|
HC SPIROMETRY
|
Facility
|
IP
|
$321.09
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$208.71 |
| Max. Negotiated Rate |
$288.98 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: BCBS Trust/PPO |
$262.11
|
| Rate for Payer: BCN Commercial |
$248.14
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cofinity Commercial |
$276.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.87
|
| Rate for Payer: Healthscope Commercial |
$288.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.93
|
| Rate for Payer: Nomi Health Commercial |
$263.29
|
| Rate for Payer: PHP Commercial |
$272.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.71
|
| Rate for Payer: Priority Health HMO/PPO |
$279.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.56
|
| Rate for Payer: UHC Core |
$268.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.82
|
|
|
HC SPIROMETRY
|
Facility
|
OP
|
$321.09
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$76.26 |
| Max. Negotiated Rate |
$288.98 |
| Rate for Payer: Aetna Commercial |
$272.93
|
| Rate for Payer: Aetna Medicare |
$83.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.34
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$80.27
|
| Rate for Payer: BCBS Trust/PPO |
$263.97
|
| Rate for Payer: BCN Commercial |
$249.65
|
| Rate for Payer: BCN Medicare Advantage |
$80.27
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cofinity Commercial |
$276.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.27
|
| Rate for Payer: Healthscope Commercial |
$288.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.82
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.29
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.93
|
| Rate for Payer: Nomi Health Commercial |
$263.29
|
| Rate for Payer: PACE Senior Care Partners |
$76.26
|
| Rate for Payer: PACE SWMI |
$80.27
|
| Rate for Payer: PHP Commercial |
$272.93
|
| Rate for Payer: PHP Medicare Advantage |
$80.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.71
|
| Rate for Payer: Priority Health HMO/PPO |
$279.35
|
| Rate for Payer: Priority Health Medicare |
$81.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.13
|
| Rate for Payer: Railroad Medicare Medicare |
$80.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.56
|
| Rate for Payer: UHC Core |
$268.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.27
|
| Rate for Payer: UHC Exchange |
$80.27
|
| Rate for Payer: UHC Medicare Advantage |
$80.27
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$80.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.82
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
IP
|
$566.31
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$368.10 |
| Max. Negotiated Rate |
$509.68 |
| Rate for Payer: Aetna Commercial |
$481.36
|
| Rate for Payer: BCBS Trust/PPO |
$462.28
|
| Rate for Payer: BCN Commercial |
$437.64
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cofinity Commercial |
$487.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.05
|
| Rate for Payer: Healthscope Commercial |
$509.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.36
|
| Rate for Payer: Nomi Health Commercial |
$464.37
|
| Rate for Payer: PHP Commercial |
$481.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.10
|
| Rate for Payer: Priority Health HMO/PPO |
$492.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.35
|
| Rate for Payer: UHC Core |
$472.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.73
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
OP
|
$566.31
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$134.50 |
| Max. Negotiated Rate |
$509.68 |
| Rate for Payer: Aetna Commercial |
$481.36
|
| Rate for Payer: Aetna Medicare |
$147.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.97
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$141.58
|
| Rate for Payer: BCBS Trust/PPO |
$465.56
|
| Rate for Payer: BCN Commercial |
$440.31
|
| Rate for Payer: BCN Medicare Advantage |
$141.58
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cofinity Commercial |
$487.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.58
|
| Rate for Payer: Healthscope Commercial |
$509.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.73
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.66
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.36
|
| Rate for Payer: Nomi Health Commercial |
$464.37
|
| Rate for Payer: PACE Senior Care Partners |
$134.50
|
| Rate for Payer: PACE SWMI |
$141.58
|
| Rate for Payer: PHP Commercial |
$481.36
|
| Rate for Payer: PHP Medicare Advantage |
$141.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.10
|
| Rate for Payer: Priority Health HMO/PPO |
$492.69
|
| Rate for Payer: Priority Health Medicare |
$142.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.43
|
| Rate for Payer: Railroad Medicare Medicare |
$141.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.35
|
| Rate for Payer: UHC Core |
$472.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.58
|
| Rate for Payer: UHC Exchange |
$141.58
|
| Rate for Payer: UHC Medicare Advantage |
$141.58
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$141.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.73
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,200.93
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$997.72 |
| Max. Negotiated Rate |
$3,780.84 |
| Rate for Payer: Aetna Commercial |
$3,570.79
|
| Rate for Payer: Aetna Medicare |
$1,092.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.79
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$1,050.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,453.58
|
| Rate for Payer: BCN Commercial |
$3,266.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.23
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cofinity Commercial |
$3,612.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,360.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.23
|
| Rate for Payer: Healthscope Commercial |
$3,780.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,150.70
