|
HC GUIDING CATHETER LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.16 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna Commercial |
$286.88
|
| Rate for Payer: Aetna Medicare |
$87.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.47
|
| Rate for Payer: BCBS Complete |
$135.00
|
| Rate for Payer: BCBS MAPPO |
$84.38
|
| Rate for Payer: BCBS Trust/PPO |
$277.46
|
| Rate for Payer: BCN Commercial |
$262.41
|
| Rate for Payer: BCN Medicare Advantage |
$84.38
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.38
|
| Rate for Payer: Healthscope Commercial |
$303.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: PACE Senior Care Partners |
$80.16
|
| Rate for Payer: PACE SWMI |
$84.38
|
| Rate for Payer: PHP Commercial |
$286.88
|
| Rate for Payer: PHP Medicare Advantage |
$84.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.38
|
| Rate for Payer: Priority Health HMO/PPO |
$293.62
|
| Rate for Payer: Priority Health Medicare |
$85.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.12
|
| Rate for Payer: Railroad Medicare Medicare |
$84.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.00
|
| Rate for Payer: UHC Core |
$281.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.38
|
| Rate for Payer: UHC Exchange |
$84.38
|
| Rate for Payer: UHC Medicare Advantage |
$84.38
|
| Rate for Payer: VA VA |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.12
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
IP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,335.16 |
| Max. Negotiated Rate |
$3,233.30 |
| Rate for Payer: Aetna Commercial |
$3,053.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,932.60
|
| Rate for Payer: BCN Commercial |
$2,776.32
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$3,089.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,233.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,694.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,945.89
|
| Rate for Payer: PHP Commercial |
$3,053.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,125.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,407.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,161.44
|
| Rate for Payer: UHC Core |
$2,999.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,694.41
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
OP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$853.23 |
| Max. Negotiated Rate |
$3,233.30 |
| Rate for Payer: Aetna Commercial |
$3,053.67
|
| Rate for Payer: Aetna Medicare |
$934.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,122.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,122.67
|
| Rate for Payer: BCBS Complete |
$1,437.02
|
| Rate for Payer: BCBS MAPPO |
$898.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,953.44
|
| Rate for Payer: BCN Commercial |
$2,793.21
|
| Rate for Payer: BCN Medicare Advantage |
$898.14
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$3,089.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.14
|
| Rate for Payer: Healthscope Commercial |
$3,233.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,694.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,032.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,945.89
|
| Rate for Payer: PACE Senior Care Partners |
$853.23
|
| Rate for Payer: PACE SWMI |
$898.14
|
| Rate for Payer: PHP Commercial |
$3,053.67
|
| Rate for Payer: PHP Medicare Advantage |
$898.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,125.52
|
| Rate for Payer: Priority Health Medicare |
$907.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,407.01
|
| Rate for Payer: Railroad Medicare Medicare |
$898.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,161.44
|
| Rate for Payer: UHC Core |
$2,999.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$898.14
|
| Rate for Payer: UHC Exchange |
$898.14
|
| Rate for Payer: UHC Medicare Advantage |
$898.14
|
| Rate for Payer: VA VA |
$898.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,694.41
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.84 |
| Max. Negotiated Rate |
$441.47 |
| Rate for Payer: Aetna Commercial |
$416.94
|
| Rate for Payer: BCBS Trust/PPO |
$400.41
|
| Rate for Payer: BCN Commercial |
$379.07
|
| 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: PHP Commercial |
$416.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: Priority Health HMO/PPO |
$426.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.65
|
| 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 |
$116.50 |
| 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 |
$196.21
|
| Rate for Payer: BCBS MAPPO |
$122.63
|
| Rate for Payer: BCBS Trust/PPO |
$403.26
|
| Rate for Payer: BCN Commercial |
$381.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: Nomi Health Commercial |
$402.23
|
| 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 Cigna Priority Health |
$318.84
|
| Rate for Payer: Priority Health HMO/PPO |
$426.75
|
| Rate for Payer: Priority Health Medicare |
$123.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.65
|
| 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 Dual Complete DSNP |
$122.63
|
| Rate for Payer: UHC Exchange |
$122.63
|
| Rate for Payer: UHC Medicare Advantage |
$122.63
|
| Rate for Payer: VA VA |
$122.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.89
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
OP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,020.19 |
| 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 |
$1,718.21
|
| Rate for Payer: BCBS MAPPO |
$1,073.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.36
|
| Rate for Payer: BCN Commercial |
$3,339.77
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,127.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,234.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,651.20
|
| Rate for Payer: Nomi Health Commercial |
$3,522.33
|
| 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 Cigna Priority Health |
$2,792.09
|
| Rate for Payer: Priority Health HMO/PPO |
$3,737.11
|
| Rate for Payer: Priority Health Medicare |
