|
HC INCISION EXT THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$292.09
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
45000066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.15 |
| Max. Negotiated Rate |
$262.88 |
| Rate for Payer: Aetna Commercial |
$248.28
|
| Rate for Payer: BCBS Trust/PPO |
$225.73
|
| Rate for Payer: BCN Commercial |
$225.73
|
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Cofinity Commercial |
$251.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.67
|
| Rate for Payer: Healthscope Commercial |
$262.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.28
|
| Rate for Payer: PHP Commercial |
$248.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$243.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.07
|
|
|
HC INCISION EXT THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$292.09
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
45000066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.37 |
| Max. Negotiated Rate |
$262.88 |
| Rate for Payer: Aetna Commercial |
$248.28
|
| Rate for Payer: Aetna Medicare |
$75.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.28
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$73.02
|
| Rate for Payer: BCBS Trust/PPO |
$227.10
|
| Rate for Payer: BCN Commercial |
$227.10
|
| Rate for Payer: BCN Medicare Advantage |
$73.02
|
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Cofinity Commercial |
$251.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.02
|
| Rate for Payer: Healthscope Commercial |
$262.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.07
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.28
|
| Rate for Payer: PACE Senior Care Partners |
$69.37
|
| Rate for Payer: PACE SWMI |
$73.02
|
| Rate for Payer: PHP Commercial |
$248.28
|
| Rate for Payer: PHP Medicare Advantage |
$73.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.12
|
| Rate for Payer: Priority Health Medicare |
$73.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.15
|
| Rate for Payer: Railroad Medicare Medicare |
$73.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$243.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.02
|
| Rate for Payer: UHC Medicare Advantage |
$75.21
|
| Rate for Payer: VA VA |
$73.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.07
|
|
|
HC INCISION OF LABIAL FRENUM FRENOTOMY
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$823.36 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.28
|
| Rate for Payer: BCN Commercial |
$1,043.28
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.00
|
| Rate for Payer: UHC Core |
$1,127.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.50
|
|
|
HC INCISION OF LABIAL FRENUM FRENOTOMY
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
76100459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.62 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna Medicare |
$351.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.88
|
| Rate for Payer: BCBS Complete |
$378.97
|
| Rate for Payer: BCBS MAPPO |
$337.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.62
|
| Rate for Payer: BCN Commercial |
$1,049.62
|
| Rate for Payer: BCN Medicare Advantage |
$337.50
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.50
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.50
|
| Rate for Payer: Mclaren Medicaid |
$360.93
|
| Rate for Payer: Meridian Medicaid |
$378.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$354.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PACE Senior Care Partners |
$320.62
|
| Rate for Payer: PACE SWMI |
$337.50
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: PHP Medicare Advantage |
$337.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.50
|
| Rate for Payer: Priority Health Medicare |
$337.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.36
|
| Rate for Payer: Railroad Medicare Medicare |
$337.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.00
|
| Rate for Payer: UHC Core |
$1,127.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.50
|
| Rate for Payer: UHC Medicare Advantage |
$347.62
|
| Rate for Payer: VA VA |
$337.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.50
|
|
|
HC INCISION OF URETHRA
|
Facility
|
IP
|
$2,742.78
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,672.82 |
| Max. Negotiated Rate |
$2,468.50 |
| Rate for Payer: Aetna Commercial |
$2,331.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,119.62
|
| Rate for Payer: BCN Commercial |
$2,119.62
|
| Rate for Payer: Cash Price |
$2,194.22
|
| Rate for Payer: Cofinity Commercial |
$2,358.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,194.22
|
| Rate for Payer: Healthscope Commercial |
$2,468.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,057.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,331.36
|
| Rate for Payer: PHP Commercial |
$2,331.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,919.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,386.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,672.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,413.65
|
| Rate for Payer: UHC Core |
$2,290.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,057.08
|
|
|
HC INCISION OF URETHRA
|
Facility
|
OP
|
$2,742.78
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.41 |
| Max. Negotiated Rate |
$2,468.50 |
| Rate for Payer: Aetna Commercial |
