|
HC CHANNEL RFA ENDO CATHETER
|
Facility
|
OP
|
$3,721.58
|
|
| Hospital Charge Code |
27200289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$883.88 |
| Max. Negotiated Rate |
$3,349.42 |
| Rate for Payer: Aetna Commercial |
$3,163.34
|
| Rate for Payer: Aetna Medicare |
$967.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.99
|
| Rate for Payer: BCBS Complete |
$1,488.63
|
| Rate for Payer: BCBS MAPPO |
$930.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,059.51
|
| Rate for Payer: BCN Commercial |
$2,893.53
|
| Rate for Payer: BCN Medicare Advantage |
$930.39
|
| Rate for Payer: Cash Price |
$2,977.26
|
| Rate for Payer: Cofinity Commercial |
$3,200.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,977.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.39
|
| Rate for Payer: Healthscope Commercial |
$3,349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,791.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,163.34
|
| Rate for Payer: Nomi Health Commercial |
$3,051.70
|
| Rate for Payer: PACE Senior Care Partners |
$883.88
|
| Rate for Payer: PACE SWMI |
$930.39
|
| Rate for Payer: PHP Commercial |
$3,163.34
|
| Rate for Payer: PHP Medicare Advantage |
$930.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,419.03
|
| Rate for Payer: Priority Health HMO/PPO |
$3,237.77
|
| Rate for Payer: Priority Health Medicare |
$939.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,493.46
|
| Rate for Payer: Railroad Medicare Medicare |
$930.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,274.99
|
| Rate for Payer: UHC Core |
$3,107.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.39
|
| Rate for Payer: UHC Exchange |
$930.39
|
| Rate for Payer: UHC Medicare Advantage |
$930.39
|
| Rate for Payer: VA VA |
$930.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,791.18
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
IP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.88 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: Aetna Commercial |
$252.23
|
| Rate for Payer: BCBS Trust/PPO |
$242.23
|
| Rate for Payer: BCN Commercial |
$229.32
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$255.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Healthscope Commercial |
$267.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$243.33
|
| Rate for Payer: PHP Commercial |
$252.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: Priority Health HMO/PPO |
$258.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.13
|
| Rate for Payer: UHC Core |
$247.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.56
|
|
|
HC CHEM CAUTERY GRANULATION TISSUE
|
Facility
|
OP
|
$296.74
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
76100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.48 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: Aetna Commercial |
$252.23
|
| Rate for Payer: Aetna Medicare |
$77.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.73
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$74.19
|
| Rate for Payer: BCBS Trust/PPO |
$243.95
|
| Rate for Payer: BCN Commercial |
$230.72
|
| Rate for Payer: BCN Medicare Advantage |
$74.19
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cash Price |
$237.39
|
| Rate for Payer: Cofinity Commercial |
$255.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.19
|
| Rate for Payer: Healthscope Commercial |
$267.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.56
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.89
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$243.33
|
| Rate for Payer: PACE Senior Care Partners |
$70.48
|
| Rate for Payer: PACE SWMI |
$74.19
|
| Rate for Payer: PHP Commercial |
$252.23
|
| Rate for Payer: PHP Medicare Advantage |
$74.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.88
|
| Rate for Payer: Priority Health HMO/PPO |
$258.16
|
| Rate for Payer: Priority Health Medicare |
$74.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.82
|
| Rate for Payer: Railroad Medicare Medicare |
$74.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.13
|
| Rate for Payer: UHC Core |
$247.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.19
|
| Rate for Payer: UHC Exchange |
$74.19
|
| Rate for Payer: UHC Medicare Advantage |
$74.19
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$74.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.56
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
OP
|
$1,126.02
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$239.81 |
| Max. Negotiated Rate |
$1,013.42 |
| Rate for Payer: Aetna Commercial |
$957.12
|
| Rate for Payer: Aetna Medicare |
$292.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$351.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$351.88
|
| Rate for Payer: BCBS Complete |
$251.82
|
| Rate for Payer: BCBS MAPPO |
$281.50
|
| Rate for Payer: BCBS Trust/PPO |
$925.70
|
| Rate for Payer: BCN Commercial |
$875.48
|
| Rate for Payer: BCN Medicare Advantage |
$281.50
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$968.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.50
|
| Rate for Payer: Healthscope Commercial |
$1,013.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.51
