|
HC I-123 MIBG PER STUDY
|
Facility
|
IP
|
$11,938.04
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7,281.01 |
| Max. Negotiated Rate |
$10,744.24 |
| Rate for Payer: Aetna Commercial |
$10,147.33
|
| Rate for Payer: BCBS Trust/PPO |
$9,225.72
|
| Rate for Payer: BCN Commercial |
$9,225.72
|
| Rate for Payer: Cash Price |
$9,550.43
|
| Rate for Payer: Cofinity Commercial |
$10,266.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,550.43
|
| Rate for Payer: Healthscope Commercial |
$10,744.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,953.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,147.33
|
| Rate for Payer: PHP Commercial |
$10,147.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,356.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,386.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,281.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,505.48
|
| Rate for Payer: UHC Core |
$9,968.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,953.53
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$11,938.04
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,835.28 |
| Max. Negotiated Rate |
$10,744.24 |
| Rate for Payer: Aetna Commercial |
$10,147.33
|
| Rate for Payer: Aetna Medicare |
$3,103.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,730.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,730.64
|
| Rate for Payer: BCBS Complete |
$4,775.22
|
| Rate for Payer: BCBS MAPPO |
$2,984.51
|
| Rate for Payer: BCBS Trust/PPO |
$9,281.83
|
| Rate for Payer: BCN Commercial |
$9,281.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,984.51
|
| Rate for Payer: Cash Price |
$9,550.43
|
| Rate for Payer: Cofinity Commercial |
$10,266.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,550.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,984.51
|
| Rate for Payer: Healthscope Commercial |
$10,744.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,953.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,133.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,432.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,147.33
|
| Rate for Payer: PACE Senior Care Partners |
$2,835.28
|
| Rate for Payer: PACE SWMI |
$2,984.51
|
| Rate for Payer: PHP Commercial |
$10,147.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,984.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,356.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,386.09
|
| Rate for Payer: Priority Health Medicare |
$2,984.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,281.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2,984.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,505.48
|
| Rate for Payer: UHC Core |
$9,968.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,984.51
|
| Rate for Payer: UHC Medicare Advantage |
$3,074.05
|
| Rate for Payer: VA VA |
$2,984.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,953.53
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
IP
|
$73.47
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$44.81 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: Aetna Commercial |
$62.45
|
| Rate for Payer: BCBS Trust/PPO |
$56.78
|
| Rate for Payer: BCN Commercial |
$56.78
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Cofinity Commercial |
$63.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$66.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.45
|
| Rate for Payer: PHP Commercial |
$62.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.65
|
| Rate for Payer: UHC Core |
$61.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.10
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
OP
|
$73.47
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: Aetna Commercial |
$62.45
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$29.39
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$57.12
|
| Rate for Payer: BCN Commercial |
$57.12
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$58.78
|
| Rate for Payer: Cofinity Commercial |
$63.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$66.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.45
|
| Rate for Payer: PACE Senior Care Partners |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$62.45
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.92
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.81
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.65
|
| Rate for Payer: UHC Core |
$61.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.10
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
IP
|
$66.79
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$40.74 |
| Max. Negotiated Rate |
$60.11 |
| Rate for Payer: Aetna Commercial |
$56.77
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$51.62
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.43
|
| Rate for Payer: Healthscope Commercial |
$60.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.77
|
| Rate for Payer: PHP Commercial |
$56.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.78
|
| Rate for Payer: UHC Core |
$55.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.09
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
OP
|
$66.79
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$60.11 |
| Rate for Payer: Aetna Commercial |
$56.77
|
| Rate for Payer: Aetna Medicare |
$17.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.87
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$16.70
|
| Rate for Payer: BCBS Trust/PPO |
$51.93
|
| Rate for Payer: BCN Commercial |