$2,331.36
|
| Rate for Payer: Aetna Medicare |
$713.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.12
|
| Rate for Payer: BCBS Complete |
$1,402.94
|
| Rate for Payer: BCBS MAPPO |
$685.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,132.51
|
| Rate for Payer: BCN Commercial |
$2,132.51
|
| Rate for Payer: BCN Medicare Advantage |
$685.70
|
| Rate for Payer: Cash Price |
$2,194.22
|
| Rate for Payer: Cash Price |
$2,194.22
|
| Rate for Payer: Cofinity Commercial |
$2,358.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,194.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.70
|
| Rate for Payer: Healthscope Commercial |
$2,468.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,057.08
|
| Rate for Payer: Mclaren Medicaid |
$1,336.13
|
| Rate for Payer: Meridian Medicaid |
$1,402.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$719.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$788.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,331.36
|
| Rate for Payer: PACE Senior Care Partners |
$651.41
|
| Rate for Payer: PACE SWMI |
$685.70
|
| Rate for Payer: PHP Commercial |
$2,331.36
|
| Rate for Payer: PHP Medicare Advantage |
$685.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,336.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,919.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,386.22
|
| Rate for Payer: Priority Health Medicare |
$685.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,672.82
|
| Rate for Payer: Railroad Medicare Medicare |
$685.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,413.65
|
| Rate for Payer: UHC Core |
$2,290.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.70
|
| Rate for Payer: UHC Medicare Advantage |
$706.27
|
| Rate for Payer: VA VA |
$685.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,057.08
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
OP
|
$1,143.42
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$1,029.08 |
| Rate for Payer: Aetna Commercial |
$971.91
|
| Rate for Payer: Aetna Medicare |
$297.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$357.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$357.32
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$285.86
|
| Rate for Payer: BCBS Trust/PPO |
$889.01
|
| Rate for Payer: BCN Commercial |
$889.01
|
| Rate for Payer: BCN Medicare Advantage |
$285.86
|
| Rate for Payer: Cash Price |
$914.74
|
| Rate for Payer: Cash Price |
$914.74
|
| Rate for Payer: Cofinity Commercial |
$983.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.86
|
| Rate for Payer: Healthscope Commercial |
$1,029.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.56
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$300.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$971.91
|
| Rate for Payer: PACE Senior Care Partners |
$271.56
|
| Rate for Payer: PACE SWMI |
$285.86
|
| Rate for Payer: PHP Commercial |
$971.91
|
| Rate for Payer: PHP Medicare Advantage |
$285.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$994.78
|
| Rate for Payer: Priority Health Medicare |
$285.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$697.37
|
| Rate for Payer: Railroad Medicare Medicare |
$285.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.21
|
| Rate for Payer: UHC Core |
$954.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.86
|
| Rate for Payer: UHC Medicare Advantage |
$294.43
|
| Rate for Payer: VA VA |
$285.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.56
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
IP
|
$1,143.42
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$697.37 |
| Max. Negotiated Rate |
$1,029.08 |
| Rate for Payer: Aetna Commercial |
$971.91
|
| Rate for Payer: BCBS Trust/PPO |
$883.63
|
| Rate for Payer: BCN Commercial |
$883.63
|
| Rate for Payer: Cash Price |
$914.74
|
| Rate for Payer: Cofinity Commercial |
$983.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.74
|
| Rate for Payer: Healthscope Commercial |
$1,029.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$971.91
|
| Rate for Payer: PHP Commercial |
$971.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$994.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$697.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.21
|
| Rate for Payer: UHC Core |
$954.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.56
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
IP
|
$571.84
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$348.77 |
| Max. Negotiated Rate |
$514.66 |
| Rate for Payer: Aetna Commercial |
$486.06
|
| Rate for Payer: BCBS Trust/PPO |
$441.92
|
| Rate for Payer: BCN Commercial |
$441.92
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$491.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: PHP Commercial |
$486.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.22
|
| Rate for Payer: UHC Core |
$477.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.88
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
OP
|
$571.84
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$135.81 |
| Max. Negotiated Rate |
$514.66 |
| Rate for Payer: Aetna Commercial |
$486.06
|
| Rate for Payer: Aetna Medicare |
$148.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.70
|
| Rate for Payer: BCBS Complete |
$228.74
|
| Rate for Payer: BCBS MAPPO |
$142.96
|
| Rate for Payer: BCBS Trust/PPO |
$444.61
|
| Rate for Payer: BCN Commercial |
