|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.40 |
| Max. Negotiated Rate |
$441.47 |
| Rate for Payer: Aetna Commercial |
$416.94
|
| Rate for Payer: BCBS Trust/PPO |
$405.12
|
| Rate for Payer: BCN Commercial |
$405.12
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$421.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$441.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: Nomi Health Commercial |
$402.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.89
|
| Rate for Payer: PHP Commercial |
$416.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$426.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.66
|
| Rate for Payer: UHC Core |
$409.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.89
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
OP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$441.47 |
| Rate for Payer: Aetna Commercial |
$416.94
|
| Rate for Payer: Aetna Medicare |
$127.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.29
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$122.63
|
| Rate for Payer: BCBS Trust/PPO |
$403.26
|
| Rate for Payer: BCN Commercial |
$403.26
|
| Rate for Payer: BCN Medicare Advantage |
$122.63
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$421.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.63
|
| Rate for Payer: Healthscope Commercial |
$441.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.89
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.76
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: Nomi Health Commercial |
$402.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.89
|
| Rate for Payer: PACE Senior Care Partners |
$116.50
|
| Rate for Payer: PACE SWMI |
$122.63
|
| Rate for Payer: PHP Commercial |
$416.94
|
| Rate for Payer: PHP Medicare Advantage |
$122.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$426.75
|
| Rate for Payer: Priority Health Medicare |
$123.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.40
|
| Rate for Payer: Railroad Medicare Medicare |
$122.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.66
|
| Rate for Payer: UHC Core |
$409.58
|
| Rate for Payer: UHC Exchange |
$122.63
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHC Medicare Advantage |
$122.63
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
| Rate for Payer: VA VA |
$122.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.89
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
IP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,989.69 |
| Max. Negotiated Rate |
$3,865.98 |
| Rate for Payer: Aetna Commercial |
$3,651.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,547.68
|
| Rate for Payer: BCN Commercial |
$3,547.68
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$3,694.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$3,865.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,221.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,651.20
|
| Rate for Payer: Nomi Health Commercial |
$3,522.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,221.65
|
| Rate for Payer: PHP Commercial |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,737.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,989.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,780.07
|
| Rate for Payer: UHC Core |
$3,586.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,221.65
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
OP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.30 |
| Max. Negotiated Rate |
$3,865.98 |
| Rate for Payer: Aetna Commercial |
$3,651.20
|
| Rate for Payer: Aetna Medicare |
$1,116.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,342.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,342.35
|
| Rate for Payer: BCBS Complete |
$795.10
|
| Rate for Payer: BCBS MAPPO |
$1,073.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.36
|
| Rate for Payer: BCN Commercial |
$3,531.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,073.88
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$3,694.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,073.88
|
| Rate for Payer: Healthscope Commercial |
$3,865.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,221.65
|
| Rate for Payer: Mclaren Medicaid |
$757.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,127.58
|
| Rate for Payer: Meridian Medicaid |
$795.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,234.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,181.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,651.20
|
| Rate for Payer: Nomi Health Commercial |
$3,522.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,221.65
|
| Rate for Payer: PACE Senior Care Partners |
$1,020.19
|
| Rate for Payer: PACE SWMI |
$1,073.88
|
| Rate for Payer: PHP Commercial |
$3,651.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,073.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$757.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,737.11
|
| Rate for Payer: Priority Health Medicare |
$1,084.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,989.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,073.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,780.07
|
| Rate for Payer: UHC Core |
$3,586.77
|
| Rate for Payer: UHC Exchange |
$1,073.88
|
| Rate for Payer: UHC Medicaid |
$757.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,073.88
