|
HC HBO PER 30 MINUTES
|
Facility
|
OP
|
$654.23
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$99.70 |
| Max. Negotiated Rate |
$588.81 |
| Rate for Payer: Aetna Commercial |
$556.10
|
| Rate for Payer: Aetna Medicare |
$170.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.45
|
| Rate for Payer: BCBS Complete |
$104.69
|
| Rate for Payer: BCBS MAPPO |
$163.56
|
| Rate for Payer: BCBS Trust/PPO |
$537.84
|
| Rate for Payer: BCN Commercial |
$508.66
|
| Rate for Payer: BCN Medicare Advantage |
$163.56
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cash Price |
$523.38
|
| Rate for Payer: Cofinity Commercial |
$562.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$588.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.67
|
| Rate for Payer: Mclaren Medicaid |
$99.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.74
|
| Rate for Payer: Meridian Medicaid |
$104.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.10
|
| Rate for Payer: Nomi Health Commercial |
$536.47
|
| Rate for Payer: PACE Senior Care Partners |
$155.38
|
| Rate for Payer: PACE SWMI |
$163.56
|
| Rate for Payer: PHP Commercial |
$556.10
|
| Rate for Payer: PHP Medicare Advantage |
$163.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.25
|
| Rate for Payer: Priority Health HMO/PPO |
$569.18
|
| Rate for Payer: Priority Health Medicare |
$165.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.33
|
| Rate for Payer: Railroad Medicare Medicare |
$163.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.72
|
| Rate for Payer: UHC Core |
$546.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.56
|
| Rate for Payer: UHC Exchange |
$163.56
|
| Rate for Payer: UHC Medicare Advantage |
$163.56
|
| Rate for Payer: UHCCP Medicaid |
$99.70
|
| Rate for Payer: VA VA |
$163.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.67
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
OP
|
$835.42
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$751.88 |
| Rate for Payer: Aetna Commercial |
$710.11
|
| Rate for Payer: Aetna Medicare |
$217.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$261.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$261.07
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$208.85
|
| Rate for Payer: BCBS Trust/PPO |
$686.80
|
| Rate for Payer: BCN Commercial |
$649.54
|
| Rate for Payer: BCN Medicare Advantage |
$208.85
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cofinity Commercial |
$718.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.85
|
| Rate for Payer: Healthscope Commercial |
$751.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$626.57
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.30
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.11
|
| Rate for Payer: Nomi Health Commercial |
$685.04
|
| Rate for Payer: PACE Senior Care Partners |
$198.41
|
| Rate for Payer: PACE SWMI |
$208.85
|
| Rate for Payer: PHP Commercial |
$710.11
|
| Rate for Payer: PHP Medicare Advantage |
$208.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.02
|
| Rate for Payer: Priority Health HMO/PPO |
$726.82
|
| Rate for Payer: Priority Health Medicare |
$210.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$559.73
|
| Rate for Payer: Railroad Medicare Medicare |
$208.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.17
|
| Rate for Payer: UHC Core |
$697.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.85
|
| Rate for Payer: UHC Exchange |
$208.85
|
| Rate for Payer: UHC Medicare Advantage |
$208.85
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$208.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$626.57
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
IP
|
$835.42
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$543.02 |
| Max. Negotiated Rate |
$751.88 |
| Rate for Payer: Aetna Commercial |
$710.11
|
| Rate for Payer: BCBS Trust/PPO |
$681.95
|
| Rate for Payer: BCN Commercial |
$645.61
|
| Rate for Payer: Cash Price |
$668.34
|
| Rate for Payer: Cofinity Commercial |
$718.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.34
|
| Rate for Payer: Healthscope Commercial |
$751.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$626.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.11
|
| Rate for Payer: Nomi Health Commercial |
$685.04
|
| Rate for Payer: PHP Commercial |
$710.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.02
|
| Rate for Payer: Priority Health HMO/PPO |
$726.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$559.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.17
|
| Rate for Payer: UHC Core |
$697.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$626.57
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
OP
|
$535.76
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$93.19 |
| Max. Negotiated Rate |
$482.18 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Medicare |
$139.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.43
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$133.94
|
| Rate for Payer: BCBS Trust/PPO |
$440.45
|
| Rate for Payer: BCN Commercial |
$416.55
|
| Rate for Payer: BCN Medicare Advantage |
$133.94
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cofinity Commercial |
$460.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.94
|
| Rate for Payer: Healthscope Commercial |
$482.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.82
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.64
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.40
|
| Rate for Payer: Nomi Health Commercial |
$439.32
|
| Rate for Payer: PACE Senior Care Partners |
$127.24
|
| Rate for Payer: PACE SWMI |
$133.94
|
| Rate for Payer: PHP Commercial |
$455.40
|
| Rate for Payer: PHP Medicare Advantage |