|
| Rate for Payer: Mclaren Medicaid |
$239.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.58
|
| Rate for Payer: Meridian Medicaid |
$251.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: Nomi Health Commercial |
$923.34
|
| Rate for Payer: PACE Senior Care Partners |
$267.43
|
| Rate for Payer: PACE SWMI |
$281.50
|
| Rate for Payer: PHP Commercial |
$957.12
|
| Rate for Payer: PHP Medicare Advantage |
$281.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: Priority Health HMO/PPO |
$979.64
|
| Rate for Payer: Priority Health Medicare |
$284.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$754.43
|
| Rate for Payer: Railroad Medicare Medicare |
$281.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.90
|
| Rate for Payer: UHC Core |
$940.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.50
|
| Rate for Payer: UHC Exchange |
$281.50
|
| Rate for Payer: UHC Medicare Advantage |
$281.50
|
| Rate for Payer: UHCCP Medicaid |
$239.81
|
| Rate for Payer: VA VA |
$281.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.51
|
|
|
HC CHEMO ADMIN INTO CNS
|
Facility
|
IP
|
$1,126.02
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$731.91 |
| Max. Negotiated Rate |
$1,013.42 |
| Rate for Payer: Aetna Commercial |
$957.12
|
| Rate for Payer: BCBS Trust/PPO |
$919.17
|
| Rate for Payer: BCN Commercial |
$870.19
|
| Rate for Payer: Cash Price |
$900.82
|
| Rate for Payer: Cofinity Commercial |
$968.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.82
|
| Rate for Payer: Healthscope Commercial |
$1,013.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.12
|
| Rate for Payer: Nomi Health Commercial |
$923.34
|
| Rate for Payer: PHP Commercial |
$957.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.91
|
| Rate for Payer: Priority Health HMO/PPO |
$979.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$754.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.90
|
| Rate for Payer: UHC Core |
$940.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.51
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,203.25
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$760.77 |
| Max. Negotiated Rate |
$2,882.93 |
| Rate for Payer: Aetna Commercial |
$2,722.76
|
| Rate for Payer: Aetna Medicare |
$832.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,001.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,001.02
|
| Rate for Payer: BCBS Complete |
$895.16
|
| Rate for Payer: BCBS MAPPO |
$800.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,633.39
|
| Rate for Payer: BCN Commercial |
$2,490.53
|
| Rate for Payer: BCN Medicare Advantage |
$800.81
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$2,754.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.81
|
| Rate for Payer: Healthscope Commercial |
$2,882.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,402.44
|
| Rate for Payer: Mclaren Medicaid |
$852.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.85
|
| Rate for Payer: Meridian Medicaid |
$895.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$920.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: Nomi Health Commercial |
$2,626.66
|
| Rate for Payer: PACE Senior Care Partners |
$760.77
|
| Rate for Payer: PACE SWMI |
$800.81
|
| Rate for Payer: PHP Commercial |
$2,722.76
|
| Rate for Payer: PHP Medicare Advantage |
$800.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2,786.83
|
| Rate for Payer: Priority Health Medicare |
$808.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,146.18
|
| Rate for Payer: Railroad Medicare Medicare |
$800.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,818.86
|
| Rate for Payer: UHC Core |
$2,674.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.81
|
| Rate for Payer: UHC Exchange |
$800.81
|
| Rate for Payer: UHC Medicare Advantage |
$800.81
|
| Rate for Payer: UHCCP Medicaid |
$852.47
|
| Rate for Payer: VA VA |
$800.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,402.44
|
|
|
HC CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Facility
|
IP
|
$3,203.25
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,082.11 |
| Max. Negotiated Rate |
$2,882.93 |
| Rate for Payer: Aetna Commercial |
$2,722.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,614.81
|
| Rate for Payer: BCN Commercial |
$2,475.47
|
| Rate for Payer: Cash Price |
$2,562.60
|
| Rate for Payer: Cofinity Commercial |
$2,754.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,562.60
|
| Rate for Payer: Healthscope Commercial |
$2,882.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,402.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,722.76
|
| Rate for Payer: Nomi Health Commercial |
$2,626.66
|
| Rate for Payer: PHP Commercial |
$2,722.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,082.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2,786.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,146.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,818.86
|
| Rate for Payer: UHC Core |
$2,674.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,402.44
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
OP
|
$1,955.95
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$464.54 |
| Max. Negotiated Rate |
