|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$171.07
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.06 |
| Max. Negotiated Rate |
$153.96 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: BCBS Trust/PPO |
$141.29
|
| Rate for Payer: BCN Commercial |
$141.29
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Cofinity Commercial |
$147.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.86
|
| Rate for Payer: Healthscope Commercial |
$153.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.41
|
| Rate for Payer: Nomi Health Commercial |
$140.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.30
|
| Rate for Payer: PHP Commercial |
$145.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$148.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.54
|
| Rate for Payer: UHC Core |
$142.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.30
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$171.07
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$153.96 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Aetna Medicare |
$44.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.46
|
| Rate for Payer: BCBS Complete |
$31.67
|
| Rate for Payer: BCBS MAPPO |
$42.77
|
| Rate for Payer: BCBS Trust/PPO |
$140.64
|
| Rate for Payer: BCN Commercial |
$140.64
|
| Rate for Payer: BCN Medicare Advantage |
$42.77
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Cofinity Commercial |
$147.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.77
|
| Rate for Payer: Healthscope Commercial |
$153.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.30
|
| Rate for Payer: Mclaren Medicaid |
$30.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.91
|
| Rate for Payer: Meridian Medicaid |
$31.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.41
|
| Rate for Payer: Nomi Health Commercial |
$140.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.30
|
| Rate for Payer: PACE Senior Care Partners |
$40.63
|
| Rate for Payer: PACE SWMI |
$42.77
|
| Rate for Payer: PHP Commercial |
$145.41
|
| Rate for Payer: PHP Medicare Advantage |
$42.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$148.83
|
| Rate for Payer: Priority Health Medicare |
$43.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.06
|
| Rate for Payer: Railroad Medicare Medicare |
$42.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.54
|
| Rate for Payer: UHC Core |
$142.84
|
| Rate for Payer: UHC Exchange |
$42.77
|
| Rate for Payer: UHC Medicaid |
$30.16
|
| Rate for Payer: UHC Medicare Advantage |
$42.77
|
| Rate for Payer: UHCCP Medicaid |
$30.16
|
| Rate for Payer: VA VA |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.30
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$157.93
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna Medicare |
$41.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.35
|
| Rate for Payer: BCBS Complete |
$29.23
|
| Rate for Payer: BCBS MAPPO |
$39.48
|
| Rate for Payer: BCBS Trust/PPO |
$129.83
|
| Rate for Payer: BCN Commercial |
$129.83
|
| Rate for Payer: BCN Medicare Advantage |
$39.48
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.45
|
| Rate for Payer: Mclaren Medicaid |
$27.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.46
|
| Rate for Payer: Meridian Medicaid |
$29.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PACE Senior Care Partners |
$37.51
|
| Rate for Payer: PACE SWMI |
$39.48
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: PHP Medicare Advantage |
$39.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.40
|
| Rate for Payer: Priority Health Medicare |
$39.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.92
|
| Rate for Payer: Railroad Medicare Medicare |
$39.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.98
|
| Rate for Payer: UHC Core |
$131.87
|
| Rate for Payer: UHC Exchange |
$39.48
|
| Rate for Payer: UHC Medicaid |
$27.84
|
| Rate for Payer: UHC Medicare Advantage |
$39.48
|
| Rate for Payer: UHCCP Medicaid |
$27.84
|
| Rate for Payer: VA VA |
$39.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.45
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$157.93
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: BCBS Trust/PPO |
$130.43
|
| Rate for Payer: BCN Commercial |
$130.43
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.98
|
| Rate for Payer: UHC Core |
$131.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.45
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$409.83
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$285.24 |
| Max. Negotiated Rate |
$368.85 |
| Rate for Payer: Aetna Commercial |
$348.36
|
| Rate for Payer: BCBS Trust/PPO |
$338.48
|
| Rate for Payer: BCN Commercial |
$338.48
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cofinity Commercial |
$352.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.86
|
| Rate for Payer: Healthscope Commercial |
$368.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.36
|
| Rate for Payer: Nomi Health Commercial |
$336.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.37
|
| Rate for Payer: PHP Commercial |
$348.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$356.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.65
|