|
| Rate for Payer: UHCCP Medicaid |
$757.30
|
| Rate for Payer: VA VA |
$1,073.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,221.65
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
OP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,007.05 |
| Max. Negotiated Rate |
$5,140.94 |
| Rate for Payer: Aetna Commercial |
$4,855.33
|
| Rate for Payer: Aetna Medicare |
$1,485.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.05
|
| Rate for Payer: BCBS Complete |
$1,057.32
|
| Rate for Payer: BCBS MAPPO |
$1,428.04
|
| Rate for Payer: BCBS Trust/PPO |
$4,695.96
|
| Rate for Payer: BCN Commercial |
$4,695.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.04
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$4,912.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.04
|
| Rate for Payer: Healthscope Commercial |
$5,140.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,284.11
|
| Rate for Payer: Mclaren Medicaid |
$1,007.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,499.44
|
| Rate for Payer: Meridian Medicaid |
$1,057.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,570.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,855.33
|
| Rate for Payer: Nomi Health Commercial |
$4,683.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,284.11
|
| Rate for Payer: PACE Senior Care Partners |
$1,356.64
|
| Rate for Payer: PACE SWMI |
$1,428.04
|
| Rate for Payer: PHP Commercial |
$4,855.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,007.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,969.57
|
| Rate for Payer: Priority Health Medicare |
$1,442.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,975.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,026.69
|
| Rate for Payer: UHC Core |
$4,769.65
|
| Rate for Payer: UHC Exchange |
$1,428.04
|
| Rate for Payer: UHC Medicaid |
$1,007.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,428.04
|
| Rate for Payer: UHCCP Medicaid |
$1,007.05
|
| Rate for Payer: VA VA |
$1,428.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,284.11
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
IP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,975.66 |
| Max. Negotiated Rate |
$5,140.94 |
| Rate for Payer: Aetna Commercial |
$4,855.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,717.66
|
| Rate for Payer: BCN Commercial |
$4,717.66
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$4,912.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,140.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,284.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,855.33
|
| Rate for Payer: Nomi Health Commercial |
$4,683.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,284.11
|
| Rate for Payer: PHP Commercial |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,969.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,975.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,026.69
|
| Rate for Payer: UHC Core |
$4,769.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,284.11
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
IP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.31 |
| Max. Negotiated Rate |
$596.52 |
| Rate for Payer: Aetna Commercial |
$563.38
|
| Rate for Payer: BCBS Trust/PPO |
$547.41
|
| Rate for Payer: BCN Commercial |
$547.41
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$570.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Healthscope Commercial |
$596.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: Nomi Health Commercial |
$543.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.10
|
| Rate for Payer: PHP Commercial |
$563.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$576.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.26
|
| Rate for Payer: UHC Core |
$553.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.10
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
OP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.85 |
| Max. Negotiated Rate |
$596.52 |
| Rate for Payer: Aetna Commercial |
$563.38
|
| Rate for Payer: Aetna Medicare |
$172.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.12
|
| Rate for Payer: BCBS Complete |
$122.68
|
| Rate for Payer: BCBS MAPPO |
$165.70
|
| Rate for Payer: BCBS Trust/PPO |
$544.89
|
| Rate for Payer: BCN Commercial |
$544.89
|
| Rate for Payer: BCN Medicare Advantage |
$165.70
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$570.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.70
|
| Rate for Payer: Healthscope Commercial |
$596.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.10
|
| Rate for Payer: Mclaren Medicaid |
$116.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.99
|
| Rate for Payer: Meridian Medicaid |
$122.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$182.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: Nomi Health Commercial |
$543.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.10
|
| Rate for Payer: PACE Senior Care Partners |
$157.41
|
| Rate for Payer: PACE SWMI |
$165.70
|
| Rate for Payer: PHP Commercial |
$563.38
|
| Rate for Payer: PHP Medicare Advantage |
$165.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$576.64
|
| Rate for Payer: Priority Health Medicare |
$167.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.31
|
| Rate for Payer: Railroad Medicare Medicare |