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,102.74
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,570.79
|
| Rate for Payer: Nomi Health Commercial |
$3,444.76
|
| Rate for Payer: PACE Senior Care Partners |
$997.72
|
| Rate for Payer: PACE SWMI |
$1,050.23
|
| Rate for Payer: PHP Commercial |
$3,570.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,730.60
|
| Rate for Payer: Priority Health HMO/PPO |
$3,654.81
|
| Rate for Payer: Priority Health Medicare |
$1,060.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,814.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,696.82
|
| Rate for Payer: UHC Core |
$3,507.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.23
|
| Rate for Payer: UHC Exchange |
$1,050.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,050.23
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$1,050.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,150.70
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,200.93
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,730.60 |
| Max. Negotiated Rate |
$3,780.84 |
| Rate for Payer: Aetna Commercial |
$3,570.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,429.22
|
| Rate for Payer: BCN Commercial |
$3,246.48
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cofinity Commercial |
$3,612.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,360.74
|
| Rate for Payer: Healthscope Commercial |
$3,780.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,150.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,570.79
|
| Rate for Payer: Nomi Health Commercial |
$3,444.76
|
| Rate for Payer: PHP Commercial |
$3,570.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,730.60
|
| Rate for Payer: Priority Health HMO/PPO |
$3,654.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,814.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,696.82
|
| Rate for Payer: UHC Core |
$3,507.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,150.70
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$140.24
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: Aetna Commercial |
$119.20
|
| Rate for Payer: BCBS Trust/PPO |
$114.48
|
| Rate for Payer: BCN Commercial |
$108.38
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$120.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Healthscope Commercial |
$126.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PHP Commercial |
$119.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO |
$122.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.41
|
| Rate for Payer: UHC Core |
$117.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.18
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: Aetna Commercial |
$119.20
|
| Rate for Payer: Aetna Medicare |
$36.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.83
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$35.06
|
| Rate for Payer: BCBS Trust/PPO |
$115.29
|
| Rate for Payer: BCN Commercial |
$109.04
|
| Rate for Payer: BCN Medicare Advantage |
$35.06
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$120.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.06
|
| Rate for Payer: Healthscope Commercial |
$126.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.18
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.81
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PACE Senior Care Partners |
$33.31
|
| Rate for Payer: PACE SWMI |
$35.06
|
| Rate for Payer: PHP Commercial |
$119.20
|
| Rate for Payer: PHP Medicare Advantage |
$35.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO |
$122.01
|
| Rate for Payer: Priority Health Medicare |
$35.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.96
|
| Rate for Payer: Railroad Medicare Medicare |
$35.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.41
|
| Rate for Payer: UHC Core |
$117.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.06
|
| Rate for Payer: UHC Exchange |
$35.06
|
| Rate for Payer: UHC Medicare Advantage |
$35.06
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$35.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.18
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: Aetna Commercial |
$119.20
|
| Rate for Payer: Aetna Medicare |
$36.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.83
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$35.06
|
| Rate for Payer: BCBS Trust/PPO |
$115.29
|
| Rate for Payer: BCN Commercial |
$109.04
|
| Rate for Payer: BCN Medicare Advantage |
$35.06
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$120.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.06
|
| Rate for Payer: Healthscope Commercial |
$126.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.18
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.81
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PACE Senior Care Partners |
$33.31
|
| Rate for Payer: PACE SWMI |
$35.06
|
| Rate for Payer: PHP Commercial |
$119.20
|
| Rate for Payer: PHP Medicare Advantage |
$35.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO |
$122.01
|
| Rate for Payer: Priority Health Medicare |
$35.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.96
|
| Rate for Payer: Railroad Medicare Medicare |
$35.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.41
|
| Rate for Payer: UHC Core |
$117.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.06
|
| Rate for Payer: UHC Exchange |
$35.06
|
| Rate for Payer: UHC Medicare Advantage |
$35.06
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$35.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.18
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$140.24
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$126.22 |
| Rate for Payer: Aetna Commercial |
$119.20
|
| Rate for Payer: BCBS Trust/PPO |
$114.48
|
| Rate for Payer: BCN Commercial |
$108.38
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$120.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Healthscope Commercial |
$126.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PHP Commercial |