$133.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.24
|
| Rate for Payer: Priority Health HMO/PPO |
$466.11
|
| Rate for Payer: Priority Health Medicare |
$135.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.96
|
| Rate for Payer: Railroad Medicare Medicare |
$133.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.47
|
| Rate for Payer: UHC Core |
$447.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.94
|
| Rate for Payer: UHC Exchange |
$133.94
|
| Rate for Payer: UHC Medicare Advantage |
$133.94
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$133.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.82
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
IP
|
$535.76
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$348.24 |
| Max. Negotiated Rate |
$482.18 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: BCBS Trust/PPO |
$437.34
|
| Rate for Payer: BCN Commercial |
$414.04
|
| Rate for Payer: Cash Price |
$428.61
|
| Rate for Payer: Cofinity Commercial |
$460.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.61
|
| Rate for Payer: Healthscope Commercial |
$482.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.40
|
| Rate for Payer: Nomi Health Commercial |
$439.32
|
| Rate for Payer: PHP Commercial |
$455.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.24
|
| Rate for Payer: Priority Health HMO/PPO |
$466.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.47
|
| Rate for Payer: UHC Core |
$447.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.82
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
IP
|
$6,486.08
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,215.95 |
| Max. Negotiated Rate |
$5,837.47 |
| Rate for Payer: Aetna Commercial |
$5,513.17
|
| Rate for Payer: BCBS Trust/PPO |
$5,294.59
|
| Rate for Payer: BCN Commercial |
$5,012.44
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cofinity Commercial |
$5,578.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,188.86
|
| Rate for Payer: Healthscope Commercial |
$5,837.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,864.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,513.17
|
| Rate for Payer: Nomi Health Commercial |
$5,318.59
|
| Rate for Payer: PHP Commercial |
$5,513.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,215.95
|
| Rate for Payer: Priority Health HMO/PPO |
$5,642.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,345.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,707.75
|
| Rate for Payer: UHC Core |
$5,415.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,864.56
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
OP
|
$6,486.08
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,540.44 |
| Max. Negotiated Rate |
$5,837.47 |
| Rate for Payer: Aetna Commercial |
$5,513.17
|
| Rate for Payer: Aetna Medicare |
$1,686.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.90
|
| Rate for Payer: BCBS Complete |
$2,441.90
|
| Rate for Payer: BCBS MAPPO |
$1,621.52
|
| Rate for Payer: BCBS Trust/PPO |
$5,332.21
|
| Rate for Payer: BCN Commercial |
$5,042.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,621.52
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cash Price |
$5,188.86
|
| Rate for Payer: Cofinity Commercial |
$5,578.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,621.52
|
| Rate for Payer: Healthscope Commercial |
$5,837.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,864.56
|
| Rate for Payer: Mclaren Medicaid |
$2,325.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,702.60
|
| Rate for Payer: Meridian Medicaid |
$2,441.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,513.17
|
| Rate for Payer: Nomi Health Commercial |
$5,318.59
|
| Rate for Payer: PACE Senior Care Partners |
$1,540.44
|
| Rate for Payer: PACE SWMI |
$1,621.52
|
| Rate for Payer: PHP Commercial |
$5,513.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,621.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,325.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,215.95
|
| Rate for Payer: Priority Health HMO/PPO |
$5,642.89
|
| Rate for Payer: Priority Health Medicare |
$1,637.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,345.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,621.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,707.75
|
| Rate for Payer: UHC Core |
$5,415.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,621.52
|
| Rate for Payer: UHC Exchange |
$1,621.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,621.52
|
| Rate for Payer: UHCCP Medicaid |
$2,325.46
|
| Rate for Payer: VA VA |
$1,621.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,864.56
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.83
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS MAPPO |
$15.87
|
| Rate for Payer: BCBS Trust/PPO |
$52.17
|
| Rate for Payer: BCN Commercial |
$49.34
|
| Rate for Payer: BCN Medicare Advantage |
$15.87
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.87
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Mclaren Medicaid |
$10.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.66
|
| Rate for Payer: Meridian Medicaid |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE Senior Care Partners |
$15.07
|
| Rate for Payer: PACE SWMI |
$15.87
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: PHP Medicare Advantage |
$15.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: Priority Health HMO/PPO |
$55.21
|
| Rate for Payer: Priority Health Medicare |
$16.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.52
|
| Rate for Payer: Railroad Medicare Medicare |
$15.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.87
|
| Rate for Payer: UHC Exchange |
$15.87