$165.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.26
|
| Rate for Payer: UHC Core |
$553.44
|
| Rate for Payer: UHC Exchange |
$165.70
|
| Rate for Payer: UHC Medicaid |
$116.85
|
| Rate for Payer: UHC Medicare Advantage |
$165.70
|
| Rate for Payer: UHCCP Medicaid |
$116.85
|
| Rate for Payer: VA VA |
$165.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.10
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS MAPPO |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.27
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.93
|
| Rate for Payer: Meridian Medicaid |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.27
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Medicare |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: UHCCP Medicaid |
$9.35
|
| Rate for Payer: VA VA |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$8.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS MAPPO |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$27.92
|
| Rate for Payer: BCN Commercial |
$27.92
|
| Rate for Payer: BCN Medicare Advantage |
$8.49
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Mclaren Medicaid |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.91
|
| Rate for Payer: Meridian Medicaid |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PACE Senior Care Partners |
$8.07
|
| Rate for Payer: PACE SWMI |
$8.49
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: PHP Medicare Advantage |
$8.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Medicare |
$8.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: UHC Exchange |
$8.49
|
| Rate for Payer: UHC Medicaid |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$8.49
|
| Rate for Payer: UHCCP Medicaid |
$5.99
|
| Rate for Payer: VA VA |
$8.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: BCBS Trust/PPO |
$28.05
|
| Rate for Payer: BCN Commercial |
$28.05
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.14 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: BCBS Trust/PPO |
$122.39
|
| Rate for Payer: BCN Commercial |
$122.39
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.14
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.41
|
| Rate for Payer: UHC Core |
$123.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.14
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna Medicare |
$38.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.31
|
| Rate for Payer: BCBS Complete |
$27.43
|
| Rate for Payer: BCBS MAPPO |
$37.05
|
| Rate for Payer: BCBS Trust/PPO |
$121.83
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$121.83
|
| Rate for Payer: BCN Medicare Advantage |
$37.05
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.14
|
| Rate for Payer: Mclaren Medicaid |
$26.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.90
|
| Rate for Payer: Meridian Medicaid |
$27.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.14
|
| Rate for Payer: PACE Senior Care Partners |
$35.20
|
| Rate for Payer: PACE SWMI |
$37.05
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: PHP Medicare Advantage |
$37.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.93
|
| Rate for Payer: Priority Health Medicare |
$37.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.14
|
| Rate for Payer: Railroad Medicare Medicare |
$37.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.41
|
| Rate for Payer: UHC Core |
$123.74
|
| Rate for Payer: UHC Exchange |
$37.05
|
| Rate for Payer: UHC Medicaid |
$26.13
|
| Rate for Payer: UHC Medicare Advantage |
$37.05
|
| Rate for Payer: UHCCP Medicaid |
$26.13
|
| Rate for Payer: VA VA |
$37.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.14
|
|
|
HC HAI PICC FLUSH
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$35.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.10
|
| Rate for Payer: BCBS Complete |
$24.93
|
| Rate for Payer: BCBS MAPPO |
$33.68
|
| Rate for Payer: BCBS Trust/PPO |
$110.75
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$110.75
|
| Rate for Payer: BCN Medicare Advantage |
$33.68
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.68
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Mclaren Medicaid |
$23.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: Meridian Medicaid |
$24.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PACE Senior Care Partners |
$31.99
|
| Rate for Payer: PACE SWMI |
$33.68
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Medicare |
$34.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.76
|
| Rate for Payer: Railroad Medicare Medicare |
$33.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: UHC Exchange |
$33.68
|
| Rate for Payer: UHC Medicaid |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$33.68
|
| Rate for Payer: UHCCP Medicaid |
$23.75
|
| Rate for Payer: VA VA |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HAI PICC FLUSH
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.76 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$111.26
|
| Rate for Payer: BCN Commercial |
$111.26
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.76 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$111.26
|
| Rate for Payer: BCN Commercial |
$111.26
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$35.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.10
|
| Rate for Payer: BCBS Complete |
$24.93
|
