|
HC CHEMODNRV EXTREMITY 5/< MUSCLES
|
Facility
|
OP
|
$115.59
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$104.03 |
| Rate for Payer: Aetna Commercial |
$98.25
|
| Rate for Payer: Aetna Medicare |
$30.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.12
|
| Rate for Payer: BCBS Complete |
$46.24
|
| Rate for Payer: BCBS MAPPO |
$28.90
|
| Rate for Payer: BCBS Trust/PPO |
$95.03
|
| Rate for Payer: BCN Commercial |
$89.87
|
| Rate for Payer: BCN Medicare Advantage |
$28.90
|
| Rate for Payer: Cash Price |
$92.47
|
| Rate for Payer: Cofinity Commercial |
$99.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.90
|
| Rate for Payer: Healthscope Commercial |
$104.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.25
|
| Rate for Payer: Nomi Health Commercial |
$94.78
|
| Rate for Payer: PACE Senior Care Partners |
$27.45
|
| Rate for Payer: PACE SWMI |
$28.90
|
| Rate for Payer: PHP Commercial |
$98.25
|
| Rate for Payer: PHP Medicare Advantage |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.13
|
| Rate for Payer: Priority Health HMO/PPO |
$100.56
|
| Rate for Payer: Priority Health Medicare |
$29.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.45
|
| Rate for Payer: Railroad Medicare Medicare |
$28.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.72
|
| Rate for Payer: UHC Core |
$96.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.90
|
| Rate for Payer: UHC Exchange |
$28.90
|
| Rate for Payer: UHC Medicare Advantage |
$28.90
|
| Rate for Payer: VA VA |
$28.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.69
|
|
|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
IP
|
$527.48
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.86 |
| Max. Negotiated Rate |
$474.73 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: BCBS Trust/PPO |
$430.58
|
| Rate for Payer: BCN Commercial |
$407.64
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PHP Commercial |
$448.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO |
$458.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.18
|
| Rate for Payer: UHC Core |
$440.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.61
|
|
|
HC CHEMODNRV EXTREMITY 5 OR MORE MUSCLES
|
Facility
|
OP
|
$527.48
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
36100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.28 |
| Max. Negotiated Rate |
$515.13 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: Aetna Medicare |
$137.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.84
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$131.87
|
| Rate for Payer: BCBS Trust/PPO |
$433.64
|
| Rate for Payer: BCN Commercial |
$410.12
|
| Rate for Payer: BCN Medicare Advantage |
$131.87
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.87
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.61
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.46
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PACE Senior Care Partners |
$125.28
|
| Rate for Payer: PACE SWMI |
$131.87
|
| Rate for Payer: PHP Commercial |
$448.36
|
| Rate for Payer: PHP Medicare Advantage |
$131.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO |
$458.91
|
| Rate for Payer: Priority Health Medicare |
$133.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.41
|
| Rate for Payer: Railroad Medicare Medicare |
$131.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.18
|
| Rate for Payer: UHC Core |
$440.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.87
|
| Rate for Payer: UHC Exchange |
$131.87
|
| Rate for Payer: UHC Medicare Advantage |
$131.87
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$131.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.61
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
OP
|
$541.99
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.72 |
| Max. Negotiated Rate |
$487.79 |
| Rate for Payer: Aetna Commercial |
$460.69
|
| Rate for Payer: Aetna Medicare |
$140.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.37
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$135.50
|
| Rate for Payer: BCBS Trust/PPO |
$445.57
|
| Rate for Payer: BCN Commercial |
$421.40
|
| Rate for Payer: BCN Medicare Advantage |
$135.50
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$466.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.50
|
| Rate for Payer: Healthscope Commercial |
$487.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.49
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.27
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: PACE Senior Care Partners |
$128.72
|
| Rate for Payer: PACE SWMI |
$135.50
|
| Rate for Payer: PHP Commercial |
$460.69
|
