|
HC CRP-SF
|
Facility
|
OP
|
$29.97
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna Medicare |
$7.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.37
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$24.64
|
| Rate for Payer: BCN Commercial |
$23.30
|
| Rate for Payer: BCN Medicare Advantage |
$7.49
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.48
|
| Rate for Payer: Mclaren Medicaid |
$3.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.87
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Nomi Health Commercial |
$24.58
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.49
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: PHP Medicare Advantage |
$7.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.48
|
| Rate for Payer: Priority Health HMO/PPO |
$26.07
|
| Rate for Payer: Priority Health Medicare |
$7.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.37
|
| Rate for Payer: UHC Core |
$25.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.49
|
| Rate for Payer: UHC Exchange |
$7.49
|
| Rate for Payer: UHC Medicare Advantage |
$7.49
|
| Rate for Payer: UHCCP Medicaid |
$3.75
|
| Rate for Payer: VA VA |
$7.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.48
|
|
|
HC CRP-SF
|
Facility
|
IP
|
$29.97
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$24.46
|
| Rate for Payer: BCN Commercial |
$23.16
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$26.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Nomi Health Commercial |
$24.58
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.48
|
| Rate for Payer: Priority Health HMO/PPO |
$26.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.37
|
| Rate for Payer: UHC Core |
$25.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.48
|
|
|
HC CRRT INITIAL
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$169.58 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna Medicare |
$185.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.12
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$178.50
|
| Rate for Payer: BCBS Trust/PPO |
$586.98
|
| Rate for Payer: BCN Commercial |
$555.14
|
| Rate for Payer: BCN Medicare Advantage |
$178.50
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.50
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: Nomi Health Commercial |
$585.48
|
| Rate for Payer: PACE Senior Care Partners |
$169.58
|
| Rate for Payer: PACE SWMI |
$178.50
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: PHP Medicare Advantage |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO |
$621.18
|
| Rate for Payer: Priority Health Medicare |
$180.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$478.38
|
| Rate for Payer: Railroad Medicare Medicare |
$178.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.32
|
| Rate for Payer: UHC Core |
$596.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.50
|
| Rate for Payer: UHC Exchange |
$178.50
|
| Rate for Payer: UHC Medicare Advantage |
$178.50
|
| Rate for Payer: VA VA |
$178.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.50
|
|
|
HC CRRT INITIAL
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$464.10 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: BCBS Trust/PPO |
$582.84
|
| Rate for Payer: BCN Commercial |
$551.78
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: Nomi Health Commercial |
$585.48
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO |
$621.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$478.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.32
|
| Rate for Payer: UHC Core |
$596.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.50
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
OP
|
$1,135.08
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$269.58 |
| Max. Negotiated Rate |
$1,021.57 |
| Rate for Payer: Aetna Commercial |
$964.82
|
| Rate for Payer: Aetna Medicare |
$295.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$354.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$354.71
|
| Rate for Payer: BCBS Complete |
$316.75
|
| Rate for Payer: BCBS MAPPO |
$283.77
|
| Rate for Payer: BCBS Trust/PPO |
$933.15
|
| Rate for Payer: BCN Commercial |
$882.52
|
| Rate for Payer: BCN Medicare Advantage |
$283.77
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cofinity Commercial |
$976.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.77
|
| Rate for Payer: Healthscope Commercial |
$1,021.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.31
|
| Rate for Payer: Mclaren Medicaid |
$301.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$297.96
|
| Rate for Payer: Meridian Medicaid |
$316.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.82
|
| Rate for Payer: Nomi Health Commercial |
$930.77
|
| Rate for Payer: PACE Senior Care Partners |
$269.58
|
| Rate for Payer: PACE SWMI |
$283.77
|
| Rate for Payer: PHP Commercial |
$964.82
|
| Rate for Payer: PHP Medicare Advantage |
$283.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.80
|
| Rate for Payer: Priority Health HMO/PPO |
$987.52
|
| Rate for Payer: Priority Health Medicare |
$286.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.50
|
| Rate for Payer: Railroad Medicare Medicare |
$283.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$998.87
|
| Rate for Payer: UHC Core |