|
| Rate for Payer: UHC Medicare Advantage |
$15.87
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$15.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: BCBS Trust/PPO |
$51.80
|
| Rate for Payer: BCN Commercial |
$49.04
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.25
|
| Rate for Payer: Priority Health HMO/PPO |
$55.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
IP
|
$403.49
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$262.27 |
| Max. Negotiated Rate |
$363.14 |
| Rate for Payer: Aetna Commercial |
$342.97
|
| Rate for Payer: BCBS Trust/PPO |
$329.37
|
| Rate for Payer: BCN Commercial |
$311.82
|
| Rate for Payer: Cash Price |
$322.79
|
| Rate for Payer: Cofinity Commercial |
$347.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.79
|
| Rate for Payer: Healthscope Commercial |
$363.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.97
|
| Rate for Payer: Nomi Health Commercial |
$330.86
|
| Rate for Payer: PHP Commercial |
$342.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.27
|
| Rate for Payer: Priority Health HMO/PPO |
$351.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.07
|
| Rate for Payer: UHC Core |
$336.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.62
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
OP
|
$403.49
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.83 |
| Max. Negotiated Rate |
$363.14 |
| Rate for Payer: Aetna Commercial |
$342.97
|
| Rate for Payer: Aetna Medicare |
$104.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.09
|
| Rate for Payer: BCBS Complete |
$195.46
|
| Rate for Payer: BCBS MAPPO |
$100.87
|
| Rate for Payer: BCBS Trust/PPO |
$331.71
|
| Rate for Payer: BCN Commercial |
$313.71
|
| Rate for Payer: BCN Medicare Advantage |
$100.87
|
| Rate for Payer: Cash Price |
$322.79
|
| Rate for Payer: Cash Price |
$322.79
|
| Rate for Payer: Cofinity Commercial |
$347.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.87
|
| Rate for Payer: Healthscope Commercial |
$363.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.62
|
| Rate for Payer: Mclaren Medicaid |
$186.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.92
|
| Rate for Payer: Meridian Medicaid |
$195.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.97
|
| Rate for Payer: Nomi Health Commercial |
$330.86
|
| Rate for Payer: PACE Senior Care Partners |
$95.83
|
| Rate for Payer: PACE SWMI |
$100.87
|
| Rate for Payer: PHP Commercial |
$342.97
|
| Rate for Payer: PHP Medicare Advantage |
$100.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.27
|
| Rate for Payer: Priority Health HMO/PPO |
$351.04
|
| Rate for Payer: Priority Health Medicare |
$101.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.34
|
| Rate for Payer: Railroad Medicare Medicare |
$100.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.07
|
| Rate for Payer: UHC Core |
$336.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.87
|
| Rate for Payer: UHC Exchange |
$100.87
|
| Rate for Payer: UHC Medicare Advantage |
$100.87
|
| Rate for Payer: UHCCP Medicaid |
$186.14
|
| Rate for Payer: VA VA |
$100.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.62
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$5.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$6.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.80
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: UHCCP Medicaid |
$5.92
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.48
|
| Rate for Payer: BCN Commercial |
$24.12
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$5.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$6.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$5.92
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$1,989.66
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,293.28 |
| Max. Negotiated Rate |
$1,790.69 |
| Rate for Payer: Aetna Commercial |
$1,691.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,624.16
|
| Rate for Payer: BCN Commercial |
$1,537.61
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cofinity Commercial |
$1,711.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,591.73
|
| Rate for Payer: Healthscope Commercial |
$1,790.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,492.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.21
|
| Rate for Payer: Nomi Health Commercial |
$1,631.52
|
| Rate for Payer: PHP Commercial |
$1,691.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,293.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,731.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,333.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,750.90
|
| Rate for Payer: UHC Core |
$1,661.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,492.24
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$1,989.66
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$472.54 |
| Max. Negotiated Rate |
$1,790.69 |
| Rate for Payer: Aetna Commercial |
$1,691.21
|
| Rate for Payer: Aetna Medicare |
$517.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$621.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$621.77
|
| Rate for Payer: BCBS Complete |
$526.74
|
| Rate for Payer: BCBS MAPPO |
$497.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,635.70
|
| Rate for Payer: BCN Commercial |
$1,546.96
|
| Rate for Payer: BCN Medicare Advantage |
$497.42
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cofinity Commercial |
$1,711.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,591.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.42
|
| Rate for Payer: Healthscope Commercial |
$1,790.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,492.24
|
| Rate for Payer: Mclaren Medicaid |