$444.61
|
| Rate for Payer: BCN Medicare Advantage |
$142.96
|
| Rate for Payer: Cash Price |
$457.47
|
| Rate for Payer: Cofinity Commercial |
$491.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.96
|
| Rate for Payer: Healthscope Commercial |
$514.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$428.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$150.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.06
|
| Rate for Payer: PACE Senior Care Partners |
$135.81
|
| Rate for Payer: PACE SWMI |
$142.96
|
| Rate for Payer: PHP Commercial |
$486.06
|
| Rate for Payer: PHP Medicare Advantage |
$142.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.50
|
| Rate for Payer: Priority Health Medicare |
$142.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.77
|
| Rate for Payer: Railroad Medicare Medicare |
$142.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.22
|
| Rate for Payer: UHC Core |
$477.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.96
|
| Rate for Payer: UHC Medicare Advantage |
$147.25
|
| Rate for Payer: VA VA |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$428.88
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
OP
|
$2,608.96
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$619.63 |
| Max. Negotiated Rate |
$2,348.06 |
| Rate for Payer: Aetna Commercial |
$2,217.62
|
| Rate for Payer: Aetna Medicare |
$678.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$815.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$815.30
|
| Rate for Payer: BCBS Complete |
$1,043.58
|
| Rate for Payer: BCBS MAPPO |
$652.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.47
|
| Rate for Payer: BCN Commercial |
$2,028.47
|
| Rate for Payer: BCN Medicare Advantage |
$652.24
|
| Rate for Payer: Cash Price |
$2,087.17
|
| Rate for Payer: Cofinity Commercial |
$2,243.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,087.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.24
|
| Rate for Payer: Healthscope Commercial |
$2,348.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,956.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$684.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$750.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,217.62
|
| Rate for Payer: PACE Senior Care Partners |
$619.63
|
| Rate for Payer: PACE SWMI |
$652.24
|
| Rate for Payer: PHP Commercial |
$2,217.62
|
| Rate for Payer: PHP Medicare Advantage |
$652.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,269.80
|
| Rate for Payer: Priority Health Medicare |
$652.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,591.20
|
| Rate for Payer: Railroad Medicare Medicare |
$652.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,295.88
|
| Rate for Payer: UHC Core |
$2,178.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.24
|
| Rate for Payer: UHC Medicare Advantage |
$671.81
|
| Rate for Payer: VA VA |
$652.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,956.72
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
IP
|
$2,608.96
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,591.20 |
| Max. Negotiated Rate |
$2,348.06 |
| Rate for Payer: Aetna Commercial |
$2,217.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,016.20
|
| Rate for Payer: BCN Commercial |
$2,016.20
|
| Rate for Payer: Cash Price |
$2,087.17
|
| Rate for Payer: Cofinity Commercial |
$2,243.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,087.17
|
| Rate for Payer: Healthscope Commercial |
$2,348.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,956.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,217.62
|
| Rate for Payer: PHP Commercial |
$2,217.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,826.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,269.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,591.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,295.88
|
| Rate for Payer: UHC Core |
$2,178.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,956.72
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
OP
|
$161.52
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$38.36 |
| Max. Negotiated Rate |
$145.37 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.48
|
| Rate for Payer: BCBS Complete |
$64.61
|
| Rate for Payer: BCBS MAPPO |
$40.38
|
| Rate for Payer: BCBS Trust/PPO |
$125.58
|
| Rate for Payer: BCN Commercial |
$125.58
|
| Rate for Payer: BCN Medicare Advantage |
$40.38
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.38
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.29
|
| Rate for Payer: PACE Senior Care Partners |
$38.36
|
| Rate for Payer: PACE SWMI |
$40.38
|
| Rate for Payer: PHP Commercial |
$137.29
|
| Rate for Payer: PHP Medicare Advantage |
$40.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.52
|
| Rate for Payer: Priority Health Medicare |
$40.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.51
|
| Rate for Payer: Railroad Medicare Medicare |
$40.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.14
|
| Rate for Payer: UHC Core |
$134.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.38
|
| Rate for Payer: UHC Medicare Advantage |
$41.59
|
| Rate for Payer: VA VA |
$40.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.14
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
IP
|
$161.52
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$98.51 |
| Max. Negotiated Rate |