| Rate for Payer: UHC Core |
$342.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.37
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$409.83
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$368.85 |
| Rate for Payer: Aetna Commercial |
$348.36
|
| Rate for Payer: Aetna Medicare |
$106.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.07
|
| Rate for Payer: BCBS Complete |
$75.86
|
| Rate for Payer: BCBS MAPPO |
$102.46
|
| Rate for Payer: BCBS Trust/PPO |
$336.92
|
| Rate for Payer: BCN Commercial |
$336.92
|
| Rate for Payer: BCN Medicare Advantage |
$102.46
|
| Rate for Payer: Cash Price |
$327.86
|
| Rate for Payer: Cofinity Commercial |
$352.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.46
|
| Rate for Payer: Healthscope Commercial |
$368.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.37
|
| Rate for Payer: Mclaren Medicaid |
$72.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.58
|
| Rate for Payer: Meridian Medicaid |
$75.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$112.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.36
|
| Rate for Payer: Nomi Health Commercial |
$336.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.37
|
| Rate for Payer: PACE Senior Care Partners |
$97.33
|
| Rate for Payer: PACE SWMI |
$102.46
|
| Rate for Payer: PHP Commercial |
$348.36
|
| Rate for Payer: PHP Medicare Advantage |
$102.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$356.55
|
| Rate for Payer: Priority Health Medicare |
$103.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.24
|
| Rate for Payer: Railroad Medicare Medicare |
$102.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.65
|
| Rate for Payer: UHC Core |
$342.21
|
| Rate for Payer: UHC Exchange |
$102.46
|
| Rate for Payer: UHC Medicaid |
$72.25
|
| Rate for Payer: UHC Medicare Advantage |
$102.46
|
| Rate for Payer: UHCCP Medicaid |
$72.25
|
| Rate for Payer: VA VA |
$102.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.37
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$710.44
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$639.40 |
| Rate for Payer: Aetna Commercial |
$603.87
|
| Rate for Payer: Aetna Medicare |
$184.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.01
|
| Rate for Payer: BCBS Complete |
$131.50
|
| Rate for Payer: BCBS MAPPO |
$177.61
|
| Rate for Payer: BCBS Trust/PPO |
$584.05
|
| Rate for Payer: BCN Commercial |
$584.05
|
| Rate for Payer: BCN Medicare Advantage |
$177.61
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cofinity Commercial |
$610.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.61
|
| Rate for Payer: Healthscope Commercial |
$639.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.83
|
| Rate for Payer: Mclaren Medicaid |
$125.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.49
|
| Rate for Payer: Meridian Medicaid |
$131.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.87
|
| Rate for Payer: Nomi Health Commercial |
$582.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.83
|
| Rate for Payer: PACE Senior Care Partners |
$168.73
|
| Rate for Payer: PACE SWMI |
$177.61
|
| Rate for Payer: PHP Commercial |
$603.87
|
| Rate for Payer: PHP Medicare Advantage |
$177.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$618.08
|
| Rate for Payer: Priority Health Medicare |
$179.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.47
|
| Rate for Payer: Railroad Medicare Medicare |
$177.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.19
|
| Rate for Payer: UHC Core |
$593.22
|
| Rate for Payer: UHC Exchange |
$177.61
|
| Rate for Payer: UHC Medicaid |
$125.25
|
| Rate for Payer: UHC Medicare Advantage |
$177.61
|
| Rate for Payer: UHCCP Medicaid |
$125.25
|
| Rate for Payer: VA VA |
$177.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.83
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$710.44
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$494.47 |
| Max. Negotiated Rate |
$639.40 |
| Rate for Payer: Aetna Commercial |
$603.87
|
| Rate for Payer: BCBS Trust/PPO |
$586.75
|
| Rate for Payer: BCN Commercial |
$586.75
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cofinity Commercial |
$610.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.35
|
| Rate for Payer: Healthscope Commercial |
$639.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.87
|
| Rate for Payer: Nomi Health Commercial |
$582.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.83
|
| Rate for Payer: PHP Commercial |
$603.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$618.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.19
|
| Rate for Payer: UHC Core |
$593.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.83
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$288.28
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$259.45 |
| Rate for Payer: Aetna Commercial |
$245.04
|
| Rate for Payer: BCBS Trust/PPO |
$238.09
|
| Rate for Payer: BCN Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cofinity Commercial |
$247.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.62
|
| Rate for Payer: Healthscope Commercial |
$259.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.04
|
| Rate for Payer: Nomi Health Commercial |