$501.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$522.29
|
| Rate for Payer: Meridian Medicaid |
$526.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$572.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.21
|
| Rate for Payer: Nomi Health Commercial |
$1,631.52
|
| Rate for Payer: PACE Senior Care Partners |
$472.54
|
| Rate for Payer: PACE SWMI |
$497.42
|
| Rate for Payer: PHP Commercial |
$1,691.21
|
| Rate for Payer: PHP Medicare Advantage |
$497.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$501.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,293.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,731.00
|
| Rate for Payer: Priority Health Medicare |
$502.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,333.07
|
| Rate for Payer: Railroad Medicare Medicare |
$497.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,750.90
|
| Rate for Payer: UHC Core |
$1,661.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$497.42
|
| Rate for Payer: UHC Exchange |
$497.42
|
| Rate for Payer: UHC Medicare Advantage |
$497.42
|
| Rate for Payer: UHCCP Medicaid |
$501.62
|
| Rate for Payer: VA VA |
$497.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,492.24
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,436.53 |
| Max. Negotiated Rate |
$1,989.05 |
| Rate for Payer: Aetna Commercial |
$1,878.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.06
|
| Rate for Payer: BCN Commercial |
$1,707.93
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$1,900.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Healthscope Commercial |
$1,989.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: PHP Commercial |
$1,878.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: Priority Health HMO/PPO |
$1,922.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,480.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,944.84
|
| Rate for Payer: UHC Core |
$1,845.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.54
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$501.62 |
| Max. Negotiated Rate |
$1,989.05 |
| Rate for Payer: Aetna Commercial |
$1,878.54
|
| Rate for Payer: Aetna Medicare |
$574.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$690.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$690.64
|
| Rate for Payer: BCBS Complete |
$526.74
|
| Rate for Payer: BCBS MAPPO |
$552.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.88
|
| Rate for Payer: BCN Commercial |
$1,718.31
|
| Rate for Payer: BCN Medicare Advantage |
$552.51
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$1,900.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.51
|
| Rate for Payer: Healthscope Commercial |
$1,989.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.54
|
| Rate for Payer: Mclaren Medicaid |
$501.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.14
|
| Rate for Payer: Meridian Medicaid |
$526.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$635.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: PACE Senior Care Partners |
$524.89
|
| Rate for Payer: PACE SWMI |
$552.51
|
| Rate for Payer: PHP Commercial |
$1,878.54
|
| Rate for Payer: PHP Medicare Advantage |
$552.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$501.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: Priority Health HMO/PPO |
$1,922.74
|
| Rate for Payer: Priority Health Medicare |
$558.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,480.73
|
| Rate for Payer: Railroad Medicare Medicare |
$552.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,944.84
|
| Rate for Payer: UHC Core |
$1,845.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.51
|
| Rate for Payer: UHC Exchange |
$552.51
|
| Rate for Payer: UHC Medicare Advantage |
$552.51
|
| Rate for Payer: UHCCP Medicaid |
$501.62
|
| Rate for Payer: VA VA |
$552.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.54
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$562.41
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.57 |
| Max. Negotiated Rate |
$506.17 |
| Rate for Payer: Aetna Commercial |
$478.05
|
| Rate for Payer: Aetna Medicare |
$146.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.75
|
| Rate for Payer: BCBS Complete |
$259.94
|
| Rate for Payer: BCBS MAPPO |
$140.60
|
| Rate for Payer: BCBS Trust/PPO |
$462.36
|
| Rate for Payer: BCN Commercial |
$437.27
|
| Rate for Payer: BCN Medicare Advantage |
$140.60
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$483.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.60
|
| Rate for Payer: Healthscope Commercial |
$506.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.81
|
| Rate for Payer: Mclaren Medicaid |
$247.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.63
|
| Rate for Payer: Meridian Medicaid |
$259.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.05
|
| Rate for Payer: Nomi Health Commercial |
$461.18
|
| Rate for Payer: PACE Senior Care Partners |
$133.57
|
| Rate for Payer: PACE SWMI |
$140.60
|
| Rate for Payer: PHP Commercial |
$478.05
|
| Rate for Payer: PHP Medicare Advantage |
$140.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.57
|
| Rate for Payer: Priority Health HMO/PPO |
$489.30
|
| Rate for Payer: Priority Health Medicare |
$142.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.81
|
| Rate for Payer: Railroad Medicare Medicare |
$140.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.92
|
| Rate for Payer: UHC Core |
$469.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.60
|
| Rate for Payer: UHC Exchange |
$140.60
|
| Rate for Payer: UHC Medicare Advantage |
$140.60
|
| Rate for Payer: UHCCP Medicaid |
$247.55
|
| Rate for Payer: VA VA |
$140.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.81