$1,084.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,878.01
|
| 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 Dual Complete DSNP |
$1,073.88
|
| Rate for Payer: UHC Exchange |
$1,073.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,073.88
|
| Rate for Payer: VA VA |
$1,073.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,221.65
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
IP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,792.09 |
| Max. Negotiated Rate |
$3,865.98 |
| Rate for Payer: Aetna Commercial |
$3,651.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,506.44
|
| Rate for Payer: BCN Commercial |
$3,319.59
|
| 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: PHP Commercial |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,792.09
|
| Rate for Payer: Priority Health HMO/PPO |
$3,737.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,878.01
|
| 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 57
|
Facility
|
OP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,356.64 |
| 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 |
$2,284.86
|
| Rate for Payer: BCBS MAPPO |
$1,428.04
|
| Rate for Payer: BCBS Trust/PPO |
$4,695.96
|
| Rate for Payer: BCN Commercial |
$4,441.20
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,499.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,855.33
|
| Rate for Payer: Nomi Health Commercial |
$4,683.96
|
| 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 Cigna Priority Health |
$3,712.90
|
| Rate for Payer: Priority Health HMO/PPO |
$4,969.57
|
| Rate for Payer: Priority Health Medicare |
$1,442.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,827.14
|
| 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 Dual Complete DSNP |
$1,428.04
|
| Rate for Payer: UHC Exchange |
$1,428.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,428.04
|
| 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 |
$3,712.90 |
| Max. Negotiated Rate |
$5,140.94 |
| Rate for Payer: Aetna Commercial |
$4,855.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,662.83
|
| Rate for Payer: BCN Commercial |
$4,414.35
|
| 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: PHP Commercial |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.90
|
| Rate for Payer: Priority Health HMO/PPO |
$4,969.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,827.14
|
| 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 |
$430.82 |
| Max. Negotiated Rate |
$596.52 |
| Rate for Payer: Aetna Commercial |
$563.38
|
| Rate for Payer: BCBS Trust/PPO |
$541.04
|
| Rate for Payer: BCN Commercial |
$512.21
|
| 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: PHP Commercial |
$563.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.82
|
| Rate for Payer: Priority Health HMO/PPO |
$576.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.08
|
| 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 |
$157.42 |
| 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 |
$265.12
|
| Rate for Payer: BCBS MAPPO |
$165.70
|
| Rate for Payer: BCBS Trust/PPO |
$544.89
|
| Rate for Payer: BCN Commercial |
$515.33
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: Nomi Health Commercial |
$543.50
|
| Rate for Payer: PACE Senior Care Partners |
$157.42
|
| 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 Cigna Priority Health |
$430.82
|
| Rate for Payer: Priority Health HMO/PPO |
$576.64
|
| Rate for Payer: Priority Health Medicare |
$167.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.08
|
| 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 Dual Complete DSNP |
$165.70
|
| Rate for Payer: UHC Exchange |
$165.70
|
| Rate for Payer: UHC Medicare Advantage |
$165.70
|
| Rate for Payer: VA VA |
$165.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.10
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: BCBS Trust/PPO |
$27.17
|
| Rate for Payer: BCN Commercial |
$25.73
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO |
$28.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.30
|
| Rate for Payer: UHC Core |
$27.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.97
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.40
|
| Rate for Payer: BCBS Complete |
$13.32
|
| Rate for Payer: BCBS MAPPO |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$27.37
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: BCN Medicare Advantage |
$8.32
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: PACE Senior Care Partners |
$7.91
|
| Rate for Payer: PACE SWMI |
$8.32
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: PHP Medicare Advantage |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO |
$28.96
|
| Rate for Payer: Priority Health Medicare |
$8.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.30
|
| Rate for Payer: Railroad Medicare Medicare |
$8.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.30
|
| Rate for Payer: UHC Core |
$27.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.32
|
| Rate for Payer: UHC Exchange |
$8.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.32
|
| Rate for Payer: VA VA |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.97
|
|
|
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 |
$96.32 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: BCBS Trust/PPO |
$120.97
|
| Rate for Payer: BCN Commercial |
$114.52
|
| 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: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health HMO/PPO |
$128.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.29
|
| 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 |
$59.28
|
| 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 |
$115.22
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| 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 Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health HMO/PPO |
$128.93
|
| Rate for Payer: Priority Health Medicare |
$37.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.29
|
| 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 Dual Complete DSNP |
$37.05
|
| Rate for Payer: UHC Exchange |