$51.93
|
| Rate for Payer: BCN Medicare Advantage |
$16.70
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$60.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.09
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.77
|
| Rate for Payer: PACE Senior Care Partners |
$15.86
|
| Rate for Payer: PACE SWMI |
$16.70
|
| Rate for Payer: PHP Commercial |
$56.77
|
| Rate for Payer: PHP Medicare Advantage |
$16.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$16.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.78
|
| Rate for Payer: UHC Core |
$55.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.70
|
| Rate for Payer: UHC Medicare Advantage |
$17.20
|
| Rate for Payer: VA VA |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.09
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.66
|
| Rate for Payer: BCBS Complete |
$18.77
|
| Rate for Payer: BCBS MAPPO |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.48
|
| Rate for Payer: BCN Commercial |
$36.48
|
| Rate for Payer: BCN Medicare Advantage |
$11.73
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.73
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PACE Senior Care Partners |
$11.14
|
| Rate for Payer: PACE SWMI |
$11.73
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: PHP Medicare Advantage |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.82
|
| Rate for Payer: Priority Health Medicare |
$11.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.29
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.73
|
| Rate for Payer: UHC Medicare Advantage |
$12.08
|
| Rate for Payer: VA VA |
$11.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.19
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: BCBS Trust/PPO |
$36.26
|
| Rate for Payer: BCN Commercial |
$36.26
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.29
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.19
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
IP
|
$46.93
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: BCBS Trust/PPO |
$36.27
|
| Rate for Payer: BCN Commercial |
$36.27
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: PHP Commercial |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.30
|
| Rate for Payer: UHC Core |
$39.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.20
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
OP
|
$46.93
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.67
|
| Rate for Payer: BCBS Complete |
$18.77
|
| Rate for Payer: BCBS MAPPO |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.49
|
| Rate for Payer: BCN Commercial |
$36.49
|
| Rate for Payer: BCN Medicare Advantage |
$11.73
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.73
|
| Rate for Payer: Healthscope Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: PACE Senior Care Partners |
$11.15
|
| Rate for Payer: PACE SWMI |
$11.73
|
| Rate for Payer: PHP Commercial |
$39.89
|
| Rate for Payer: PHP Medicare Advantage |
$11.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.83
|
| Rate for Payer: Priority Health Medicare |
$11.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.30
|
| Rate for Payer: UHC Core |
$39.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.73
|
| Rate for Payer: UHC Medicare Advantage |
$12.08
|
| Rate for Payer: VA VA |
$11.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.20
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
OP
|
$46.93
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.67
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS MAPPO |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.49
|
| Rate for Payer: BCN Commercial |
$36.49
|
| Rate for Payer: BCN Medicare Advantage |
$11.73
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.73
|
| Rate for Payer: Healthscope Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.20
|
| Rate for Payer: Mclaren Medicaid |
$15.06
|
| Rate for Payer: Meridian Medicaid |
$15.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: PACE Senior Care Partners |
$11.15
|
| Rate for Payer: PACE SWMI |
$11.73
|
| Rate for Payer: PHP Commercial |
$39.89
|
| Rate for Payer: PHP Medicare Advantage |
$11.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.83
|
| Rate for Payer: Priority Health Medicare |
$11.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.30
|
| Rate for Payer: UHC Core |
$39.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.73
|
| Rate for Payer: UHC Medicare Advantage |
$12.08
|
| Rate for Payer: VA VA |
$11.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.20
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
IP
|
$46.93
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: BCBS Trust/PPO |
$36.27
|
| Rate for Payer: BCN Commercial |
$36.27
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.89
|
| Rate for Payer: PHP Commercial |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.30
|
| Rate for Payer: UHC Core |
$39.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.20
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
OP
|
$400.66
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Aetna Commercial |
$340.56
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.21
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$100.16
|
| Rate for Payer: BCBS Trust/PPO |
$311.51
|
| Rate for Payer: BCN Commercial |
$311.51
|
| Rate for Payer: BCN Medicare Advantage |
$100.16
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.16
|
| Rate for Payer: Healthscope Commercial |
