|
HC ADAPTOR PERFUSION
|
Facility
|
IP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
OP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.82
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| Rate for Payer: BCN Commercial |
$9.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.20
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.06
|
| Rate for Payer: UHC Exchange |
$3.06
|
| Rate for Payer: UHC Medicare Advantage |
$3.06
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,114.22 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$2,314.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,781.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,781.88
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: BCBS MAPPO |
$2,225.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,318.33
|
| Rate for Payer: BCN Commercial |
$6,921.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,225.50
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,225.50
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,336.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,559.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PACE Senior Care Partners |
$2,114.22
|
| Rate for Payer: PACE SWMI |
$2,225.50
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Medicare |
$2,247.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,225.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,225.50
|
| Rate for Payer: UHC Exchange |
$2,225.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,225.50
|
| Rate for Payer: VA VA |
$2,225.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADD. ABLATION
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: BCBS Trust/PPO |
$7,266.70
|
| Rate for Payer: BCN Commercial |
$6,879.47
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,114.22 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$2,314.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,781.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,781.88
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: BCBS MAPPO |
$2,225.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,318.33
|
| Rate for Payer: BCN Commercial |
$6,921.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,225.50
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,225.50
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,336.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,559.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PACE Senior Care Partners |
$2,114.22
|
| Rate for Payer: PACE SWMI |
$2,225.50
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Medicare |
$2,247.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,225.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,225.50
|
| Rate for Payer: UHC Exchange |
$2,225.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,225.50
|
| Rate for Payer: VA VA |
$2,225.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: BCBS Trust/PPO |
$7,266.70
|
| Rate for Payer: BCN Commercial |
$6,879.47
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$49.16 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: Aetna Medicare |
$14.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.07
|
| Rate for Payer: BCBS Complete |
$7.59
|
| Rate for Payer: BCBS MAPPO |
$13.66
|
| Rate for Payer: BCBS Trust/PPO |
$44.90
|
| Rate for Payer: BCN Commercial |
$42.47
|
| Rate for Payer: BCN Medicare Advantage |
$13.66
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$46.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.66
|
| Rate for Payer: Healthscope Commercial |
$49.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.96
|
| Rate for Payer: Mclaren Medicaid |
$7.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.34
|
| Rate for Payer: Meridian Medicaid |
$7.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: Nomi Health Commercial |
$44.79
|
| Rate for Payer: PACE Senior Care Partners |
$12.97
|
| Rate for Payer: PACE SWMI |
$13.66
|
| Rate for Payer: PHP Commercial |
$46.43
|
| Rate for Payer: PHP Medicare Advantage |
$13.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health HMO/PPO |
$47.52
|
| Rate for Payer: Priority Health Medicare |
$13.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.07
|
| Rate for Payer: UHC Core |
$45.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.66
|
| Rate for Payer: UHC Exchange |
$13.66
|
| Rate for Payer: UHC Medicare Advantage |
$13.66
|
| Rate for Payer: UHCCP Medicaid |
$7.23
|
| Rate for Payer: VA VA |
$13.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.96
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$49.16 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.59
|
| Rate for Payer: BCN Commercial |
$42.21
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$46.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Healthscope Commercial |
$49.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: Nomi Health Commercial |
$44.79
|
| Rate for Payer: PHP Commercial |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health HMO/PPO |
$47.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.07
|
| Rate for Payer: UHC Core |
$45.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.96
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$84.93
|
| Rate for Payer: BCN Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$85.53
|
| Rate for Payer: BCN Commercial |
$80.89
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.71
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.01
|
| Rate for Payer: UHC Exchange |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: BCBS Trust/PPO |
$84.08
|
| Rate for Payer: BCN Commercial |
$79.60
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$88.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Healthscope Commercial |
$92.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| Rate for Payer: PHP Commercial |
$87.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO |
$89.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.64
|
| Rate for Payer: UHC Core |
$86.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.25
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Aetna Medicare |
$26.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.19
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$25.75
|
| Rate for Payer: BCBS Trust/PPO |
$84.68
|
| Rate for Payer: BCN Commercial |
$80.08
|