$947.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.77
|
| Rate for Payer: UHC Exchange |
$283.77
|
| Rate for Payer: UHC Medicare Advantage |
$283.77
|
| Rate for Payer: UHCCP Medicaid |
$301.64
|
| Rate for Payer: VA VA |
$283.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.31
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
IP
|
$1,135.08
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$737.80 |
| Max. Negotiated Rate |
$1,021.57 |
| Rate for Payer: Aetna Commercial |
$964.82
|
| Rate for Payer: BCBS Trust/PPO |
$926.57
|
| Rate for Payer: BCN Commercial |
$877.19
|
| Rate for Payer: Cash Price |
$908.06
|
| Rate for Payer: Cofinity Commercial |
$976.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.06
|
| Rate for Payer: Healthscope Commercial |
$1,021.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.82
|
| Rate for Payer: Nomi Health Commercial |
$930.77
|
| Rate for Payer: PHP Commercial |
$964.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.80
|
| Rate for Payer: Priority Health HMO/PPO |
$987.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$998.87
|
| Rate for Payer: UHC Core |
$947.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.31
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
OP
|
$127.50
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.84
|
| Rate for Payer: BCBS Complete |
$51.00
|
| Rate for Payer: BCBS MAPPO |
$31.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.82
|
| Rate for Payer: BCN Commercial |
$99.13
|
| Rate for Payer: BCN Medicare Advantage |
$31.88
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.88
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PACE Senior Care Partners |
$30.28
|
| Rate for Payer: PACE SWMI |
$31.88
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: PHP Medicare Advantage |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Medicare |
$32.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: Railroad Medicare Medicare |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.88
|
| Rate for Payer: UHC Exchange |
$31.88
|
| Rate for Payer: UHC Medicare Advantage |
$31.88
|
| Rate for Payer: VA VA |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
IP
|
$127.50
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$98.53
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.38
|
| Rate for Payer: Nomi Health Commercial |
$104.55
|
| Rate for Payer: PHP Commercial |
$108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.88
|
| Rate for Payer: Priority Health HMO/PPO |
$110.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.20
|
| Rate for Payer: UHC Core |
$106.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.62
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
OP
|
$416.84
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$375.16 |
| Rate for Payer: Aetna Commercial |
$354.31
|
| Rate for Payer: Aetna Medicare |
$108.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.26
|
| Rate for Payer: BCBS Complete |
$166.74
|
| Rate for Payer: BCBS MAPPO |
$104.21
|
| Rate for Payer: BCBS Trust/PPO |
$342.68
|
| Rate for Payer: BCN Commercial |
$324.09
|
| Rate for Payer: BCN Medicare Advantage |
$104.21
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$358.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.21
|
| Rate for Payer: Healthscope Commercial |
$375.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: PACE Senior Care Partners |
$99.00
|
| Rate for Payer: PACE SWMI |
$104.21
|
| Rate for Payer: PHP Commercial |
$354.31
|
| Rate for Payer: PHP Medicare Advantage |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.95
|
| Rate for Payer: Priority Health HMO/PPO |
$362.65
|
| Rate for Payer: Priority Health Medicare |
$105.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.28
|
| Rate for Payer: Railroad Medicare Medicare |
$104.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.82
|
| Rate for Payer: UHC Core |
$348.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.21
|
| Rate for Payer: UHC Exchange |
$104.21
|
| Rate for Payer: UHC Medicare Advantage |
$104.21
|
| Rate for Payer: VA VA |
$104.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.63
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
IP
|
$416.84
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$270.95 |
| Max. Negotiated Rate |
$375.16 |
| Rate for Payer: Aetna Commercial |
$354.31
|
| Rate for Payer: BCBS Trust/PPO |
$340.27
|
| Rate for Payer: BCN Commercial |
$322.13
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$358.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$375.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: PHP Commercial |
$354.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.95
|
| Rate for Payer: Priority Health HMO/PPO |
$362.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.82
|
| Rate for Payer: UHC Core |
$348.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.63
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
IP
|
$280.50
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: BCBS Trust/PPO |
$228.97
|
| Rate for Payer: BCN Commercial |
$216.77
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC CRRT SUBSEQUENT CARTRIDGE
|
Facility
|
OP
|
$280.50
|
|
| Hospital Charge Code |
27000608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.66