| Rate for Payer: PHP Medicare Advantage |
$135.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: Priority Health HMO/PPO |
$471.53
|
| Rate for Payer: Priority Health Medicare |
$136.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.13
|
| Rate for Payer: Railroad Medicare Medicare |
$135.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.95
|
| Rate for Payer: UHC Core |
$452.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.50
|
| Rate for Payer: UHC Exchange |
$135.50
|
| Rate for Payer: UHC Medicare Advantage |
$135.50
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$135.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.49
|
|
|
HC CHEMODNRV MUSC FACIAL
|
Facility
|
IP
|
$541.99
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$487.79 |
| Rate for Payer: Aetna Commercial |
$460.69
|
| Rate for Payer: BCBS Trust/PPO |
$442.43
|
| Rate for Payer: BCN Commercial |
$418.85
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$466.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Healthscope Commercial |
$487.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: PHP Commercial |
$460.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: Priority Health HMO/PPO |
$471.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.95
|
| Rate for Payer: UHC Core |
$452.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.49
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
OP
|
$662.42
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.32 |
| Max. Negotiated Rate |
$596.18 |
| Rate for Payer: Aetna Commercial |
$563.06
|
| Rate for Payer: Aetna Medicare |
$172.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.01
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$165.60
|
| Rate for Payer: BCBS Trust/PPO |
$544.58
|
| Rate for Payer: BCN Commercial |
$515.03
|
| Rate for Payer: BCN Medicare Advantage |
$165.60
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cofinity Commercial |
$569.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.60
|
| Rate for Payer: Healthscope Commercial |
$596.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.82
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.89
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.06
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: PACE Senior Care Partners |
$157.32
|
| Rate for Payer: PACE SWMI |
$165.60
|
| Rate for Payer: PHP Commercial |
$563.06
|
| Rate for Payer: PHP Medicare Advantage |
$165.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO |
$576.31
|
| Rate for Payer: Priority Health Medicare |
$167.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.82
|
| Rate for Payer: Railroad Medicare Medicare |
$165.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.93
|
| Rate for Payer: UHC Core |
$553.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.60
|
| Rate for Payer: UHC Exchange |
$165.60
|
| Rate for Payer: UHC Medicare Advantage |
$165.60
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$165.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.82
|
|
|
HC CHEMODNRV MUSC FACIAL BIL
|
Facility
|
IP
|
$662.42
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
36100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.57 |
| Max. Negotiated Rate |
$596.18 |
| Rate for Payer: Aetna Commercial |
$563.06
|
| Rate for Payer: BCBS Trust/PPO |
$540.73
|
| Rate for Payer: BCN Commercial |
$511.92
|
| Rate for Payer: Cash Price |
$529.94
|
| Rate for Payer: Cofinity Commercial |
$569.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.94
|
| Rate for Payer: Healthscope Commercial |
$596.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.06
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: PHP Commercial |
$563.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO |
$576.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.93
|
| Rate for Payer: UHC Core |
$553.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.82
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
IP
|
$240.33
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.21 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: BCBS Trust/PPO |
$196.18
|
| Rate for Payer: BCN Commercial |
$185.73
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$197.07
|
| Rate for Payer: PHP Commercial |
$204.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.21
|
| Rate for Payer: Priority Health HMO/PPO |
$209.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.49
|
| Rate for Payer: UHC Core |
$200.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.25
|
|
|
HC CHEMODNRV MUSC MIGRAINE BIL
|
Facility
|
OP
|
$240.33
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