$360.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: PACE Senior Care Partners |
$95.16
|
| Rate for Payer: PACE SWMI |
$100.16
|
| Rate for Payer: PHP Commercial |
$340.56
|
| Rate for Payer: PHP Medicare Advantage |
$100.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.57
|
| Rate for Payer: Priority Health Medicare |
$100.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.36
|
| Rate for Payer: Railroad Medicare Medicare |
$100.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.58
|
| Rate for Payer: UHC Core |
$334.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.16
|
| Rate for Payer: UHC Medicare Advantage |
$103.17
|
| Rate for Payer: VA VA |
$100.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.50
|
|
|
HC IAPB MONITORING SERVICES HOURL
|
Facility
|
IP
|
$400.66
|
|
| Hospital Charge Code |
27000118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$244.36 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Aetna Commercial |
$340.56
|
| Rate for Payer: BCBS Trust/PPO |
$309.63
|
| Rate for Payer: BCN Commercial |
$309.63
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$360.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: PHP Commercial |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.58
|
| Rate for Payer: UHC Core |
$334.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.50
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
IP
|
$390.63
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$238.25 |
| Max. Negotiated Rate |
$351.57 |
| Rate for Payer: Aetna Commercial |
$332.04
|
| Rate for Payer: BCBS Trust/PPO |
$301.88
|
| Rate for Payer: BCN Commercial |
$301.88
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.50
|
| Rate for Payer: Healthscope Commercial |
$351.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$332.04
|
| Rate for Payer: PHP Commercial |
$332.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.75
|
| Rate for Payer: UHC Core |
$326.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.97
|
|
|
HC IAP CHEMO ADMINISTRATON
|
Facility
|
OP
|
$390.63
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
33500010
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$92.77 |
| Max. Negotiated Rate |
$351.57 |
| Rate for Payer: Aetna Commercial |
$332.04
|
| Rate for Payer: Aetna Medicare |
$101.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.07
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$97.66
|
| Rate for Payer: BCBS Trust/PPO |
$303.71
|
| Rate for Payer: BCN Commercial |
$303.71
|
| Rate for Payer: BCN Medicare Advantage |
$97.66
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$351.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.97
|
| Rate for Payer: Mclaren Medicaid |
$222.16
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$332.04
|
| Rate for Payer: PACE Senior Care Partners |
$92.77
|
| Rate for Payer: PACE SWMI |
$97.66
|
| Rate for Payer: PHP Commercial |
$332.04
|
| Rate for Payer: PHP Medicare Advantage |
$97.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.85
|
| Rate for Payer: Priority Health Medicare |
$97.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.25
|
| Rate for Payer: Railroad Medicare Medicare |
$97.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.75
|
| Rate for Payer: UHC Core |
$326.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.66
|
| Rate for Payer: UHC Medicare Advantage |
$100.59
|
| Rate for Payer: VA VA |
$97.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.97
|
|
|
HC IBD DIFF
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: BCBS Trust/PPO |
$47.14
|
| Rate for Payer: BCN Commercial |
$47.14
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFF
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna Medicare |
$15.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.06
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$47.43
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: BCN Medicare Advantage |
$15.25
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Senior Care Partners |
$14.49
|
| Rate for Payer: PACE SWMI |
$15.25
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: PHP Medicare Advantage |
$15.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Medicare |
$15.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.25
|
| Rate for Payer: UHC Medicare Advantage |
$15.71
|
| Rate for Payer: VA VA |
$15.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna Medicare |
$15.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.06
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$47.43
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: BCN Medicare Advantage |
$15.25
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Senior Care Partners |
$14.49
|
| Rate for Payer: PACE SWMI |
$15.25
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: PHP Medicare Advantage |
$15.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Medicare |
$15.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.25
|
| Rate for Payer: UHC Medicare Advantage |
$15.71
|
| Rate for Payer: VA VA |
$15.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFFERENTIATION
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
30200174
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: BCBS Trust/PPO |
$47.14
|
| Rate for Payer: BCN Commercial |
$47.14
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Medicare |
$14.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.81
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$14.25
|