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS MAPPO |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$230.60
|
| Rate for Payer: BCN Commercial |
$218.09
|
| Rate for Payer: BCN Medicare Advantage |
$70.12
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.12
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PACE Senior Care Partners |
$66.62
|
| Rate for Payer: PACE SWMI |
$70.12
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: PHP Medicare Advantage |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$70.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: Railroad Medicare Medicare |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.12
|
| Rate for Payer: UHC Exchange |
$70.12
|
| Rate for Payer: UHC Medicare Advantage |
$70.12
|
| Rate for Payer: VA VA |
$70.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC CRUTCHES
|
Facility
|
OP
|
$126.70
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$114.03 |
| Rate for Payer: Aetna Commercial |
$107.70
|
| Rate for Payer: Aetna Medicare |
$32.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.59
|
| Rate for Payer: BCBS Complete |
$50.68
|
| Rate for Payer: BCBS MAPPO |
$31.68
|
| Rate for Payer: BCBS Trust/PPO |
$104.16
|
| Rate for Payer: BCN Commercial |
$98.51
|
| Rate for Payer: BCN Medicare Advantage |
$31.68
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cofinity Commercial |
$108.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.68
|
| Rate for Payer: Healthscope Commercial |
$114.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.70
|
| Rate for Payer: Nomi Health Commercial |
$103.89
|
| Rate for Payer: PACE Senior Care Partners |
$30.09
|
| Rate for Payer: PACE SWMI |
$31.68
|
| Rate for Payer: PHP Commercial |
$107.70
|
| Rate for Payer: PHP Medicare Advantage |
$31.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.36
|
| Rate for Payer: Priority Health HMO/PPO |
$110.23
|
| Rate for Payer: Priority Health Medicare |
$31.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.89
|
| Rate for Payer: Railroad Medicare Medicare |
$31.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.50
|
| Rate for Payer: UHC Core |
$105.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.68
|
| Rate for Payer: UHC Exchange |
$31.68
|
| Rate for Payer: UHC Medicare Advantage |
$31.68
|
| Rate for Payer: VA VA |
$31.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.02
|
|
|
HC CRUTCHES
|
Facility
|
IP
|
$126.70
|
|
| Hospital Charge Code |
96000002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$114.03 |
| Rate for Payer: Aetna Commercial |
$107.70
|
| Rate for Payer: BCBS Trust/PPO |
$103.43
|
| Rate for Payer: BCN Commercial |
$97.91
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cofinity Commercial |
$108.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.36
|
| Rate for Payer: Healthscope Commercial |
$114.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.70
|
| Rate for Payer: Nomi Health Commercial |
$103.89
|
| Rate for Payer: PHP Commercial |
$107.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.36
|
| Rate for Payer: Priority Health HMO/PPO |
$110.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.50
|
| Rate for Payer: UHC Core |
$105.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.02
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
OP
|
$12,081.12
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,869.27 |
| Max. Negotiated Rate |
$10,873.01 |
| Rate for Payer: Aetna Commercial |
$10,268.95
|
| Rate for Payer: Aetna Medicare |
$3,141.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,775.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,775.35
|
| Rate for Payer: BCBS Complete |
$7,744.38
|
| Rate for Payer: BCBS MAPPO |
$3,020.28
|
| Rate for Payer: BCBS Trust/PPO |
$9,931.89
|
| Rate for Payer: BCN Commercial |
$9,393.07
|
| Rate for Payer: BCN Medicare Advantage |
$3,020.28
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cofinity Commercial |
$10,389.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,664.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,020.28
|
| Rate for Payer: Healthscope Commercial |
$10,873.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,060.84
|
| Rate for Payer: Mclaren Medicaid |
$7,375.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,171.29
|
| Rate for Payer: Meridian Medicaid |
$7,744.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,473.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,268.95
|
| Rate for Payer: Nomi Health Commercial |
$9,906.52
|
| Rate for Payer: PACE Senior Care Partners |
$2,869.27
|
| Rate for Payer: PACE SWMI |
$3,020.28
|
| Rate for Payer: PHP Commercial |
$10,268.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,020.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,375.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,852.73
|
| Rate for Payer: Priority Health HMO/PPO |
$10,510.57
|
| Rate for Payer: Priority Health Medicare |
$3,050.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,094.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,020.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,631.39
|
| Rate for Payer: UHC Core |
$10,087.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,020.28
|
| Rate for Payer: UHC Exchange |