36100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: Aetna Medicare |
$62.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.10
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$60.08
|
| Rate for Payer: BCBS Trust/PPO |
$197.58
|
| Rate for Payer: BCN Commercial |
$186.86
|
| Rate for Payer: BCN Medicare Advantage |
$60.08
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.08
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.25
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.09
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$197.07
|
| Rate for Payer: PACE Senior Care Partners |
$57.08
|
| Rate for Payer: PACE SWMI |
$60.08
|
| Rate for Payer: PHP Commercial |
$204.28
|
| Rate for Payer: PHP Medicare Advantage |
$60.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.21
|
| Rate for Payer: Priority Health HMO/PPO |
$209.09
|
| Rate for Payer: Priority Health Medicare |
$60.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.02
|
| Rate for Payer: Railroad Medicare Medicare |
$60.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.49
|
| Rate for Payer: UHC Core |
$200.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.08
|
| Rate for Payer: UHC Exchange |
$60.08
|
| Rate for Payer: UHC Medicare Advantage |
$60.08
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$60.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.25
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
IP
|
$448.42
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.47 |
| Max. Negotiated Rate |
$403.58 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: BCBS Trust/PPO |
$366.05
|
| Rate for Payer: BCN Commercial |
$346.54
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cofinity Commercial |
$385.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.74
|
| Rate for Payer: Healthscope Commercial |
$403.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.16
|
| Rate for Payer: Nomi Health Commercial |
$367.70
|
| Rate for Payer: PHP Commercial |
$381.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.47
|
| Rate for Payer: Priority Health HMO/PPO |
$390.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.61
|
| Rate for Payer: UHC Core |
$374.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.32
|
|
|
HC CHEMODNRV MUSC NECK
|
Facility
|
OP
|
$448.42
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
36100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$403.58 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: Aetna Medicare |
$116.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.13
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$112.10
|
| Rate for Payer: BCBS Trust/PPO |
$368.65
|
| Rate for Payer: BCN Commercial |
$348.65
|
| Rate for Payer: BCN Medicare Advantage |
$112.10
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cofinity Commercial |
$385.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.10
|
| Rate for Payer: Healthscope Commercial |
$403.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.32
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.71
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.16
|
| Rate for Payer: Nomi Health Commercial |
$367.70
|
| Rate for Payer: PACE Senior Care Partners |
$106.50
|
| Rate for Payer: PACE SWMI |
$112.10
|
| Rate for Payer: PHP Commercial |
$381.16
|
| Rate for Payer: PHP Medicare Advantage |
$112.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.47
|
| Rate for Payer: Priority Health HMO/PPO |
$390.13
|
| Rate for Payer: Priority Health Medicare |
$113.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.44
|
| Rate for Payer: Railroad Medicare Medicare |
$112.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.61
|
| Rate for Payer: UHC Core |
$374.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.10
|
| Rate for Payer: UHC Exchange |
$112.10
|
| Rate for Payer: UHC Medicare Advantage |
$112.10
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$112.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.32
|
|
|
HC CHEMODNRV TRUNK MUSC 1-5 MUSC
|
Facility
|
IP
|
$696.44
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.69 |
| Max. Negotiated Rate |
$626.80 |
| Rate for Payer: Aetna Commercial |
$591.97
|
| Rate for Payer: BCBS Trust/PPO |
$568.50
|
| Rate for Payer: BCN Commercial |
$538.21
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cofinity Commercial |
$598.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.15
|
| Rate for Payer: Healthscope Commercial |
$626.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.97
|
| Rate for Payer: Nomi Health Commercial |
$571.08
|
| Rate for Payer: PHP Commercial |