$119.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO |
$122.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.41
|
| Rate for Payer: UHC Core |
$117.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.18
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$396.97
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$357.27 |
| Rate for Payer: Aetna Commercial |
$337.42
|
| Rate for Payer: Aetna Medicare |
$103.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.05
|
| Rate for Payer: BCBS Complete |
$119.79
|
| Rate for Payer: BCBS MAPPO |
$99.24
|
| Rate for Payer: BCBS Trust/PPO |
$326.35
|
| Rate for Payer: BCN Commercial |
$308.64
|
| Rate for Payer: BCN Medicare Advantage |
$99.24
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cofinity Commercial |
$341.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.24
|
| Rate for Payer: Healthscope Commercial |
$357.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.73
|
| Rate for Payer: Mclaren Medicaid |
$114.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.20
|
| Rate for Payer: Meridian Medicaid |
$119.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.42
|
| Rate for Payer: Nomi Health Commercial |
$325.52
|
| Rate for Payer: PACE Senior Care Partners |
$94.28
|
| Rate for Payer: PACE SWMI |
$99.24
|
| Rate for Payer: PHP Commercial |
$337.42
|
| Rate for Payer: PHP Medicare Advantage |
$99.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.03
|
| Rate for Payer: Priority Health HMO/PPO |
$345.36
|
| Rate for Payer: Priority Health Medicare |
$100.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.97
|
| Rate for Payer: Railroad Medicare Medicare |
$99.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.33
|
| Rate for Payer: UHC Core |
$331.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.24
|
| Rate for Payer: UHC Exchange |
$99.24
|
| Rate for Payer: UHC Medicare Advantage |
$99.24
|
| Rate for Payer: UHCCP Medicaid |
$114.08
|
| Rate for Payer: VA VA |
$99.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.73
|
|
|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$396.97
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$258.03 |
| Max. Negotiated Rate |
$357.27 |
| Rate for Payer: Aetna Commercial |
$337.42
|
| Rate for Payer: BCBS Trust/PPO |
$324.05
|
| Rate for Payer: BCN Commercial |
$306.78
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cofinity Commercial |
$341.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.58
|
| Rate for Payer: Healthscope Commercial |
$357.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.42
|
| Rate for Payer: Nomi Health Commercial |
$325.52
|
| Rate for Payer: PHP Commercial |
$337.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.03
|
| Rate for Payer: Priority Health HMO/PPO |
$345.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.33
|
| Rate for Payer: UHC Core |
$331.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.73
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$84.88 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$92.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.68
|
| Rate for Payer: BCBS Complete |
$119.79
|
| Rate for Payer: BCBS MAPPO |
$89.34
|
| Rate for Payer: BCBS Trust/PPO |
$293.80
|
| Rate for Payer: BCN Commercial |
$277.86
|
| Rate for Payer: BCN Medicare Advantage |
$89.34
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.34
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.04
|
| Rate for Payer: Mclaren Medicaid |
$114.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$119.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PACE Senior Care Partners |
$84.88
|
| Rate for Payer: PACE SWMI |
$89.34
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: PHP Medicare Advantage |
$89.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO |
$310.92
|
| Rate for Payer: Priority Health Medicare |
$90.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.44
|
| Rate for Payer: Railroad Medicare Medicare |
$89.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.49
|
| Rate for Payer: UHC Core |
$298.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.34
|
| Rate for Payer: UHC Exchange |
$89.34
|
| Rate for Payer: UHC Medicare Advantage |
$89.34
|
| Rate for Payer: UHCCP Medicaid |
$114.08
|
| Rate for Payer: VA VA |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: BCBS Trust/PPO |
$291.73
|
| Rate for Payer: BCN Commercial |
$276.18
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO |
$310.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.49
|
| Rate for Payer: UHC Core |
$298.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.04
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$552.32
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$359.01 |
| Max. Negotiated Rate |
$497.09 |
| Rate for Payer: Aetna Commercial |
$469.47
|
| Rate for Payer: BCBS Trust/PPO |
$450.86
|
| Rate for Payer: BCN Commercial |
$426.83
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cofinity Commercial |
$475.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.86
|
| Rate for Payer: Healthscope Commercial |
$497.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.47
|
| Rate for Payer: Nomi Health Commercial |
$452.90
|
| Rate for Payer: PHP Commercial |
$469.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.01
|
| Rate for Payer: Priority Health HMO/PPO |
$480.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.04
|
| Rate for Payer: UHC Core |
$461.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.24
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
OP
|
$552.32
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$93.19 |
| Max. Negotiated Rate |
$497.09 |
| Rate for Payer: Aetna Commercial |
$469.47
|
| Rate for Payer: Aetna Medicare |
$143.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.60
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$138.08
|
| Rate for Payer: BCBS Trust/PPO |
$454.06
|
| Rate for Payer: BCN Commercial |
$429.43
|
| Rate for Payer: BCN Medicare Advantage |
$138.08