$3,020.28
|
| Rate for Payer: UHC Medicare Advantage |
$3,020.28
|
| Rate for Payer: UHCCP Medicaid |
$7,375.11
|
| Rate for Payer: VA VA |
$3,020.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,060.84
|
|
|
HC CRYOABLATION KIDNEY UNILATERAL
|
Facility
|
IP
|
$12,081.12
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
36100572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,852.73 |
| Max. Negotiated Rate |
$10,873.01 |
| Rate for Payer: Aetna Commercial |
$10,268.95
|
| Rate for Payer: BCBS Trust/PPO |
$9,861.82
|
| Rate for Payer: BCN Commercial |
$9,336.29
|
| Rate for Payer: Cash Price |
$9,664.90
|
| Rate for Payer: Cofinity Commercial |
$10,389.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,664.90
|
| Rate for Payer: Healthscope Commercial |
$10,873.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,060.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,268.95
|
| Rate for Payer: Nomi Health Commercial |
$9,906.52
|
| Rate for Payer: PHP Commercial |
$10,268.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,852.73
|
| Rate for Payer: Priority Health HMO/PPO |
$10,510.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,094.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,631.39
|
| Rate for Payer: UHC Core |
$10,087.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,060.84
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
IP
|
$10,529.77
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,844.35 |
| Max. Negotiated Rate |
$9,476.79 |
| Rate for Payer: Aetna Commercial |
$8,950.30
|
| Rate for Payer: BCBS Trust/PPO |
$8,595.45
|
| Rate for Payer: BCN Commercial |
$8,137.41
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cofinity Commercial |
$9,055.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,423.82
|
| Rate for Payer: Healthscope Commercial |
$9,476.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,897.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,950.30
|
| Rate for Payer: Nomi Health Commercial |
$8,634.41
|
| Rate for Payer: PHP Commercial |
$8,950.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,844.35
|
| Rate for Payer: Priority Health HMO/PPO |
$9,160.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,054.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,266.20
|
| Rate for Payer: UHC Core |
$8,792.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,897.33
|
|
|
HC CRYOABLATION LIVER TUMOR
|
Facility
|
OP
|
$10,529.77
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
36100613
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,500.82 |
| Max. Negotiated Rate |
$9,476.79 |
| Rate for Payer: Aetna Commercial |
$8,950.30
|
| Rate for Payer: Aetna Medicare |
$2,737.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,290.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,290.55
|
| Rate for Payer: BCBS Complete |
$7,744.38
|
| Rate for Payer: BCBS MAPPO |
$2,632.44
|
| Rate for Payer: BCBS Trust/PPO |
$8,656.52
|
| Rate for Payer: BCN Commercial |
$8,186.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,632.44
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cash Price |
$8,423.82
|
| Rate for Payer: Cofinity Commercial |
$9,055.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,423.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,632.44
|
| Rate for Payer: Healthscope Commercial |
$9,476.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,897.33
|
| Rate for Payer: Mclaren Medicaid |
$7,375.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,764.06
|
| Rate for Payer: Meridian Medicaid |
$7,744.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,027.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,950.30
|
| Rate for Payer: Nomi Health Commercial |
$8,634.41
|
| Rate for Payer: PACE Senior Care Partners |
$2,500.82
|
| Rate for Payer: PACE SWMI |
$2,632.44
|
| Rate for Payer: PHP Commercial |
$8,950.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,632.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,375.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,844.35
|
| Rate for Payer: Priority Health HMO/PPO |
$9,160.90
|
| Rate for Payer: Priority Health Medicare |
$2,658.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,054.95
|
| Rate for Payer: Railroad Medicare Medicare |
$2,632.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,266.20
|
| Rate for Payer: UHC Core |
$8,792.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,632.44
|
| Rate for Payer: UHC Exchange |
$2,632.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,632.44
|
| Rate for Payer: UHCCP Medicaid |
$7,375.11
|
| Rate for Payer: VA VA |
$2,632.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,897.33
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
IP
|
$10,891.56
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,079.51 |
| Max. Negotiated Rate |
$9,802.40 |
| Rate for Payer: Aetna Commercial |
$9,257.83
|
| Rate for Payer: BCBS Trust/PPO |
$8,890.78
|
| Rate for Payer: BCN Commercial |
$8,417.00
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cofinity Commercial |
$9,366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,713.25
|
| Rate for Payer: Healthscope Commercial |
$9,802.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,168.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,257.83