$591.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.69
|
| Rate for Payer: Priority Health HMO/PPO |
$605.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.87
|
| Rate for Payer: UHC Core |
$581.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.33
|
|
|
HC CHEMODNRV TRUNK MUSC 1-5 MUSC
|
Facility
|
OP
|
$696.44
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
36100453
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$626.80 |
| Rate for Payer: Aetna Commercial |
$591.97
|
| Rate for Payer: Aetna Medicare |
$181.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.64
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$174.11
|
| Rate for Payer: BCBS Trust/PPO |
$572.54
|
| Rate for Payer: BCN Commercial |
$541.48
|
| Rate for Payer: BCN Medicare Advantage |
$174.11
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cofinity Commercial |
$598.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.11
|
| Rate for Payer: Healthscope Commercial |
$626.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.33
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.82
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.97
|
| Rate for Payer: Nomi Health Commercial |
$571.08
|
| Rate for Payer: PACE Senior Care Partners |
$165.40
|
| Rate for Payer: PACE SWMI |
$174.11
|
| Rate for Payer: PHP Commercial |
$591.97
|
| Rate for Payer: PHP Medicare Advantage |
$174.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.69
|
| Rate for Payer: Priority Health HMO/PPO |
$605.90
|
| Rate for Payer: Priority Health Medicare |
$175.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.61
|
| Rate for Payer: Railroad Medicare Medicare |
$174.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.87
|
| Rate for Payer: UHC Core |
$581.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.11
|
| Rate for Payer: UHC Exchange |
$174.11
|
| Rate for Payer: UHC Medicare Advantage |
$174.11
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$174.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.33
|
|
|
HC CHEMO INFUSION CONCURRENT
|
Facility
|
IP
|
$197.68
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$128.49 |
| Max. Negotiated Rate |
$177.91 |
| Rate for Payer: Aetna Commercial |
$168.03
|
| Rate for Payer: BCBS Trust/PPO |
$161.37
|
| Rate for Payer: BCN Commercial |
$152.77
|
| Rate for Payer: Cash Price |
$158.14
|
| Rate for Payer: Cofinity Commercial |
$170.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.14
|
| Rate for Payer: Healthscope Commercial |
$177.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.03
|
| Rate for Payer: Nomi Health Commercial |
$162.10
|
| Rate for Payer: PHP Commercial |
$168.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.49
|
| Rate for Payer: Priority Health HMO/PPO |
$171.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.96
|
| Rate for Payer: UHC Core |
$165.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.26
|
|
|
HC CHEMO INFUSION CONCURRENT
|
Facility
|
OP
|
$197.68
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
33500011
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$177.91 |
| Rate for Payer: Aetna Commercial |
$168.03
|
| Rate for Payer: Aetna Medicare |
$51.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.78
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$49.42
|
| Rate for Payer: BCBS Trust/PPO |
$162.51
|
| Rate for Payer: BCN Commercial |
$153.70
|
| Rate for Payer: BCN Medicare Advantage |
$49.42
|
| Rate for Payer: Cash Price |
$158.14
|
| Rate for Payer: Cash Price |
$158.14
|
| Rate for Payer: Cofinity Commercial |
$170.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.42
|
| Rate for Payer: Healthscope Commercial |
$177.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.26
|
| Rate for Payer: Mclaren Medicaid |
$32.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.89
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.03
|
| Rate for Payer: Nomi Health Commercial |
$162.10
|
| Rate for Payer: PACE Senior Care Partners |
$46.95
|
| Rate for Payer: PACE SWMI |
$49.42
|
| Rate for Payer: PHP Commercial |
$168.03
|
| Rate for Payer: PHP Medicare Advantage |
$49.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.49
|
| Rate for Payer: Priority Health HMO/PPO |
$171.98
|
| Rate for Payer: Priority Health Medicare |
$49.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.45
|
| Rate for Payer: Railroad Medicare Medicare |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.96
|
| Rate for Payer: UHC Core |
$165.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.42
|
| Rate for Payer: UHC Exchange |
$49.42
|
| Rate for Payer: UHC Medicare Advantage |
$49.42
|
| Rate for Payer: UHCCP Medicaid |