$37.05
|
| Rate for Payer: UHC Medicare Advantage |
$37.05
|
| 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 |
$53.88
|
| 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 |
$104.74
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| 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 Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Medicare |
$34.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.26
|
| 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 Dual Complete DSNP |
$33.68
|
| Rate for Payer: UHC Exchange |
$33.68
|
| Rate for Payer: UHC Medicare Advantage |
$33.68
|
| 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 |
$87.56 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$109.96
|
| Rate for Payer: BCN Commercial |
$104.10
|
| 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: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.26
|
| 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 |
$87.56 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$109.96
|
| Rate for Payer: BCN Commercial |
$104.10
|
| 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: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.26
|
| 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 |
$53.88
|
| 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 |
$104.74
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| 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 Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Medicare |
$34.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.26
|
| 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 Dual Complete DSNP |
$33.68
|
| Rate for Payer: UHC Exchange |
$33.68
|
| Rate for Payer: UHC Medicare Advantage |
$33.68
|
| Rate for Payer: VA VA |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.95 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: BCBS Trust/PPO |
$86.59
|
| Rate for Payer: BCN Commercial |
$81.98
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health HMO/PPO |
$92.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.35
|
| Rate for Payer: UHC Core |
$88.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.56
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Aetna Medicare |
$27.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.15
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS MAPPO |
$26.52
|
| Rate for Payer: BCBS Trust/PPO |
$87.21
|
| Rate for Payer: BCN Commercial |
$82.48
|
| Rate for Payer: BCN Medicare Advantage |
$26.52
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.52
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.56
|
| Rate for Payer: Mclaren Medicaid |
$11.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.85
|
| Rate for Payer: Meridian Medicaid |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| Rate for Payer: PACE Senior Care Partners |
$25.19
|
| Rate for Payer: PACE SWMI |
$26.52
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: PHP Medicare Advantage |
$26.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health HMO/PPO |
$92.29
|
| Rate for Payer: Priority Health Medicare |
$26.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.07
|
| Rate for Payer: Railroad Medicare Medicare |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.35
|
| Rate for Payer: UHC Core |
$88.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.52
|
| Rate for Payer: UHC Exchange |
$26.52
|
| Rate for Payer: UHC Medicare Advantage |
$26.52
|
| Rate for Payer: UHCCP Medicaid |
$11.41
|
| Rate for Payer: VA VA |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.56
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$596.12 |
| Max. Negotiated Rate |
$2,258.98 |
| Rate for Payer: Aetna Commercial |
$2,133.48
|
| Rate for Payer: Aetna Medicare |
$652.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$784.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$784.37
|
| Rate for Payer: BCBS Complete |
$1,003.99
|
| Rate for Payer: BCBS MAPPO |
$627.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,063.45
|
| Rate for Payer: BCN Commercial |
$1,951.51
|
| Rate for Payer: BCN Medicare Advantage |
$627.50
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$2,158.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$627.50
|
| Rate for Payer: Healthscope Commercial |
$2,258.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,882.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: Nomi Health Commercial |
$2,058.18
|
| Rate for Payer: PACE Senior Care Partners |
$596.12
|
| Rate for Payer: PACE SWMI |
$627.50
|
| Rate for Payer: PHP Commercial |
$2,133.48
|
| Rate for Payer: PHP Medicare Advantage |
$627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health HMO/PPO |
$2,183.68
|
| Rate for Payer: Priority Health Medicare |
$633.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,681.69
|
| Rate for Payer: Railroad Medicare Medicare |
$627.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,208.78
|
| Rate for Payer: UHC Core |
$2,095.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$627.50
|
| Rate for Payer: UHC Exchange |
$627.50
|
| Rate for Payer: UHC Medicare Advantage |
$627.50
|
| Rate for Payer: VA VA |
$627.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,882.48
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,631.49 |
| Max. Negotiated Rate |
$2,258.98 |
| Rate for Payer: Aetna Commercial |
$2,133.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.90
|
| Rate for Payer: BCN Commercial |
$1,939.71
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$2,158.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,258.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,882.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: Nomi Health Commercial |
$2,058.18
|
| Rate for Payer: PHP Commercial |
$2,133.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health HMO/PPO |
$2,183.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,681.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,208.78
|
| Rate for Payer: UHC Core |
$2,095.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,882.48
|
|