| Rate for Payer: BCN Medicare Advantage |
$25.75
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$88.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.75
|
| Rate for Payer: Healthscope Commercial |
$92.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.25
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.04
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| Rate for Payer: PACE Senior Care Partners |
$24.46
|
| Rate for Payer: PACE SWMI |
$25.75
|
| Rate for Payer: PHP Commercial |
$87.55
|
| Rate for Payer: PHP Medicare Advantage |
$25.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO |
$89.61
|
| Rate for Payer: Priority Health Medicare |
$26.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.01
|
| Rate for Payer: Railroad Medicare Medicare |
$25.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.64
|
| Rate for Payer: UHC Core |
$86.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.75
|
| Rate for Payer: UHC Exchange |
$25.75
|
| Rate for Payer: UHC Medicare Advantage |
$25.75
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$25.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.25
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$26.60
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna Commercial |
$22.61
|
| Rate for Payer: Aetna Medicare |
$6.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.31
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$6.65
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$20.68
|
| Rate for Payer: BCN Medicare Advantage |
$6.65
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$22.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.65
|
| Rate for Payer: Healthscope Commercial |
$23.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.61
|
| Rate for Payer: Nomi Health Commercial |
$21.81
|
| Rate for Payer: PACE Senior Care Partners |
$6.32
|
| Rate for Payer: PACE SWMI |
$6.65
|
| Rate for Payer: PHP Commercial |
$22.61
|
| Rate for Payer: PHP Medicare Advantage |
$6.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.29
|
| Rate for Payer: Priority Health HMO/PPO |
$23.14
|
| Rate for Payer: Priority Health Medicare |
$6.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.41
|
| Rate for Payer: UHC Core |
$22.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.65
|
| Rate for Payer: UHC Exchange |
$6.65
|
| Rate for Payer: UHC Medicare Advantage |
$6.65
|
| Rate for Payer: VA VA |
$6.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.95
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$26.60
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna Commercial |
$22.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.71
|
| Rate for Payer: BCN Commercial |
$20.56
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$22.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$23.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.61
|
| Rate for Payer: Nomi Health Commercial |
$21.81
|
| Rate for Payer: PHP Commercial |
$22.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.29
|
| Rate for Payer: Priority Health HMO/PPO |
$23.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.41
|
| Rate for Payer: UHC Core |
$22.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.95
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$26.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.86
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: BCBS MAPPO |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$83.82
|
| Rate for Payer: BCN Commercial |
$79.27
|
| Rate for Payer: BCN Medicare Advantage |
$25.49
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.49
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Medicare |
$25.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: Railroad Medicare Medicare |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.49
|
| Rate for Payer: UHC Exchange |
$25.49
|
| Rate for Payer: UHC Medicare Advantage |
$25.49
|
| Rate for Payer: VA VA |
$25.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: BCBS Trust/PPO |
$83.23
|
| Rate for Payer: BCN Commercial |
$78.79
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$585.48
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$139.05 |
| Max. Negotiated Rate |
$526.93 |
| Rate for Payer: Aetna Commercial |
$497.66
|
| Rate for Payer: Aetna Medicare |
$152.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.96
|
| Rate for Payer: BCBS Complete |
$151.29
|
| Rate for Payer: BCBS MAPPO |
$146.37
|
| Rate for Payer: BCBS Trust/PPO |
$481.32
|
| Rate for Payer: BCN Commercial |
$455.21
|
| Rate for Payer: BCN Medicare Advantage |
$146.37
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$503.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.37
|
| Rate for Payer: Healthscope Commercial |
$526.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.11
|
| Rate for Payer: Mclaren Medicaid |
$144.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.69
|
| Rate for Payer: Meridian Medicaid |
$151.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.66
|
| Rate for Payer: Nomi Health Commercial |
$480.09
|
| Rate for Payer: PACE Senior Care Partners |
$139.05
|
| Rate for Payer: PACE SWMI |
$146.37
|
| Rate for Payer: PHP Commercial |
$497.66
|
| Rate for Payer: PHP Medicare Advantage |
$146.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.56
|
| Rate for Payer: Priority Health HMO/PPO |
$509.37
|
| Rate for Payer: Priority Health Medicare |
$147.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.27
|
| Rate for Payer: Railroad Medicare Medicare |
$146.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.22
|
| Rate for Payer: UHC Core |
$488.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.37
|
| Rate for Payer: UHC Exchange |
$146.37
|
| Rate for Payer: UHC Medicare Advantage |
$146.37
|
| Rate for Payer: UHCCP Medicaid |
$144.08
|
| Rate for Payer: VA VA |
$146.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.11
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$585.48
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$380.56 |
| Max. Negotiated Rate |
$526.93 |
| Rate for Payer: Aetna Commercial |
$497.66
|
| Rate for Payer: BCBS Trust/PPO |
$477.93
|
| Rate for Payer: BCN Commercial |
$452.46
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$503.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.38
|
| Rate for Payer: Healthscope Commercial |