$1,760.36 |
| Rate for Payer: Aetna Commercial |
$1,662.56
|
| Rate for Payer: Aetna Medicare |
$508.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.23
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$488.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,607.99
|
| Rate for Payer: BCN Commercial |
$1,520.75
|
| Rate for Payer: BCN Medicare Advantage |
$488.99
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,682.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.99
|
| Rate for Payer: Healthscope Commercial |
$1,760.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,466.96
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$513.44
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: Nomi Health Commercial |
$1,603.88
|
| Rate for Payer: PACE Senior Care Partners |
$464.54
|
| Rate for Payer: PACE SWMI |
$488.99
|
| Rate for Payer: PHP Commercial |
$1,662.56
|
| Rate for Payer: PHP Medicare Advantage |
$488.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,701.68
|
| Rate for Payer: Priority Health Medicare |
$493.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,310.49
|
| Rate for Payer: Railroad Medicare Medicare |
$488.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,721.24
|
| Rate for Payer: UHC Core |
$1,633.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.99
|
| Rate for Payer: UHC Exchange |
$488.99
|
| Rate for Payer: UHC Medicare Advantage |
$488.99
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$488.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,466.96
|
|
|
HC CHEMODENERVATION TRUNK 6 OR > MUSCLES
|
Facility
|
IP
|
$1,955.95
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
36000374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,271.37 |
| Max. Negotiated Rate |
$1,760.36 |
| Rate for Payer: Aetna Commercial |
$1,662.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.64
|
| Rate for Payer: BCN Commercial |
$1,511.56
|
| Rate for Payer: Cash Price |
$1,564.76
|
| Rate for Payer: Cofinity Commercial |
$1,682.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,564.76
|
| Rate for Payer: Healthscope Commercial |
$1,760.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,466.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.56
|
| Rate for Payer: Nomi Health Commercial |
$1,603.88
|
| Rate for Payer: PHP Commercial |
$1,662.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,701.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,310.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,721.24
|
| Rate for Payer: UHC Core |
$1,633.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,466.96
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$100.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.69
|
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: BCBS MAPPO |
$96.55
|
| Rate for Payer: BCBS Trust/PPO |
$317.50
|
| Rate for Payer: BCN Commercial |
$300.28
|
| Rate for Payer: BCN Medicare Advantage |
$96.55
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.38
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PACE Senior Care Partners |
$91.72
|
| Rate for Payer: PACE SWMI |
$96.55
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$96.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO |
$336.00
|
| Rate for Payer: Priority Health Medicare |
$97.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.76
|
| Rate for Payer: Railroad Medicare Medicare |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.86
|
| Rate for Payer: UHC Core |
$322.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.55
|
| Rate for Payer: UHC Exchange |
$96.55
|
| Rate for Payer: UHC Medicare Advantage |
$96.55
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
| Rate for Payer: VA VA |
$96.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC CHEMODENERV SALIV GLANDS
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: BCBS Trust/PPO |
$315.26
|
| Rate for Payer: BCN Commercial |
$298.46
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO |
$336.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.86
|
| Rate for Payer: UHC Core |
$322.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC CHEMODNRV EA ADD EXT 1-4 MUSC
|
Facility
|
IP
|
$696.44
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| 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 EA ADD EXT 1-4 MUSC
|
Facility
|
OP
|
$696.44
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
36100452
|
|
Hospital Revenue Code
|
761
|
| 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 |
$278.58
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.82
|
| 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 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: VA VA |
$174.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.33
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
OP
|
$671.38
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$604.24 |
| Rate for Payer: Aetna Commercial |
$570.67
|
| Rate for Payer: Aetna Medicare |
$174.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.81
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$167.84
|
| Rate for Payer: BCBS Trust/PPO |
$551.94
|
| Rate for Payer: BCN Commercial |
$522.00
|