| Rate for Payer: BCBS Trust/PPO |
$44.32
|
| Rate for Payer: BCN Commercial |
$44.32
|
| Rate for Payer: BCN Medicare Advantage |
$14.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.25
|
| Rate for Payer: Healthscope Commercial |
$51.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.75
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: PACE Senior Care Partners |
$13.54
|
| Rate for Payer: PACE SWMI |
$14.25
|
| Rate for Payer: PHP Commercial |
$48.45
|
| Rate for Payer: PHP Medicare Advantage |
$14.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.59
|
| Rate for Payer: Priority Health Medicare |
$14.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.76
|
| Rate for Payer: Railroad Medicare Medicare |
$14.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.16
|
| Rate for Payer: UHC Core |
$47.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.25
|
| Rate for Payer: UHC Medicare Advantage |
$14.68
|
| Rate for Payer: VA VA |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.75
|
|
|
HC IBD DIFFERENTIATION CMPT
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: BCBS Trust/PPO |
$44.05
|
| Rate for Payer: BCN Commercial |
$44.05
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.60
|
| Rate for Payer: Healthscope Commercial |
$51.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.45
|
| Rate for Payer: PHP Commercial |
$48.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.16
|
| Rate for Payer: UHC Core |
$47.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.75
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
IP
|
$24,480.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,930.35 |
| Max. Negotiated Rate |
$22,032.00 |
| Rate for Payer: Aetna Commercial |
$20,808.00
|
| Rate for Payer: BCBS Trust/PPO |
$18,918.14
|
| Rate for Payer: BCN Commercial |
$18,918.14
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$21,052.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Healthscope Commercial |
$22,032.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,360.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PHP Commercial |
$20,808.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,297.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,930.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,542.40
|
| Rate for Payer: UHC Core |
$20,440.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,360.00
|
|
|
HC ICD CRT/DUAL IMPLANT/REPLACE
|
Facility
|
OP
|
$24,480.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
36100080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,814.00 |
| Max. Negotiated Rate |
$22,660.63 |
| Rate for Payer: Aetna Commercial |
$20,808.00
|
| Rate for Payer: Aetna Medicare |
$6,364.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,650.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,650.00
|
| Rate for Payer: BCBS Complete |
$22,660.63
|
| Rate for Payer: BCBS MAPPO |
$6,120.00
|
| Rate for Payer: BCBS Trust/PPO |
$19,033.20
|
| Rate for Payer: BCN Commercial |
$19,033.20
|
| Rate for Payer: BCN Medicare Advantage |
$6,120.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cash Price |
$19,584.00
|
| Rate for Payer: Cofinity Commercial |
$21,052.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,584.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,120.00
|
| Rate for Payer: Healthscope Commercial |
$22,032.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,360.00
|
| Rate for Payer: Mclaren Medicaid |
$21,581.55
|
| Rate for Payer: Meridian Medicaid |
$22,660.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,426.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,038.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,808.00
|
| Rate for Payer: PACE Senior Care Partners |
$5,814.00
|
| Rate for Payer: PACE SWMI |
$6,120.00
|
| Rate for Payer: PHP Commercial |
$20,808.00
|
| Rate for Payer: PHP Medicare Advantage |
$6,120.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,581.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,297.60
|
| Rate for Payer: Priority Health Medicare |
$6,120.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,930.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,542.40
|
| Rate for Payer: UHC Core |
$20,440.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,120.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,303.60
|
| Rate for Payer: VA VA |
$6,120.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,360.00
|
|
|
HC ICD CRT/DUAL REPLACEMENT
|
Facility
|
IP
|
$11,220.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
36100075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,843.08 |
| Max. Negotiated Rate |
$10,098.00 |
| Rate for Payer: Aetna Commercial |
$9,537.00
|
| Rate for Payer: BCBS Trust/PPO |
$8,670.82
|
| Rate for Payer: BCN Commercial |
$8,670.82
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cofinity Commercial |
$9,649.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,976.00
|
| Rate for Payer: Healthscope Commercial |
$10,098.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,415.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,537.00
|
| Rate for Payer: PHP Commercial |
$9,537.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,854.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,761.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,843.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,873.60
|
| Rate for Payer: UHC Core |
$9,368.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,415.00
|
|