$236.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.21
|
| Rate for Payer: PHP Commercial |
$245.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.69
|
| Rate for Payer: UHC Core |
$240.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.21
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$288.28
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.82 |
| Max. Negotiated Rate |
$259.45 |
| Rate for Payer: Aetna Commercial |
$245.04
|
| Rate for Payer: Aetna Medicare |
$74.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.09
|
| Rate for Payer: BCBS Complete |
$53.36
|
| Rate for Payer: BCBS MAPPO |
$72.07
|
| Rate for Payer: BCBS Trust/PPO |
$236.99
|
| Rate for Payer: BCN Commercial |
$236.99
|
| Rate for Payer: BCN Medicare Advantage |
$72.07
|
| Rate for Payer: Cash Price |
$230.62
|
| Rate for Payer: Cofinity Commercial |
$247.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.07
|
| Rate for Payer: Healthscope Commercial |
$259.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.21
|
| Rate for Payer: Mclaren Medicaid |
$50.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.67
|
| Rate for Payer: Meridian Medicaid |
$53.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.04
|
| Rate for Payer: Nomi Health Commercial |
$236.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.21
|
| Rate for Payer: PACE Senior Care Partners |
$68.47
|
| Rate for Payer: PACE SWMI |
$72.07
|
| Rate for Payer: PHP Commercial |
$245.04
|
| Rate for Payer: PHP Medicare Advantage |
$72.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$250.80
|
| Rate for Payer: Priority Health Medicare |
$72.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.64
|
| Rate for Payer: Railroad Medicare Medicare |
$72.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.69
|
| Rate for Payer: UHC Core |
$240.71
|
| Rate for Payer: UHC Exchange |
$72.07
|
| Rate for Payer: UHC Medicaid |
$50.82
|
| Rate for Payer: UHC Medicare Advantage |
$72.07
|
| Rate for Payer: UHCCP Medicaid |
$50.82
|
| Rate for Payer: VA VA |
$72.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.21
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$226.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$204.01 |
| Rate for Payer: Aetna Commercial |
$192.68
|
| Rate for Payer: Aetna Medicare |
$58.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.84
|
| Rate for Payer: BCBS Complete |
$41.96
|
| Rate for Payer: BCBS MAPPO |
$56.67
|
| Rate for Payer: BCBS Trust/PPO |
$186.35
|
| Rate for Payer: BCN Commercial |
$186.35
|
| Rate for Payer: BCN Medicare Advantage |
$56.67
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cofinity Commercial |
$194.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.67
|
| Rate for Payer: Healthscope Commercial |
$204.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.01
|
| Rate for Payer: Mclaren Medicaid |
$39.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.50
|
| Rate for Payer: Meridian Medicaid |
$41.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.68
|
| Rate for Payer: Nomi Health Commercial |
$185.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.01
|
| Rate for Payer: PACE Senior Care Partners |
$53.84
|
| Rate for Payer: PACE SWMI |
$56.67
|
| Rate for Payer: PHP Commercial |
$192.68
|
| Rate for Payer: PHP Medicare Advantage |
$56.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.21
|
| Rate for Payer: Priority Health Medicare |
$57.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.77
|
| Rate for Payer: Railroad Medicare Medicare |
$56.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.48
|
| Rate for Payer: UHC Core |
$189.28
|
| Rate for Payer: UHC Exchange |
$56.67
|
| Rate for Payer: UHC Medicaid |
$39.96
|
| Rate for Payer: UHC Medicare Advantage |
$56.67
|
| Rate for Payer: UHCCP Medicaid |
$39.96
|
| Rate for Payer: VA VA |
$56.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.01
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$226.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$157.77 |
| Max. Negotiated Rate |
$204.01 |
| Rate for Payer: Aetna Commercial |
$192.68
|
| Rate for Payer: BCBS Trust/PPO |
$187.22
|
| Rate for Payer: BCN Commercial |
$187.22
|
| Rate for Payer: Cash Price |
$181.34
|
| Rate for Payer: Cofinity Commercial |
$194.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.34
|
| Rate for Payer: Healthscope Commercial |
$204.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.68
|
| Rate for Payer: Nomi Health Commercial |
$185.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.01
|
| Rate for Payer: PHP Commercial |
$192.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.48
|
| Rate for Payer: UHC Core |
$189.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.01
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: BCBS Trust/PPO |
$450.50
|
| Rate for Payer: BCN Commercial |
$450.50
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.17 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.46
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Mclaren Medicaid |
$96.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$100.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Senior Care Partners |
$129.55