| Rate for Payer: BCBS MAPPO |
$33.68
|
| Rate for Payer: BCBS Trust/PPO |
$110.75
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$110.75
|
| Rate for Payer: BCN Medicare Advantage |
$33.68
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.68
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Mclaren Medicaid |
$23.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: Meridian Medicaid |
$24.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PACE Senior Care Partners |
$31.99
|
| Rate for Payer: PACE SWMI |
$33.68
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Medicare |
$34.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.76
|
| Rate for Payer: Railroad Medicare Medicare |
$33.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: UHC Exchange |
$33.68
|
| Rate for Payer: UHC Medicaid |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$33.68
|
| Rate for Payer: UHCCP Medicaid |
$23.75
|
| Rate for Payer: VA VA |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$108.20
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$97.38 |
| Rate for Payer: Aetna Commercial |
$91.97
|
| Rate for Payer: BCBS Trust/PPO |
$89.36
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cofinity Commercial |
$93.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.56
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.97
|
| Rate for Payer: Nomi Health Commercial |
$88.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.15
|
| Rate for Payer: PHP Commercial |
$91.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.22
|
| Rate for Payer: UHC Core |
$90.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.15
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$108.20
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$97.38 |
| Rate for Payer: Aetna Commercial |
$91.97
|
| Rate for Payer: Aetna Medicare |
$28.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.03
|
| Rate for Payer: BCBS MAPPO |
$27.05
|
| Rate for Payer: BCBS Trust/PPO |
$88.95
|
| Rate for Payer: BCN Commercial |
$88.95
|
| Rate for Payer: BCN Medicare Advantage |
$27.05
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cofinity Commercial |
$93.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.05
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.15
|
| Rate for Payer: Mclaren Medicaid |
$19.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.40
|
| Rate for Payer: Meridian Medicaid |
$20.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.97
|
| Rate for Payer: Nomi Health Commercial |
$88.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.15
|
| Rate for Payer: PACE Senior Care Partners |
$25.70
|
| Rate for Payer: PACE SWMI |
$27.05
|
| Rate for Payer: PHP Commercial |
$91.97
|
| Rate for Payer: PHP Medicare Advantage |
$27.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.13
|
| Rate for Payer: Priority Health Medicare |
$27.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.31
|
| Rate for Payer: Railroad Medicare Medicare |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.22
|
| Rate for Payer: UHC Core |
$90.35
|
| Rate for Payer: UHC Exchange |
$27.05
|
| Rate for Payer: UHC Medicaid |
$19.08
|
| Rate for Payer: UHC Medicare Advantage |
$27.05
|
| Rate for Payer: UHCCP Medicaid |
$19.08
|
| Rate for Payer: VA VA |
$27.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.15
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,560.18
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,781.89 |
| Max. Negotiated Rate |
$2,304.16 |
| Rate for Payer: Aetna Commercial |
$2,176.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,114.45
|
| Rate for Payer: BCN Commercial |
$2,114.45
|
| Rate for Payer: Cash Price |
$2,048.14
|
| Rate for Payer: Cofinity Commercial |
$2,201.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.14
|
| Rate for Payer: Healthscope Commercial |
$2,304.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,920.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.15
|
| Rate for Payer: Nomi Health Commercial |
$2,099.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,920.13
|
| Rate for Payer: PHP Commercial |
$2,176.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,227.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,781.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,252.96
|
| Rate for Payer: UHC Core |
$2,137.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,920.13
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,560.18
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$2,304.16 |
| Rate for Payer: Aetna Commercial |
$2,176.15
|
| Rate for Payer: Aetna Medicare |
$665.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$800.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$800.06
|
| Rate for Payer: BCBS Complete |
$473.89
|
| Rate for Payer: BCBS MAPPO |
$640.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,104.72
|
| Rate for Payer: BCN Commercial |
$2,104.72
|
| Rate for Payer: BCN Medicare Advantage |
$640.04
|
| Rate for Payer: Cash Price |
$2,048.14
|
| Rate for Payer: Cofinity Commercial |
$2,201.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.04
|
| Rate for Payer: Healthscope Commercial |
$2,304.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,920.13
|
| Rate for Payer: Mclaren Medicaid |
$451.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.05
|