$32.69
|
| Rate for Payer: VA VA |
$49.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.26
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
IP
|
$262.13
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$170.38 |
| Max. Negotiated Rate |
$235.92 |
| Rate for Payer: Aetna Commercial |
$222.81
|
| Rate for Payer: BCBS Trust/PPO |
$213.98
|
| Rate for Payer: BCN Commercial |
$202.57
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cofinity Commercial |
$225.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.70
|
| Rate for Payer: Healthscope Commercial |
$235.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.81
|
| Rate for Payer: Nomi Health Commercial |
$214.95
|
| Rate for Payer: PHP Commercial |
$222.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.38
|
| Rate for Payer: Priority Health HMO/PPO |
$228.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.67
|
| Rate for Payer: UHC Core |
$218.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.60
|
|
|
HC CHEMO INFUSION EACH ADDL HR
|
Facility
|
OP
|
$262.13
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
33500002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$235.92 |
| Rate for Payer: Aetna Commercial |
$222.81
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.92
|
| Rate for Payer: BCBS Complete |
$52.94
|
| Rate for Payer: BCBS MAPPO |
$65.53
|
| Rate for Payer: BCBS Trust/PPO |
$215.50
|
| Rate for Payer: BCN Commercial |
$203.81
|
| Rate for Payer: BCN Medicare Advantage |
$65.53
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cofinity Commercial |
$225.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.53
|
| Rate for Payer: Healthscope Commercial |
$235.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.60
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.81
|
| Rate for Payer: Meridian Medicaid |
$52.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.81
|
| Rate for Payer: Nomi Health Commercial |
$214.95
|
| Rate for Payer: PACE Senior Care Partners |
$62.26
|
| Rate for Payer: PACE SWMI |
$65.53
|
| Rate for Payer: PHP Commercial |
$222.81
|
| Rate for Payer: PHP Medicare Advantage |
$65.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.38
|
| Rate for Payer: Priority Health HMO/PPO |
$228.05
|
| Rate for Payer: Priority Health Medicare |
$66.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.63
|
| Rate for Payer: Railroad Medicare Medicare |
$65.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.67
|
| Rate for Payer: UHC Core |
$218.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.53
|
| Rate for Payer: UHC Exchange |
$65.53
|
| Rate for Payer: UHC Medicare Advantage |
$65.53
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$65.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.60
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
OP
|
$973.97
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$231.32 |
| Max. Negotiated Rate |
$876.57 |
| Rate for Payer: Aetna Commercial |
$827.87
|
| Rate for Payer: Aetna Medicare |
$253.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.37
|
| Rate for Payer: BCBS Complete |
$246.72
|
| Rate for Payer: BCBS MAPPO |
$243.49
|
| Rate for Payer: BCBS Trust/PPO |
$800.70
|
| Rate for Payer: BCN Commercial |
$757.26
|
| Rate for Payer: BCN Medicare Advantage |
$243.49
|
| Rate for Payer: Cash Price |
$779.18
|
| Rate for Payer: Cash Price |
$779.18
|
| Rate for Payer: Cofinity Commercial |
$837.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.49
|
| Rate for Payer: Healthscope Commercial |
$876.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$730.48
|
| Rate for Payer: Mclaren Medicaid |
$234.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.67
|
| Rate for Payer: Meridian Medicaid |
$246.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$827.87
|
| Rate for Payer: Nomi Health Commercial |
$798.66
|
| Rate for Payer: PACE Senior Care Partners |
$231.32
|
| Rate for Payer: PACE SWMI |
$243.49
|
| Rate for Payer: PHP Commercial |
$827.87
|
| Rate for Payer: PHP Medicare Advantage |
$243.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.08
|
| Rate for Payer: Priority Health HMO/PPO |
$847.35
|
| Rate for Payer: Priority Health Medicare |
$245.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.56
|
| Rate for Payer: Railroad Medicare Medicare |
$243.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.09
|
| Rate for Payer: UHC Core |
$813.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.49
|
| Rate for Payer: UHC Exchange |
$243.49
|
| Rate for Payer: UHC Medicare Advantage |
$243.49
|
| Rate for Payer: UHCCP Medicaid |
$234.96
|
| Rate for Payer: VA VA |