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicaid |
$96.17
|
| Rate for Payer: UHC Medicare Advantage |
$136.37
|
| Rate for Payer: UHCCP Medicaid |
$96.17
|
| Rate for Payer: VA VA |
$136.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.17 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.46
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Mclaren Medicaid |
$96.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$100.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Senior Care Partners |
$129.55
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicaid |
$96.17
|
| Rate for Payer: UHC Medicare Advantage |
$136.37
|
| Rate for Payer: UHCCP Medicaid |
$96.17
|
| Rate for Payer: VA VA |
$136.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: BCBS Trust/PPO |
$450.50
|
| Rate for Payer: BCN Commercial |
$450.50
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IVUS CATHETER
|
Facility
|
OP
|
$2,794.15
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.61 |
| Max. Negotiated Rate |
$2,514.74 |
| Rate for Payer: Aetna Commercial |
$2,375.03
|
| Rate for Payer: Aetna Medicare |
$726.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$873.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$873.17
|
| Rate for Payer: BCBS Complete |
$517.20
|
| Rate for Payer: BCBS MAPPO |
$698.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,297.07
|
| Rate for Payer: BCN Commercial |
$2,297.07
|
| Rate for Payer: BCN Medicare Advantage |
$698.54
|
| Rate for Payer: Cash Price |
$2,235.32
|
| Rate for Payer: Cofinity Commercial |
$2,402.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,235.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$698.54
|
| Rate for Payer: Healthscope Commercial |
$2,514.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,095.61
|
| Rate for Payer: Mclaren Medicaid |
$492.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$733.46
|
| Rate for Payer: Meridian Medicaid |
$517.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$803.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$768.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,375.03
|
| Rate for Payer: Nomi Health Commercial |
$2,291.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,095.61
|
| Rate for Payer: PACE Senior Care Partners |
$663.61
|
| Rate for Payer: PACE SWMI |
$698.54
|
| Rate for Payer: PHP Commercial |
$2,375.03
|
| Rate for Payer: PHP Medicare Advantage |
$698.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,430.91
|
| Rate for Payer: Priority Health Medicare |
$705.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,944.73
|
| Rate for Payer: Railroad Medicare Medicare |
$698.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,458.85
|
| Rate for Payer: UHC Core |
$2,333.12
|
| Rate for Payer: UHC Exchange |
$698.54
|
| Rate for Payer: UHC Medicaid |
$492.61
|
| Rate for Payer: UHC Medicare Advantage |
$698.54
|
| Rate for Payer: UHCCP Medicaid |
$492.61
|
| Rate for Payer: VA VA |
$698.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,095.61
|
|
|
HC IVUS CATHETER
|
Facility
|
IP
|
$2,794.15
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,944.73 |
| Max. Negotiated Rate |
$2,514.74 |
| Rate for Payer: Aetna Commercial |
$2,375.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,307.69
|
| Rate for Payer: BCN Commercial |
$2,307.69
|
| Rate for Payer: Cash Price |
$2,235.32
|
| Rate for Payer: Cofinity Commercial |
$2,402.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,235.32
|
| Rate for Payer: Healthscope Commercial |
$2,514.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,095.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,375.03
|
| Rate for Payer: Nomi Health Commercial |
$2,291.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,095.61
|
| Rate for Payer: PHP Commercial |
$2,375.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,430.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,944.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,458.85
|
| Rate for Payer: UHC Core |
$2,333.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,095.61
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,351.34
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.24 |
| Max. Negotiated Rate |
$1,216.21 |
| Rate for Payer: Aetna Commercial |
$1,148.64
|
| Rate for Payer: Aetna Medicare |
$351.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.29
|
| Rate for Payer: BCBS Complete |
$250.13
|
| Rate for Payer: BCBS MAPPO |
$337.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.94
|
| Rate for Payer: BCN Commercial |
$1,110.94
|
| Rate for Payer: BCN Medicare Advantage |
$337.83
|
| Rate for Payer: Cash Price |
$1,081.07
|
| Rate for Payer: Cofinity Commercial |
$1,162.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,081.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.83
|
| Rate for Payer: Healthscope Commercial |
$1,216.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,013.50
|
| Rate for Payer: Mclaren Medicaid |
$238.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.73
|
| Rate for Payer: Meridian Medicaid |
$250.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$371.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,148.64
|