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cofinity Commercial |
$475.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.08
|
| Rate for Payer: Healthscope Commercial |
$497.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.24
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.98
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.47
|
| Rate for Payer: Nomi Health Commercial |
$452.90
|
| Rate for Payer: PACE Senior Care Partners |
$131.18
|
| Rate for Payer: PACE SWMI |
$138.08
|
| Rate for Payer: PHP Commercial |
$469.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.01
|
| Rate for Payer: Priority Health HMO/PPO |
$480.52
|
| Rate for Payer: Priority Health Medicare |
$139.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.05
|
| Rate for Payer: Railroad Medicare Medicare |
$138.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.04
|
| Rate for Payer: UHC Core |
$461.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.08
|
| Rate for Payer: UHC Exchange |
$138.08
|
| Rate for Payer: UHC Medicare Advantage |
$138.08
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$138.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.24
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
IP
|
$239.29
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$155.54 |
| Max. Negotiated Rate |
$215.36 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: BCBS Trust/PPO |
$195.33
|
| Rate for Payer: BCN Commercial |
$184.92
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$205.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$215.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| Rate for Payer: PHP Commercial |
$203.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.54
|
| Rate for Payer: Priority Health HMO/PPO |
$208.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.58
|
| Rate for Payer: UHC Core |
$199.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.47
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
OP
|
$239.29
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$56.83 |
| Max. Negotiated Rate |
$215.36 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Medicare |
$62.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.78
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$59.82
|
| Rate for Payer: BCBS Trust/PPO |
$196.72
|
| Rate for Payer: BCN Commercial |
$186.05
|
| Rate for Payer: BCN Medicare Advantage |
$59.82
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$205.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.82
|
| Rate for Payer: Healthscope Commercial |
$215.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.47
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.81
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| Rate for Payer: PACE Senior Care Partners |
$56.83
|
| Rate for Payer: PACE SWMI |
$59.82
|
| Rate for Payer: PHP Commercial |
$203.40
|
| Rate for Payer: PHP Medicare Advantage |
$59.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.54
|
| Rate for Payer: Priority Health HMO/PPO |
$208.18
|
| Rate for Payer: Priority Health Medicare |
$60.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.32
|
| Rate for Payer: Railroad Medicare Medicare |
$59.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.58
|
| Rate for Payer: UHC Core |
$199.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.82
|
| Rate for Payer: UHC Exchange |
$59.82
|
| Rate for Payer: UHC Medicare Advantage |
$59.82
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$59.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.47
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
IP
|
$377.75
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$245.54 |
| Max. Negotiated Rate |
$339.98 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: BCBS Trust/PPO |
$308.36
|
| Rate for Payer: BCN Commercial |
$291.93
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cofinity Commercial |
$324.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.20
|
| Rate for Payer: Healthscope Commercial |
$339.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.09
|
| Rate for Payer: Nomi Health Commercial |
$309.75
|
| Rate for Payer: PHP Commercial |
$321.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.54
|
| Rate for Payer: Priority Health HMO/PPO |
$328.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.42
|
| Rate for Payer: UHC Core |
$315.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.31
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$377.75
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$89.72 |
| Max. Negotiated Rate |
$339.98 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Aetna Medicare |
$98.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.05
|
| Rate for Payer: BCBS Complete |
$119.79
|
| Rate for Payer: BCBS MAPPO |
$94.44
|
| Rate for Payer: BCBS Trust/PPO |
$310.55
|
| Rate for Payer: BCN Commercial |
$293.70
|
| Rate for Payer: BCN Medicare Advantage |
$94.44
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cofinity Commercial |
$324.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.44
|
| Rate for Payer: Healthscope Commercial |
$339.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.31
|
| Rate for Payer: Mclaren Medicaid |
$114.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.16
|
| Rate for Payer: Meridian Medicaid |
$119.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.09
|
| Rate for Payer: Nomi Health Commercial |
$309.75
|
| Rate for Payer: PACE Senior Care Partners |
$89.72
|
| Rate for Payer: PACE SWMI |
$94.44
|
| Rate for Payer: PHP Commercial |
$321.09
|
| Rate for Payer: PHP Medicare Advantage |
$94.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.54
|
| Rate for Payer: Priority Health HMO/PPO |
$328.64
|
| Rate for Payer: Priority Health Medicare |
$95.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.09
|
| Rate for Payer: Railroad Medicare Medicare |
$94.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.42
|
| Rate for Payer: UHC Core |
$315.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.44