$243.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$730.48
|
|
|
HC CHEMO INFUSION FIRST HR
|
Facility
|
IP
|
$973.97
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
33500001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$633.08 |
| Max. Negotiated Rate |
$876.57 |
| Rate for Payer: Aetna Commercial |
$827.87
|
| Rate for Payer: BCBS Trust/PPO |
$795.05
|
| Rate for Payer: BCN Commercial |
$752.68
|
| Rate for Payer: Cash Price |
$779.18
|
| Rate for Payer: Cofinity Commercial |
$837.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.18
|
| Rate for Payer: Healthscope Commercial |
$876.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$730.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$827.87
|
| Rate for Payer: Nomi Health Commercial |
$798.66
|
| Rate for Payer: PHP Commercial |
$827.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.08
|
| Rate for Payer: Priority Health HMO/PPO |
$847.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.09
|
| Rate for Payer: UHC Core |
$813.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$730.48
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
IP
|
$882.55
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$573.66 |
| Max. Negotiated Rate |
$794.30 |
| Rate for Payer: Aetna Commercial |
$750.17
|
| Rate for Payer: BCBS Trust/PPO |
$720.43
|
| Rate for Payer: BCN Commercial |
$682.03
|
| Rate for Payer: Cash Price |
$706.04
|
| Rate for Payer: Cofinity Commercial |
$758.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$706.04
|
| Rate for Payer: Healthscope Commercial |
$794.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.17
|
| Rate for Payer: Nomi Health Commercial |
$723.69
|
| Rate for Payer: PHP Commercial |
$750.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.66
|
| Rate for Payer: Priority Health HMO/PPO |
$767.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$591.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.64
|
| Rate for Payer: UHC Core |
$736.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.91
|
|
|
HC CHEMO INFUSION VIA PUMP
|
Facility
|
OP
|
$882.55
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
33500003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$209.61 |
| Max. Negotiated Rate |
$794.30 |
| Rate for Payer: Aetna Commercial |
$750.17
|
| Rate for Payer: Aetna Medicare |
$229.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.80
|
| Rate for Payer: BCBS Complete |
$246.72
|
| Rate for Payer: BCBS MAPPO |
$220.64
|
| Rate for Payer: BCBS Trust/PPO |
$725.54
|
| Rate for Payer: BCN Commercial |
$686.18
|
| Rate for Payer: BCN Medicare Advantage |
$220.64
|
| Rate for Payer: Cash Price |
$706.04
|
| Rate for Payer: Cash Price |
$706.04
|
| Rate for Payer: Cofinity Commercial |
$758.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$706.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.64
|
| Rate for Payer: Healthscope Commercial |
$794.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.91
|
| Rate for Payer: Mclaren Medicaid |
$234.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.67
|
| Rate for Payer: Meridian Medicaid |
$246.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.17
|
| Rate for Payer: Nomi Health Commercial |
$723.69
|
| Rate for Payer: PACE Senior Care Partners |
$209.61
|
| Rate for Payer: PACE SWMI |
$220.64
|
| Rate for Payer: PHP Commercial |
$750.17
|
| Rate for Payer: PHP Medicare Advantage |
$220.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.66
|
| Rate for Payer: Priority Health HMO/PPO |
$767.82
|
| Rate for Payer: Priority Health Medicare |
$222.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$591.31
|
| Rate for Payer: Railroad Medicare Medicare |
$220.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.64
|
| Rate for Payer: UHC Core |
$736.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.64
|
| Rate for Payer: UHC Exchange |
$220.64
|
| Rate for Payer: UHC Medicare Advantage |
$220.64
|
| Rate for Payer: UHCCP Medicaid |
$234.96
|
| Rate for Payer: VA VA |
$220.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.91
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
IP
|
$440.24
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$286.16 |
| Max. Negotiated Rate |
$396.22 |
| Rate for Payer: Aetna Commercial |
$374.20
|
| Rate for Payer: BCBS Trust/PPO |
$359.37
|
| Rate for Payer: BCN Commercial |
$340.22
|
| Rate for Payer: Cash Price |
$352.19
|
| Rate for Payer: Cofinity Commercial |
$378.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.19
|
| Rate for Payer: Healthscope Commercial |
$396.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.20
|