| Rate for Payer: Nomi Health Commercial |
$1,108.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,013.50
|
| Rate for Payer: PACE Senior Care Partners |
$320.94
|
| Rate for Payer: PACE SWMI |
$337.83
|
| Rate for Payer: PHP Commercial |
$1,148.64
|
| Rate for Payer: PHP Medicare Advantage |
$337.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,175.67
|
| Rate for Payer: Priority Health Medicare |
$341.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$940.53
|
| Rate for Payer: Railroad Medicare Medicare |
$337.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,189.18
|
| Rate for Payer: UHC Core |
$1,128.37
|
| Rate for Payer: UHC Exchange |
$337.83
|
| Rate for Payer: UHC Medicaid |
$238.24
|
| Rate for Payer: UHC Medicare Advantage |
$337.83
|
| Rate for Payer: UHCCP Medicaid |
$238.24
|
| Rate for Payer: VA VA |
$337.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,013.50
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,351.34
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$940.53 |
| Max. Negotiated Rate |
$1,216.21 |
| Rate for Payer: Aetna Commercial |
$1,148.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.07
|
| Rate for Payer: BCN Commercial |
$1,116.07
|
| Rate for Payer: Cash Price |
$1,081.07
|
| Rate for Payer: Cofinity Commercial |
$1,162.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,081.07
|
| Rate for Payer: Healthscope Commercial |
$1,216.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,013.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,148.64
|
| Rate for Payer: Nomi Health Commercial |
$1,108.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,013.50
|
| Rate for Payer: PHP Commercial |
$1,148.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,175.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$940.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,189.18
|
| Rate for Payer: UHC Core |
$1,128.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,013.50
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
IP
|
$8,224.18
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,724.03 |
| Max. Negotiated Rate |
$7,401.76 |
| Rate for Payer: Aetna Commercial |
$6,990.55
|
| Rate for Payer: BCBS Trust/PPO |
$6,792.35
|
| Rate for Payer: BCN Commercial |
$6,792.35
|
| Rate for Payer: Cash Price |
$6,579.34
|
| Rate for Payer: Cofinity Commercial |
$7,072.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,579.34
|
| Rate for Payer: Healthscope Commercial |
$7,401.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,990.55
|
| Rate for Payer: Nomi Health Commercial |
$6,743.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,168.14
|
| Rate for Payer: PHP Commercial |
$6,990.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,155.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,724.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,237.28
|
| Rate for Payer: UHC Core |
$6,867.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,168.14
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
OP
|
$8,224.18
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,449.92 |
| Max. Negotiated Rate |
$7,401.76 |
| Rate for Payer: Aetna Commercial |
$6,990.55
|
| Rate for Payer: Aetna Medicare |
$2,138.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,570.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,570.06
|
| Rate for Payer: BCBS Complete |
$1,522.30
|
| Rate for Payer: BCBS MAPPO |
$2,056.05
|
| Rate for Payer: BCBS Trust/PPO |
$6,761.10
|
| Rate for Payer: BCN Commercial |
$6,761.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,056.05
|
| Rate for Payer: Cash Price |
$6,579.34
|
| Rate for Payer: Cofinity Commercial |
$7,072.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,579.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,056.05
|
| Rate for Payer: Healthscope Commercial |
$7,401.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,168.14
|
| Rate for Payer: Mclaren Medicaid |
$1,449.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.85
|
| Rate for Payer: Meridian Medicaid |
$1,522.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,990.55
|
| Rate for Payer: Nomi Health Commercial |
$6,743.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,168.14
|
| Rate for Payer: PACE Senior Care Partners |
$1,953.24
|
| Rate for Payer: PACE SWMI |
$2,056.05
|
| Rate for Payer: PHP Commercial |
$6,990.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,056.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,449.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,155.04
|
| Rate for Payer: Priority Health Medicare |
$2,076.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,724.03
|
| Rate for Payer: Railroad Medicare Medicare |
$2,056.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,237.28
|
| Rate for Payer: UHC Core |
$6,867.19
|
| Rate for Payer: UHC Exchange |
$2,056.05
|
| Rate for Payer: UHC Medicaid |
$1,449.92
|
| Rate for Payer: UHC Medicare Advantage |
$2,056.05
|
| Rate for Payer: UHCCP Medicaid |
$1,449.92
|
| Rate for Payer: VA VA |
$2,056.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,168.14
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
OP
|
$1,562.84
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$275.53 |