| Rate for Payer: BCN Medicare Advantage |
$167.84
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cofinity Commercial |
$577.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.84
|
| Rate for Payer: Healthscope Commercial |
$604.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.54
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.24
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.67
|
| Rate for Payer: Nomi Health Commercial |
$550.53
|
| Rate for Payer: PACE Senior Care Partners |
$159.45
|
| Rate for Payer: PACE SWMI |
$167.84
|
| Rate for Payer: PHP Commercial |
$570.67
|
| Rate for Payer: PHP Medicare Advantage |
$167.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.40
|
| Rate for Payer: Priority Health HMO/PPO |
$584.10
|
| Rate for Payer: Priority Health Medicare |
$169.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$449.82
|
| Rate for Payer: Railroad Medicare Medicare |
$167.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.81
|
| Rate for Payer: UHC Core |
$560.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.84
|
| Rate for Payer: UHC Exchange |
$167.84
|
| Rate for Payer: UHC Medicare Advantage |
$167.84
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$167.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.54
|
|
|
HC CHEMODNRV EXT1-4 MUSC
|
Facility
|
IP
|
$671.38
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
36100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$436.40 |
| Max. Negotiated Rate |
$604.24 |
| Rate for Payer: Aetna Commercial |
$570.67
|
| Rate for Payer: BCBS Trust/PPO |
$548.05
|
| Rate for Payer: BCN Commercial |
$518.84
|
| Rate for Payer: Cash Price |
$537.10
|
| Rate for Payer: Cofinity Commercial |
$577.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.10
|
| Rate for Payer: Healthscope Commercial |
$604.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.67
|
| Rate for Payer: Nomi Health Commercial |
$550.53
|
| Rate for Payer: PHP Commercial |
$570.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.40
|
| Rate for Payer: Priority Health HMO/PPO |
$584.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$449.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.81
|
| Rate for Payer: UHC Core |
$560.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.54
|
|
|
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/< MUSCLES
|
Facility
|
IP
|
$115.59
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
36100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$104.03 |
| Rate for Payer: Aetna Commercial |
$98.25
|
| Rate for Payer: BCBS Trust/PPO |
$94.36
|
| Rate for Payer: BCN Commercial |
$89.33
|
| 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: Healthscope Commercial |
$104.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.25
|
| Rate for Payer: Nomi Health Commercial |
$94.78
|
| Rate for Payer: PHP Commercial |
$98.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.13
|
| Rate for Payer: Priority Health HMO/PPO |
$100.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.72
|
| Rate for Payer: UHC Core |
$96.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.69
|
|
|
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 |
$525.76 |
| 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 |
$525.76
|
| 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 |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.46
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| 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 |
$500.69
|
| 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 |
$500.69
|
| Rate for Payer: VA VA |
$131.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.61
|
|
|
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 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
|
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 |
$224.11
|
| 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 |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.27
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$213.42
|
| 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 |
$213.42
|
| Rate for Payer: VA VA |
$135.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.49
|
|
|
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 |
$496.81
|
| 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 |
$496.81
|
|
|
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 |
$224.11
|
| 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 |
$496.81
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.89
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$213.42
|
| 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 |
$213.42
|
| Rate for Payer: VA VA |
$165.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.81
|
|
|
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 |
$224.11 |
| 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 |
$224.11
|
| 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 |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.09
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$213.42
|
| 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 |
$213.42
|
| Rate for Payer: VA VA |
$60.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.25
|
|