$145.37 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: BCBS Trust/PPO |
$124.82
|
| Rate for Payer: BCN Commercial |
$124.82
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Commercial |
$138.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.29
|
| Rate for Payer: PHP Commercial |
$137.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.14
|
| Rate for Payer: UHC Core |
$134.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.14
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
IP
|
$3,679.65
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,244.22 |
| Max. Negotiated Rate |
$3,311.68 |
| Rate for Payer: Aetna Commercial |
$3,127.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,843.63
|
| Rate for Payer: BCN Commercial |
$2,843.63
|
| Rate for Payer: Cash Price |
$2,943.72
|
| Rate for Payer: Cofinity Commercial |
$3,164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.72
|
| Rate for Payer: Healthscope Commercial |
$3,311.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,759.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,127.70
|
| Rate for Payer: PHP Commercial |
$3,127.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,201.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,238.09
|
| Rate for Payer: UHC Core |
$3,072.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,759.74
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
OP
|
$3,679.65
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$780.72 |
| Max. Negotiated Rate |
$3,311.68 |
| Rate for Payer: Aetna Commercial |
$3,127.70
|
| Rate for Payer: Aetna Medicare |
$956.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,149.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,149.89
|
| Rate for Payer: BCBS Complete |
$819.75
|
| Rate for Payer: BCBS MAPPO |
$919.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,860.93
|
| Rate for Payer: BCN Commercial |
$2,860.93
|
| Rate for Payer: BCN Medicare Advantage |
$919.91
|
| Rate for Payer: Cash Price |
$2,943.72
|
| Rate for Payer: Cash Price |
$2,943.72
|
| Rate for Payer: Cofinity Commercial |
$3,164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$919.91
|
| Rate for Payer: Healthscope Commercial |
$3,311.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,759.74
|
| Rate for Payer: Mclaren Medicaid |
$780.72
|
| Rate for Payer: Meridian Medicaid |
$819.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$965.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,057.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,127.70
|
| Rate for Payer: PACE Senior Care Partners |
$873.92
|
| Rate for Payer: PACE SWMI |
$919.91
|
| Rate for Payer: PHP Commercial |
$3,127.70
|
| Rate for Payer: PHP Medicare Advantage |
$919.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$780.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,201.30
|
| Rate for Payer: Priority Health Medicare |
$919.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,244.22
|
| Rate for Payer: Railroad Medicare Medicare |
$919.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,238.09
|
| Rate for Payer: UHC Core |
$3,072.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$919.91
|
| Rate for Payer: UHC Medicare Advantage |
$947.51
|
| Rate for Payer: VA VA |
$919.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,759.74
|
|
|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,334.80
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$814.09 |
| Max. Negotiated Rate |
$1,201.32 |
| Rate for Payer: Aetna Commercial |
$1,134.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.53
|
| Rate for Payer: BCN Commercial |
$1,031.53
|
| Rate for Payer: Cash Price |
$1,067.84
|
| Rate for Payer: Cofinity Commercial |
$1,147.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.84
|
| Rate for Payer: Healthscope Commercial |
$1,201.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,001.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.58
|
| Rate for Payer: PHP Commercial |
$1,134.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,161.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$814.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,174.62
|
| Rate for Payer: UHC Core |
$1,114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,001.10
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,334.80
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.02 |
| Max. Negotiated Rate |
$1,201.32 |
| Rate for Payer: Aetna Commercial |
$1,134.58
|
| Rate for Payer: Aetna Medicare |
$347.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$417.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$417.12
|
| Rate for Payer: BCBS Complete |
$533.92
|
| Rate for Payer: BCBS MAPPO |
$333.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.81
|
| Rate for Payer: BCN Commercial |
$1,037.81
|
| Rate for Payer: BCN Medicare Advantage |
$333.70
|
| Rate for Payer: Cash Price |
$1,067.84
|
| Rate for Payer: Cofinity Commercial |
$1,147.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.70
|
| Rate for Payer: Healthscope Commercial |
$1,201.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,001.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$350.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.58
|
| Rate for Payer: PACE Senior Care Partners |
$317.02
|
| Rate for Payer: PACE SWMI |
$333.70
|
| Rate for Payer: PHP Commercial |
$1,134.58
|