| Max. Negotiated Rate |
$1,406.56 |
| Rate for Payer: Aetna Commercial |
$1,328.41
|
| Rate for Payer: Aetna Medicare |
$406.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.39
|
| Rate for Payer: BCBS Complete |
$289.28
|
| Rate for Payer: BCBS MAPPO |
$390.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.81
|
| Rate for Payer: BCN Commercial |
$1,284.81
|
| Rate for Payer: BCN Medicare Advantage |
$390.71
|
| Rate for Payer: Cash Price |
$1,250.27
|
| Rate for Payer: Cofinity Commercial |
$1,344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,250.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.71
|
| Rate for Payer: Healthscope Commercial |
$1,406.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,172.13
|
| Rate for Payer: Mclaren Medicaid |
$275.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.25
|
| Rate for Payer: Meridian Medicaid |
$289.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$429.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,328.41
|
| Rate for Payer: Nomi Health Commercial |
$1,281.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.13
|
| Rate for Payer: PACE Senior Care Partners |
$371.17
|
| Rate for Payer: PACE SWMI |
$390.71
|
| Rate for Payer: PHP Commercial |
$1,328.41
|
| Rate for Payer: PHP Medicare Advantage |
$390.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,359.67
|
| Rate for Payer: Priority Health Medicare |
$394.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,087.74
|
| Rate for Payer: Railroad Medicare Medicare |
$390.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,375.30
|
| Rate for Payer: UHC Core |
$1,304.97
|
| Rate for Payer: UHC Exchange |
$390.71
|
| Rate for Payer: UHC Medicaid |
$275.53
|
| Rate for Payer: UHC Medicare Advantage |
$390.71
|
| Rate for Payer: UHCCP Medicaid |
$275.53
|
| Rate for Payer: VA VA |
$390.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,172.13
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
IP
|
$1,562.84
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,087.74 |
| Max. Negotiated Rate |
$1,406.56 |
| Rate for Payer: Aetna Commercial |
$1,328.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.75
|
| Rate for Payer: BCN Commercial |
$1,290.75
|
| Rate for Payer: Cash Price |
$1,250.27
|
| Rate for Payer: Cofinity Commercial |
$1,344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,250.27
|
| Rate for Payer: Healthscope Commercial |
$1,406.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,172.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,328.41
|
| Rate for Payer: Nomi Health Commercial |
$1,281.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.13
|
| Rate for Payer: PHP Commercial |
$1,328.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,359.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,087.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,375.30
|
| Rate for Payer: UHC Core |
$1,304.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,172.13
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
OP
|
$3,767.76
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$664.26 |
| Max. Negotiated Rate |
$3,390.98 |
| Rate for Payer: Aetna Commercial |
$3,202.60
|
| Rate for Payer: Aetna Medicare |
$979.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,177.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,177.42
|
| Rate for Payer: BCBS Complete |
$697.41
|
| Rate for Payer: BCBS MAPPO |
$941.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,097.48
|
| Rate for Payer: BCN Commercial |
$3,097.48
|
| Rate for Payer: BCN Medicare Advantage |
$941.94
|
| Rate for Payer: Cash Price |
$3,014.21
|
| Rate for Payer: Cofinity Commercial |
$3,240.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,014.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$941.94
|
| Rate for Payer: Healthscope Commercial |
$3,390.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,825.82
|
| Rate for Payer: Mclaren Medicaid |
$664.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$989.04
|
| Rate for Payer: Meridian Medicaid |
$697.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,083.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,036.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.60
|
| Rate for Payer: Nomi Health Commercial |
$3,089.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.82
|
| Rate for Payer: PACE Senior Care Partners |
$894.84
|
| Rate for Payer: PACE SWMI |
$941.94
|
| Rate for Payer: PHP Commercial |
$3,202.60
|
| Rate for Payer: PHP Medicare Advantage |
$941.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$664.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,277.95
|
| Rate for Payer: Priority Health Medicare |
$951.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,622.36
|
| Rate for Payer: Railroad Medicare Medicare |
$941.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,315.63
|
| Rate for Payer: UHC Core |
$3,146.08
|
| Rate for Payer: UHC Exchange |
$941.94
|
| Rate for Payer: UHC Medicaid |
$664.26
|
| Rate for Payer: UHC Medicare Advantage |
$941.94
|
| Rate for Payer: UHCCP Medicaid |
$664.26
|
| Rate for Payer: VA VA |
$941.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,825.82
|
|