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$562.41
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.57 |
| Max. Negotiated Rate |
$506.17 |
| Rate for Payer: Aetna Commercial |
$478.05
|
| Rate for Payer: BCBS Trust/PPO |
$459.10
|
| Rate for Payer: BCN Commercial |
$434.63
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$483.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.93
|
| Rate for Payer: Healthscope Commercial |
$506.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.05
|
| Rate for Payer: Nomi Health Commercial |
$461.18
|
| Rate for Payer: PHP Commercial |
$478.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.57
|
| Rate for Payer: Priority Health HMO/PPO |
$489.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.92
|
| Rate for Payer: UHC Core |
$469.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.81
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,438.89
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$501.62 |
| Max. Negotiated Rate |
$2,195.00 |
| Rate for Payer: Aetna Commercial |
$2,073.06
|
| Rate for Payer: Aetna Medicare |
$634.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$762.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$762.15
|
| Rate for Payer: BCBS Complete |
$526.74
|
| Rate for Payer: BCBS MAPPO |
$609.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.01
|
| Rate for Payer: BCN Commercial |
$1,896.24
|
| Rate for Payer: BCN Medicare Advantage |
$609.72
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cofinity Commercial |
$2,097.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$609.72
|
| Rate for Payer: Healthscope Commercial |
$2,195.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,829.17
|
| Rate for Payer: Mclaren Medicaid |
$501.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$640.21
|
| Rate for Payer: Meridian Medicaid |
$526.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$701.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.06
|
| Rate for Payer: Nomi Health Commercial |
$1,999.89
|
| Rate for Payer: PACE Senior Care Partners |
$579.24
|
| Rate for Payer: PACE SWMI |
$609.72
|
| Rate for Payer: PHP Commercial |
$2,073.06
|
| Rate for Payer: PHP Medicare Advantage |
$609.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$501.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.28
|
| Rate for Payer: Priority Health HMO/PPO |
$2,121.83
|
| Rate for Payer: Priority Health Medicare |
$615.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,634.06
|
| Rate for Payer: Railroad Medicare Medicare |
$609.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,146.22
|
| Rate for Payer: UHC Core |
$2,036.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$609.72
|
| Rate for Payer: UHC Exchange |
$609.72
|
| Rate for Payer: UHC Medicare Advantage |
$609.72
|
| Rate for Payer: UHCCP Medicaid |
$501.62
|
| Rate for Payer: VA VA |
$609.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,829.17
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,438.89
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,585.28 |
| Max. Negotiated Rate |
$2,195.00 |
| Rate for Payer: Aetna Commercial |
$2,073.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,990.87
|
| Rate for Payer: BCN Commercial |
$1,884.77
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cofinity Commercial |
$2,097.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.11
|
| Rate for Payer: Healthscope Commercial |
$2,195.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,829.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.06
|
| Rate for Payer: Nomi Health Commercial |
$1,999.89
|
| Rate for Payer: PHP Commercial |
$2,073.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.28
|
| Rate for Payer: Priority Health HMO/PPO |
$2,121.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,634.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,146.22
|
| Rate for Payer: UHC Core |
$2,036.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,829.17
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: BCBS Trust/PPO |
$393.26
|
| Rate for Payer: BCN Commercial |
$372.30
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO |
$419.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.95
|
| Rate for Payer: UHC Core |
$402.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$114.42 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare |
$125.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.55
|
| Rate for Payer: BCBS Complete |
$199.65
|
| Rate for Payer: BCBS MAPPO |
$120.44
|
| Rate for Payer: BCBS Trust/PPO |
$396.05
|
| Rate for Payer: BCN Commercial |
$374.57
|
| Rate for Payer: BCN Medicare Advantage |
$120.44
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.44
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Mclaren Medicaid |
$190.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.46
|
| Rate for Payer: Meridian Medicaid |
$199.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PACE Senior Care Partners |
$114.42
|
| Rate for Payer: PACE SWMI |
$120.44
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: PHP Medicare Advantage |
$120.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO |
$419.13
|
| Rate for Payer: Priority Health Medicare |
$121.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.78
|
| Rate for Payer: Railroad Medicare Medicare |
$120.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.95
|
| Rate for Payer: UHC Core |
$402.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.44
|
| Rate for Payer: UHC Exchange |
$120.44
|
| Rate for Payer: UHC Medicare Advantage |
$120.44
|
| Rate for Payer: UHCCP Medicaid |
$190.13
|
| Rate for Payer: VA VA |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