$526.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.66
|
| Rate for Payer: Nomi Health Commercial |
$480.09
|
| Rate for Payer: PHP Commercial |
$497.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.56
|
| Rate for Payer: Priority Health HMO/PPO |
$509.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.22
|
| Rate for Payer: UHC Core |
$488.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.11
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$22.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.47
|
| Rate for Payer: BCBS Complete |
$33.88
|
| Rate for Payer: BCBS MAPPO |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$69.63
|
| Rate for Payer: BCN Commercial |
$65.85
|
| Rate for Payer: BCN Medicare Advantage |
$21.18
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| Rate for Payer: PACE Senior Care Partners |
$20.12
|
| Rate for Payer: PACE SWMI |
$21.18
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: PHP Medicare Advantage |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Medicare |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.75
|
| Rate for Payer: Railroad Medicare Medicare |
$21.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.54
|
| Rate for Payer: UHC Core |
$70.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.18
|
| Rate for Payer: UHC Exchange |
$21.18
|
| Rate for Payer: UHC Medicare Advantage |
$21.18
|
| Rate for Payer: VA VA |
$21.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$69.14
|
| Rate for Payer: BCN Commercial |
$65.46
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.54
|
| Rate for Payer: UHC Core |
$70.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
IP
|
$84.70
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$69.14
|
| Rate for Payer: BCN Commercial |
$65.46
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.54
|
| Rate for Payer: UHC Core |
$70.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
OP
|
$84.70
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Medicare |
$22.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.47
|
| Rate for Payer: BCBS Complete |
$33.88
|
| Rate for Payer: BCBS MAPPO |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$69.63
|
| Rate for Payer: BCN Commercial |
$65.85
|
| Rate for Payer: BCN Medicare Advantage |
$21.18
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Cofinity Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$76.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.00
|
| Rate for Payer: Nomi Health Commercial |
$69.45
|
| Rate for Payer: PACE Senior Care Partners |
$20.12
|
| Rate for Payer: PACE SWMI |
$21.18
|
| Rate for Payer: PHP Commercial |
$72.00
|
| Rate for Payer: PHP Medicare Advantage |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.06
|
| Rate for Payer: Priority Health HMO/PPO |
$73.69
|
| Rate for Payer: Priority Health Medicare |
$21.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.75
|
| Rate for Payer: Railroad Medicare Medicare |
$21.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.54
|
| Rate for Payer: UHC Core |
$70.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.18
|
| Rate for Payer: UHC Exchange |
$21.18
|
| Rate for Payer: UHC Medicare Advantage |
$21.18
|
| Rate for Payer: VA VA |
$21.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.52
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$127.01 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$139.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.12
|
| Rate for Payer: BCBS Complete |
$335.10
|
| Rate for Payer: BCBS MAPPO |
$133.69
|
| Rate for Payer: BCBS Trust/PPO |
$439.63
|
| Rate for Payer: BCN Commercial |
$415.78
|
| Rate for Payer: BCN Medicare Advantage |
$133.69
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.69
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Mclaren Medicaid |
$319.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.38
|
| Rate for Payer: Meridian Medicaid |
$335.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PACE Senior Care Partners |
$127.01
|
| Rate for Payer: PACE SWMI |
$133.69
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$133.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO |
$465.25
|
| Rate for Payer: Priority Health Medicare |
$135.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: Railroad Medicare Medicare |
$133.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.60
|
| Rate for Payer: UHC Core |
$446.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.69
|
| Rate for Payer: UHC Exchange |
$133.69
|
| Rate for Payer: UHC Medicare Advantage |
$133.69
|
| Rate for Payer: UHCCP Medicaid |
$319.12
|
| Rate for Payer: VA VA |
$133.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$347.60 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: BCBS Trust/PPO |
$436.53
|
| Rate for Payer: BCN Commercial |
$413.27
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO |
$465.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.60
|
| Rate for Payer: UHC Core |
$446.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$127.01 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$139.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.12
|
| Rate for Payer: BCBS Complete |
$335.10
|
| Rate for Payer: BCBS MAPPO |
$133.69
|
| Rate for Payer: BCBS Trust/PPO |
$439.63
|
| Rate for Payer: BCN Commercial |
$415.78
|
| Rate for Payer: BCN Medicare Advantage |
$133.69
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.69
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Mclaren Medicaid |
$319.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.38
|
| Rate for Payer: Meridian Medicaid |
$335.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PACE Senior Care Partners |
$127.01
|
| Rate for Payer: PACE SWMI |
$133.69
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$133.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO |
$465.25
|
| Rate for Payer: Priority Health Medicare |
$135.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: Railroad Medicare Medicare |
$133.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.60
|
| Rate for Payer: UHC Core |
$446.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.69
|
| Rate for Payer: UHC Exchange |
$133.69
|
| Rate for Payer: UHC Medicare Advantage |
$133.69
|
| Rate for Payer: UHCCP Medicaid |
$319.12
|
| Rate for Payer: VA VA |
$133.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