| Rate for Payer: Nomi Health Commercial |
$361.00
|
| Rate for Payer: PHP Commercial |
$374.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.16
|
| Rate for Payer: Priority Health HMO/PPO |
$383.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.41
|
| Rate for Payer: UHC Core |
$367.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.18
|
|
|
HC CHEMO INFUS SEQUENTIAL UP TO 1 HR
|
Facility
|
OP
|
$440.24
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
33500004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$396.22 |
| Rate for Payer: Aetna Commercial |
$374.20
|
| Rate for Payer: Aetna Medicare |
$114.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.58
|
| Rate for Payer: BCBS Complete |
$52.94
|
| Rate for Payer: BCBS MAPPO |
$110.06
|
| Rate for Payer: BCBS Trust/PPO |
$361.92
|
| Rate for Payer: BCN Commercial |
$342.29
|
| Rate for Payer: BCN Medicare Advantage |
$110.06
|
| Rate for Payer: Cash Price |
$352.19
|
| Rate for Payer: Cash Price |
$352.19
|
| Rate for Payer: Cofinity Commercial |
$378.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.06
|
| Rate for Payer: Healthscope Commercial |
$396.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.18
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.56
|
| Rate for Payer: Meridian Medicaid |
$52.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.20
|
| Rate for Payer: Nomi Health Commercial |
$361.00
|
| Rate for Payer: PACE Senior Care Partners |
$104.56
|
| Rate for Payer: PACE SWMI |
$110.06
|
| Rate for Payer: PHP Commercial |
$374.20
|
| Rate for Payer: PHP Medicare Advantage |
$110.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.16
|
| Rate for Payer: Priority Health HMO/PPO |
$383.01
|
| Rate for Payer: Priority Health Medicare |
$111.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.96
|
| Rate for Payer: Railroad Medicare Medicare |
$110.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.41
|
| Rate for Payer: UHC Core |
$367.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.06
|
| Rate for Payer: UHC Exchange |
$110.06
|
| Rate for Payer: UHC Medicare Advantage |
$110.06
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$110.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.18
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
IP
|
$438.65
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$285.12 |
| Max. Negotiated Rate |
$394.78 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: BCBS Trust/PPO |
$358.07
|
| Rate for Payer: BCN Commercial |
$338.99
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Healthscope Commercial |
$394.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: Nomi Health Commercial |
$359.69
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health HMO/PPO |
$381.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.01
|
| Rate for Payer: UHC Core |
$366.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.99
|
|
|
HC CHEMO INTO PERITONEAL CAVITY VIA PORT
|
Facility
|
OP
|
$438.65
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
33500007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$394.78 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna Medicare |
$114.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.08
|
| Rate for Payer: BCBS Complete |
$246.72
|
| Rate for Payer: BCBS MAPPO |
$109.66
|
| Rate for Payer: BCBS Trust/PPO |
$360.61
|
| Rate for Payer: BCN Commercial |
$341.05
|
| Rate for Payer: BCN Medicare Advantage |
$109.66
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.66
|
| Rate for Payer: Healthscope Commercial |
$394.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.99
|
| Rate for Payer: Mclaren Medicaid |
$234.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.15
|
| Rate for Payer: Meridian Medicaid |
$246.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: Nomi Health Commercial |
$359.69
|
| Rate for Payer: PACE Senior Care Partners |
$104.18
|
| Rate for Payer: PACE SWMI |
$109.66
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: PHP Medicare Advantage |
$109.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health HMO/PPO |
$381.63
|
| Rate for Payer: Priority Health Medicare |
$110.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.90
|
| Rate for Payer: Railroad Medicare Medicare |
$109.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.01
|
| Rate for Payer: UHC Core |
$366.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.66
|
| Rate for Payer: UHC Exchange |
$109.66
|
| Rate for Payer: UHC Medicare Advantage |
$109.66
|
| Rate for Payer: UHCCP Medicaid |
$234.96
|
| Rate for Payer: VA VA |
$109.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.99
|
|