| Rate for Payer: PHP Medicare Advantage |
$333.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,161.28
|
| Rate for Payer: Priority Health Medicare |
$333.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$814.09
|
| Rate for Payer: Railroad Medicare Medicare |
$333.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,174.62
|
| Rate for Payer: UHC Core |
$1,114.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.70
|
| Rate for Payer: UHC Medicare Advantage |
$343.71
|
| Rate for Payer: VA VA |
$333.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,001.10
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$657.75
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$401.16 |
| Max. Negotiated Rate |
$591.98 |
| Rate for Payer: Aetna Commercial |
$559.09
|
| Rate for Payer: BCBS Trust/PPO |
$508.31
|
| Rate for Payer: BCN Commercial |
$508.31
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cofinity Commercial |
$565.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.20
|
| Rate for Payer: Healthscope Commercial |
$591.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.09
|
| Rate for Payer: PHP Commercial |
$559.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.82
|
| Rate for Payer: UHC Core |
$549.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.31
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$657.75
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.22 |
| Max. Negotiated Rate |
$591.98 |
| Rate for Payer: Aetna Commercial |
$559.09
|
| Rate for Payer: Aetna Medicare |
$171.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.55
|
| Rate for Payer: BCBS Complete |
$263.10
|
| Rate for Payer: BCBS MAPPO |
$164.44
|
| Rate for Payer: BCBS Trust/PPO |
$511.40
|
| Rate for Payer: BCN Commercial |
$511.40
|
| Rate for Payer: BCN Medicare Advantage |
$164.44
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cofinity Commercial |
$565.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.44
|
| Rate for Payer: Healthscope Commercial |
$591.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.09
|
| Rate for Payer: PACE Senior Care Partners |
$156.22
|
| Rate for Payer: PACE SWMI |
$164.44
|
| Rate for Payer: PHP Commercial |
$559.09
|
| Rate for Payer: PHP Medicare Advantage |
$164.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.24
|
| Rate for Payer: Priority Health Medicare |
$164.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.16
|
| Rate for Payer: Railroad Medicare Medicare |
$164.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.82
|
| Rate for Payer: UHC Core |
$549.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.44
|
| Rate for Payer: UHC Medicare Advantage |
$169.37
|
| Rate for Payer: VA VA |
$164.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.31
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.31 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$118.24
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$74.24
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$118.96
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Mclaren Medicaid |
$70.70
|
| Rate for Payer: Meridian Medicaid |
$74.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Medicare |
$48.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.81
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS MAPPO |
$46.25
|
| Rate for Payer: BCBS Trust/PPO |
$143.84
|
| Rate for Payer: BCN Commercial |
$143.84
|
| Rate for Payer: BCN Medicare Advantage |
$46.25
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$159.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$166.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.75
|
| Rate for Payer: Mclaren Medicaid |
$10.42
|
| Rate for Payer: Meridian Medicaid |
$10.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.25
|
| Rate for Payer: PACE Senior Care Partners |
$43.94
|
| Rate for Payer: PACE SWMI |
$46.25
|
| Rate for Payer: PHP Commercial |
$157.25
|
| Rate for Payer: PHP Medicare Advantage |
$46.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.95
|
| Rate for Payer: Priority Health Medicare |
$46.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.83
|
| Rate for Payer: Railroad Medicare Medicare |
$46.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.80
|
| Rate for Payer: UHC Core |
$154.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.25
|
| Rate for Payer: UHC Medicare Advantage |
$47.64
|
| Rate for Payer: VA VA |
$46.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.75
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.83 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: BCBS Trust/PPO |
$142.97
|
| Rate for Payer: BCN Commercial |
$142.97
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$159.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.00
|
| Rate for Payer: Healthscope Commercial |
$166.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.25
|
| Rate for Payer: PHP Commercial |
$157.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.80
|
| Rate for Payer: UHC Core |
$154.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.75
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.43 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: BCBS Trust/PPO |
$189.34
|
| Rate for Payer: BCN Commercial |
$189.34
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.60
|
| Rate for Payer: UHC Core |
$204.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
