,050.19
|
| Rate for Payer: UHC Core |
$996.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$895.05
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$728.28
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna Medicare |
$189.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$227.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$227.59
|
| Rate for Payer: BCBS Complete |
$98.76
|
| Rate for Payer: BCBS MAPPO |
$182.07
|
| Rate for Payer: BCBS Trust/PPO |
$598.72
|
| Rate for Payer: BCN Commercial |
$566.24
|
| Rate for Payer: BCN Medicare Advantage |
$182.07
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.07
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.21
|
| Rate for Payer: Mclaren Medicaid |
$94.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.17
|
| Rate for Payer: Meridian Medicaid |
$98.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Nomi Health Commercial |
$597.19
|
| Rate for Payer: PACE Senior Care Partners |
$172.97
|
| Rate for Payer: PACE SWMI |
$182.07
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health HMO/PPO |
$633.60
|
| Rate for Payer: Priority Health Medicare |
$183.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.95
|
| Rate for Payer: Railroad Medicare Medicare |
$182.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.89
|
| Rate for Payer: UHC Core |
$608.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.07
|
| Rate for Payer: UHC Exchange |
$182.07
|
| Rate for Payer: UHC Medicare Advantage |
$182.07
|
| Rate for Payer: UHCCP Medicaid |
$94.06
|
| Rate for Payer: VA VA |
$182.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.21
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$728.28
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$473.38 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: BCBS Trust/PPO |
$594.49
|
| Rate for Payer: BCN Commercial |
$562.81
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Nomi Health Commercial |
$597.19
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health HMO/PPO |
$633.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.89
|
| Rate for Payer: UHC Core |
$608.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.21
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,340.87
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,821.57 |
| Max. Negotiated Rate |
$3,906.78 |
| Rate for Payer: Aetna Commercial |
$3,689.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,543.45
|
| Rate for Payer: BCN Commercial |
$3,354.62
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cofinity Commercial |
$3,733.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,472.70
|
| Rate for Payer: Healthscope Commercial |
$3,906.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,255.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,689.74
|
| Rate for Payer: Nomi Health Commercial |
$3,559.51
|
| Rate for Payer: PHP Commercial |
$3,689.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,821.57
|
| Rate for Payer: Priority Health HMO/PPO |
$3,776.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,908.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,819.97
|
| Rate for Payer: UHC Core |
$3,624.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,255.65
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,340.87
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,030.96 |
| Max. Negotiated Rate |
$6,156.08 |
| Rate for Payer: Aetna Commercial |
$3,689.74
|
| Rate for Payer: Aetna Medicare |
$1,128.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,356.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,356.52
|
| Rate for Payer: BCBS Complete |
$6,156.08
|
| Rate for Payer: BCBS MAPPO |
$1,085.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,568.63
|
| Rate for Payer: BCN Commercial |
$3,375.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,085.22
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cofinity Commercial |
$3,733.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,472.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,085.22
|
| Rate for Payer: Healthscope Commercial |
$3,906.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,255.65
|
| Rate for Payer: Mclaren Medicaid |
$5,862.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,139.48
|
| Rate for Payer: Meridian Medicaid |
$6,156.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,248.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,689.74
|
| Rate for Payer: Nomi Health Commercial |
$3,559.51
|
| Rate for Payer: PACE Senior Care Partners |
$1,030.96
|
| Rate for Payer: PACE SWMI |
$1,085.22
|
| Rate for Payer: PHP Commercial |
$3,689.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,085.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,862.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,821.57
|
| Rate for Payer: Priority Health HMO/PPO |
$3,776.56
|
| Rate for Payer: Priority Health Medicare |
$1,096.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,908.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,085.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,819.97
|
| Rate for Payer: UHC Core |
$3,624.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,085.22
|
| Rate for Payer: UHC Exchange |
$1,085.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,085.22
|
| Rate for Payer: UHCCP Medicaid |
$5,862.55
|
| Rate for Payer: VA VA |
$1,085.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,255.65
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$406.81 |
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: BCBS Trust/PPO |
$368.98
|
| Rate for Payer: BCN Commercial |
$349.31
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$388.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Healthscope Commercial |
$406.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: Nomi Health Commercial |
$370.65
|
| Rate for Payer: PHP Commercial |
$384.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: Priority Health HMO/PPO |
$393.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.77
|
| Rate for Payer: UHC Core |
$377.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.01
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$406.81 |
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: Aetna Medicare |
$117.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.25
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$113.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.60
|
| Rate for Payer: BCN Commercial |
$351.44
|
| Rate for Payer: BCN Medicare Advantage |
$113.00
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$388.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.00
|
| Rate for Payer: Healthscope Commercial |
$406.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: Nomi Health Commercial |
$370.65
|
| Rate for Payer: PACE Senior Care Partners |
$107.35
|
| Rate for Payer: PACE SWMI |
$113.00
|
| Rate for Payer: PHP Commercial |
$384.21
|
| Rate for Payer: PHP Medicare Advantage |
$113.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: Priority Health HMO/PPO |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$114.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.85
|
| Rate for Payer: Railroad Medicare Medicare |
$113.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.77
|
| Rate for Payer: UHC Core |
$377.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.00
|
| Rate for Payer: UHC Exchange |
$113.00
|
| Rate for Payer: UHC Medicare Advantage |
$113.00
|
| Rate for Payer: VA VA |
$113.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.01
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$19.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.73
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.99
|
| Rate for Payer: BCBS Trust/PPO |
$62.44
|
| Rate for Payer: BCN Commercial |
$59.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.99
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.94
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PACE Senior Care Partners |
$18.04
|
| Rate for Payer: PACE SWMI |
$18.99
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$18.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Medicare |
$19.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: Railroad Medicare Medicare |
$18.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.99
|
| Rate for Payer: UHC Exchange |
$18.99
|
| Rate for Payer: UHC Medicare Advantage |
$18.99
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$18.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: BCBS Trust/PPO |
$62.00
|
| Rate for Payer: BCN Commercial |
$58.69
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC SITZ MARKER
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: BCBS Trust/PPO |
$69.94
|
| Rate for Payer: BCN Commercial |
$66.21
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Nomi Health Commercial |
$70.26
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health HMO/PPO |
$74.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.40
|
| Rate for Payer: UHC Core |
$71.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.26
|
|