| Rate for Payer: Meridian Medicaid |
$473.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$736.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$704.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.15
|
| Rate for Payer: Nomi Health Commercial |
$2,099.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,920.13
|
| Rate for Payer: PACE Senior Care Partners |
$608.04
|
| Rate for Payer: PACE SWMI |
$640.04
|
| Rate for Payer: PHP Commercial |
$2,176.15
|
| Rate for Payer: PHP Medicare Advantage |
$640.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,227.36
|
| Rate for Payer: Priority Health Medicare |
$646.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,781.89
|
| Rate for Payer: Railroad Medicare Medicare |
$640.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,252.96
|
| Rate for Payer: UHC Core |
$2,137.75
|
| Rate for Payer: UHC Exchange |
$640.04
|
| Rate for Payer: UHC Medicaid |
$451.36
|
| Rate for Payer: UHC Medicare Advantage |
$640.04
|
| Rate for Payer: UHCCP Medicaid |
$451.36
|
| Rate for Payer: VA VA |
$640.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,920.13
|
|
|
HC HALO RING & VEST
|
Facility
|
OP
|
$6,411.04
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,130.27 |
| Max. Negotiated Rate |
$5,769.94 |
| Rate for Payer: Aetna Commercial |
$5,449.38
|
| Rate for Payer: Aetna Medicare |
$1,666.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,003.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,003.45
|
| Rate for Payer: BCBS Complete |
$1,186.68
|
| Rate for Payer: BCBS MAPPO |
$1,602.76
|
| Rate for Payer: BCBS Trust/PPO |
$5,270.52
|
| Rate for Payer: BCN Commercial |
$5,270.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.76
|
| Rate for Payer: Cash Price |
$5,128.83
|
| Rate for Payer: Cofinity Commercial |
$5,513.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,128.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.76
|
| Rate for Payer: Healthscope Commercial |
$5,769.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,808.28
|
| Rate for Payer: Mclaren Medicaid |
$1,130.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.90
|
| Rate for Payer: Meridian Medicaid |
$1,186.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,843.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,763.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,449.38
|
| Rate for Payer: Nomi Health Commercial |
$5,257.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,808.28
|
| Rate for Payer: PACE Senior Care Partners |
$1,522.62
|
| Rate for Payer: PACE SWMI |
$1,602.76
|
| Rate for Payer: PHP Commercial |
$5,449.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,130.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,577.60
|
| Rate for Payer: Priority Health Medicare |
$1,618.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,462.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,641.72
|
| Rate for Payer: UHC Core |
$5,353.22
|
| Rate for Payer: UHC Exchange |
$1,602.76
|
| Rate for Payer: UHC Medicaid |
$1,130.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,602.76
|
| Rate for Payer: UHCCP Medicaid |
$1,130.27
|
| Rate for Payer: VA VA |
$1,602.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,808.28
|
|
|
HC HALO RING & VEST
|
Facility
|
IP
|
$6,411.04
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,462.08 |
| Max. Negotiated Rate |
$5,769.94 |
| Rate for Payer: Aetna Commercial |
$5,449.38
|
| Rate for Payer: BCBS Trust/PPO |
$5,294.88
|
| Rate for Payer: BCN Commercial |
$5,294.88
|
| Rate for Payer: Cash Price |
$5,128.83
|
| Rate for Payer: Cofinity Commercial |
$5,513.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,128.83
|
| Rate for Payer: Healthscope Commercial |
$5,769.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,808.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,449.38
|
| Rate for Payer: Nomi Health Commercial |
$5,257.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,808.28
|
| Rate for Payer: PHP Commercial |
$5,449.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,577.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,462.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,641.72
|
| Rate for Payer: UHC Core |
$5,353.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,808.28
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
IP
|
$5,881.50
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,093.52 |
| Max. Negotiated Rate |
$5,293.35 |
| Rate for Payer: Aetna Commercial |
$4,999.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,857.53
|
| Rate for Payer: BCN Commercial |
$4,857.53
|
| Rate for Payer: Cash Price |
$4,705.20
|
| Rate for Payer: Cofinity Commercial |
$5,058.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,705.20
|
| Rate for Payer: Healthscope Commercial |
$5,293.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,411.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,999.27
|
| Rate for Payer: Nomi Health Commercial |
$4,822.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,411.12
|
| Rate for Payer: PHP Commercial |
$4,999.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,116.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,093.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,175.72
|
| Rate for Payer: UHC Core |
$4,911.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,411.12
|
|