|
| Rate for Payer: Nomi Health Commercial |
$8,931.08
|
| Rate for Payer: PHP Commercial |
$9,257.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,079.51
|
| Rate for Payer: Priority Health HMO/PPO |
$9,475.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,297.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,584.57
|
| Rate for Payer: UHC Core |
$9,094.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,168.67
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
OP
|
$10,891.56
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,586.75 |
| Max. Negotiated Rate |
$9,802.40 |
| Rate for Payer: Aetna Commercial |
$9,257.83
|
| Rate for Payer: Aetna Medicare |
$2,831.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,403.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,403.61
|
| Rate for Payer: BCBS Complete |
$4,400.36
|
| Rate for Payer: BCBS MAPPO |
$2,722.89
|
| Rate for Payer: BCBS Trust/PPO |
$8,953.95
|
| Rate for Payer: BCN Commercial |
$8,468.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,722.89
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cofinity Commercial |
$9,366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,713.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,722.89
|
| Rate for Payer: Healthscope Commercial |
$9,802.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,168.67
|
| Rate for Payer: Mclaren Medicaid |
$4,190.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,859.03
|
| Rate for Payer: Meridian Medicaid |
$4,400.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,131.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,257.83
|
| Rate for Payer: Nomi Health Commercial |
$8,931.08
|
| Rate for Payer: PACE Senior Care Partners |
$2,586.75
|
| Rate for Payer: PACE SWMI |
$2,722.89
|
| Rate for Payer: PHP Commercial |
$9,257.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,722.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,190.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,079.51
|
| Rate for Payer: Priority Health HMO/PPO |
$9,475.66
|
| Rate for Payer: Priority Health Medicare |
$2,750.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,297.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,722.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,584.57
|
| Rate for Payer: UHC Core |
$9,094.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,722.89
|
| Rate for Payer: UHC Exchange |
$2,722.89
|
| Rate for Payer: UHC Medicare Advantage |
$2,722.89
|
| Rate for Payer: UHCCP Medicaid |
$4,190.54
|
| Rate for Payer: VA VA |
$2,722.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,168.67
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
OP
|
$3,526.96
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.65 |
| Max. Negotiated Rate |
$3,174.26 |
| Rate for Payer: Aetna Commercial |
$2,997.92
|
| Rate for Payer: Aetna Medicare |
$917.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,102.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,102.18
|
| Rate for Payer: BCBS Complete |
$1,410.78
|
| Rate for Payer: BCBS MAPPO |
$881.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,899.51
|
| Rate for Payer: BCN Commercial |
$2,742.21
|
| Rate for Payer: BCN Medicare Advantage |
$881.74
|
| Rate for Payer: Cash Price |
$2,821.57
|
| Rate for Payer: Cofinity Commercial |
$3,033.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.74
|
| Rate for Payer: Healthscope Commercial |
$3,174.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,645.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,014.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.92
|
| Rate for Payer: Nomi Health Commercial |
$2,892.11
|
| Rate for Payer: PACE Senior Care Partners |
$837.65
|
| Rate for Payer: PACE SWMI |
$881.74
|
| Rate for Payer: PHP Commercial |
$2,997.92
|
| Rate for Payer: PHP Medicare Advantage |
$881.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3,068.46
|
| Rate for Payer: Priority Health Medicare |
$890.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,363.06
|
| Rate for Payer: Railroad Medicare Medicare |
$881.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,103.72
|
| Rate for Payer: UHC Core |
$2,945.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$881.74
|
| Rate for Payer: UHC Exchange |
$881.74
|
| Rate for Payer: UHC Medicare Advantage |
$881.74
|
| Rate for Payer: VA VA |
$881.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,645.22
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
IP
|
$3,526.96
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,292.52 |
| Max. Negotiated Rate |
$3,174.26 |
| Rate for Payer: Aetna Commercial |
$2,997.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,879.06
|
| Rate for Payer: BCN Commercial |
$2,725.63
|
| Rate for Payer: Cash Price |
$2,821.57
|
| Rate for Payer: Cofinity Commercial |
$3,033.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.57
|
| Rate for Payer: Healthscope Commercial |
$3,174.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,645.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.92
|
| Rate for Payer: Nomi Health Commercial |
$2,892.11
|
| Rate for Payer: PHP Commercial |