|
| Rate for Payer: UHC Exchange |
$94.44
|
| Rate for Payer: UHC Medicare Advantage |
$94.44
|
| Rate for Payer: UHCCP Medicaid |
$114.08
|
| Rate for Payer: VA VA |
$94.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.31
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
IP
|
$97.10
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$63.12 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.53
|
| Rate for Payer: BCBS Trust/PPO |
$79.26
|
| Rate for Payer: BCN Commercial |
$75.04
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.53
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: PHP Commercial |
$82.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health HMO/PPO |
$84.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.45
|
| Rate for Payer: UHC Core |
$81.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.83
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
OP
|
$97.10
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Commercial |
$82.53
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.34
|
| Rate for Payer: BCBS Complete |
$130.10
|
| Rate for Payer: BCBS MAPPO |
$24.27
|
| Rate for Payer: BCBS Trust/PPO |
$79.83
|
| Rate for Payer: BCN Commercial |
$75.50
|
| Rate for Payer: BCN Medicare Advantage |
$24.27
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.83
|
| Rate for Payer: Mclaren Medicaid |
$123.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.49
|
| Rate for Payer: Meridian Medicaid |
$130.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.53
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: PACE Senior Care Partners |
$23.06
|
| Rate for Payer: PACE SWMI |
$24.27
|
| Rate for Payer: PHP Commercial |
$82.53
|
| Rate for Payer: PHP Medicare Advantage |
$24.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health HMO/PPO |
$84.48
|
| Rate for Payer: Priority Health Medicare |
$24.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.06
|
| Rate for Payer: Railroad Medicare Medicare |
$24.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.45
|
| Rate for Payer: UHC Core |
$81.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.27
|
| Rate for Payer: UHC Exchange |
$24.27
|
| Rate for Payer: UHC Medicare Advantage |
$24.27
|
| Rate for Payer: UHCCP Medicaid |
$123.89
|
| Rate for Payer: VA VA |
$24.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.83
|
|
|
HC SPORE CHECK
|
Facility
|
OP
|
$23.26
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna Commercial |
$19.77
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.27
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$18.08
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$20.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.77
|
| Rate for Payer: Nomi Health Commercial |
$19.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.52
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Commercial |
$19.77
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.12
|
| Rate for Payer: Priority Health HMO/PPO |
$20.24
|
| Rate for Payer: Priority Health Medicare |
$5.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.47
|
| Rate for Payer: UHC Core |
$19.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.82
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: VA VA |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HC SPORE CHECK
|
Facility
|
IP
|
$23.26
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna Commercial |
$19.77
|
| Rate for Payer: BCBS Trust/PPO |
$18.99
|
| Rate for Payer: BCN Commercial |
$17.98
|
| Rate for Payer: Cash Price |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.61
|
| Rate for Payer: Healthscope Commercial |
$20.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.77
|
| Rate for Payer: Nomi Health Commercial |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.12
|
| Rate for Payer: Priority Health HMO/PPO |
$20.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.47
|
| Rate for Payer: UHC Core |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
OP
|
$4,707.35
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,118.00 |
| Max. Negotiated Rate |
$4,236.61 |
| Rate for Payer: Aetna Commercial |
$4,001.25
|
| Rate for Payer: Aetna Medicare |
$1,223.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,471.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,471.05
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$1,176.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,869.91
|
| Rate for Payer: BCN Commercial |
$3,659.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,176.84
|
| Rate for Payer: Cash Price |
$3,765.88
|
| Rate for Payer: Cash Price |
$3,765.88
|
| Rate for Payer: Cofinity Commercial |
$4,048.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,765.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,176.84
|
| Rate for Payer: Healthscope Commercial |
$4,236.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,530.51
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,235.68
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,353.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,001.25
|
| Rate for Payer: Nomi Health Commercial |
$3,860.03
|
| Rate for Payer: PACE Senior Care Partners |
$1,118.00
|
| Rate for Payer: PACE SWMI |
$1,176.84
|
| Rate for Payer: PHP Commercial |
$4,001.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,176.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,059.78
|
| Rate for Payer: Priority Health HMO/PPO |
$4,095.39
|
| Rate for Payer: Priority Health Medicare |
$1,188.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,153.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,176.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,142.47
|
| Rate for Payer: UHC Core |
$3,930.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,176.84
|
| Rate for Payer: UHC Exchange |
$1,176.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,176.84
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$1,176.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,530.51
|
|