$2,997.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3,068.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,363.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,103.72
|
| Rate for Payer: UHC Core |
$2,945.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,645.22
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
IP
|
$8,180.24
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,317.16 |
| Max. Negotiated Rate |
$7,362.22 |
| Rate for Payer: Aetna Commercial |
$6,953.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,677.53
|
| Rate for Payer: BCN Commercial |
$6,321.69
|
| Rate for Payer: Cash Price |
$6,544.19
|
| Rate for Payer: Cofinity Commercial |
$7,035.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,544.19
|
| Rate for Payer: Healthscope Commercial |
$7,362.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,135.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.20
|
| Rate for Payer: Nomi Health Commercial |
$6,707.80
|
| Rate for Payer: PHP Commercial |
$6,953.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,317.16
|
| Rate for Payer: Priority Health HMO/PPO |
$7,116.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,480.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,198.61
|
| Rate for Payer: UHC Core |
$6,830.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,135.18
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
OP
|
$8,180.24
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,942.81 |
| Max. Negotiated Rate |
$7,362.22 |
| Rate for Payer: Aetna Commercial |
$6,953.20
|
| Rate for Payer: Aetna Medicare |
$2,126.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,556.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,556.32
|
| Rate for Payer: BCBS Complete |
$3,272.10
|
| Rate for Payer: BCBS MAPPO |
$2,045.06
|
| Rate for Payer: BCBS Trust/PPO |
$6,724.98
|
| Rate for Payer: BCN Commercial |
$6,360.14
|
| Rate for Payer: BCN Medicare Advantage |
$2,045.06
|
| Rate for Payer: Cash Price |
$6,544.19
|
| Rate for Payer: Cofinity Commercial |
$7,035.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,544.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,045.06
|
| Rate for Payer: Healthscope Commercial |
$7,362.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,135.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,147.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,351.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.20
|
| Rate for Payer: Nomi Health Commercial |
$6,707.80
|
| Rate for Payer: PACE Senior Care Partners |
$1,942.81
|
| Rate for Payer: PACE SWMI |
$2,045.06
|
| Rate for Payer: PHP Commercial |
$6,953.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,045.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,317.16
|
| Rate for Payer: Priority Health HMO/PPO |
$7,116.81
|
| Rate for Payer: Priority Health Medicare |
$2,065.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,480.76
|
| Rate for Payer: Railroad Medicare Medicare |
$2,045.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,198.61
|
| Rate for Payer: UHC Core |
$6,830.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,045.06
|
| Rate for Payer: UHC Exchange |
$2,045.06
|
| Rate for Payer: UHC Medicare Advantage |
$2,045.06
|
| Rate for Payer: VA VA |
$2,045.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,135.18
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
OP
|
$12,272.17
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,914.64 |
| Max. Negotiated Rate |
$11,044.95 |
| Rate for Payer: Aetna Commercial |
$10,431.34
|
| Rate for Payer: Aetna Medicare |
$3,190.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,835.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,835.05
|
| Rate for Payer: BCBS Complete |
$4,908.87
|
| Rate for Payer: BCBS MAPPO |
$3,068.04
|
| Rate for Payer: BCBS Trust/PPO |
$10,088.95
|
| Rate for Payer: BCN Commercial |
$9,541.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,068.04
|
| Rate for Payer: Cash Price |
$9,817.74
|
| Rate for Payer: Cofinity Commercial |
$10,554.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,817.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,068.04
|
| Rate for Payer: Healthscope Commercial |
$11,044.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,204.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,221.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,528.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,431.34
|
| Rate for Payer: Nomi Health Commercial |
$10,063.18
|
| Rate for Payer: PACE Senior Care Partners |
$2,914.64
|
| Rate for Payer: PACE SWMI |
$3,068.04
|
| Rate for Payer: PHP Commercial |
$10,431.34
|
| Rate for Payer: PHP Medicare Advantage |
$3,068.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,976.91
|
| Rate for Payer: Priority Health HMO/PPO |
$10,676.79
|
| Rate for Payer: Priority Health Medicare |
$3,098.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,222.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,068.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,799.51
|
| Rate for Payer: UHC Core |
$10,247.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,068.04
|
| Rate for Payer: UHC Exchange |
$3,068.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,068.04
|
| Rate for Payer: VA VA |
$3,068.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,204.13
|
|
