|
HC INFUSION CATHETER LVL 6
|
Facility
|
IP
|
$676.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.48 |
| Max. Negotiated Rate |
$608.51 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: BCBS Trust/PPO |
$551.92
|
| Rate for Payer: BCN Commercial |
$522.51
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cofinity Commercial |
$581.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.90
|
| Rate for Payer: Healthscope Commercial |
$608.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.70
|
| Rate for Payer: Nomi Health Commercial |
$554.42
|
| Rate for Payer: PHP Commercial |
$574.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.48
|
| Rate for Payer: Priority Health HMO/PPO |
$588.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$453.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.99
|
| Rate for Payer: UHC Core |
$564.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.09
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
IP
|
$755.19
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.87 |
| Max. Negotiated Rate |
$679.67 |
| Rate for Payer: Aetna Commercial |
$641.91
|
| Rate for Payer: BCBS Trust/PPO |
$616.46
|
| Rate for Payer: BCN Commercial |
$583.61
|
| Rate for Payer: Cash Price |
$604.15
|
| Rate for Payer: Cofinity Commercial |
$649.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.15
|
| Rate for Payer: Healthscope Commercial |
$679.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$566.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$641.91
|
| Rate for Payer: Nomi Health Commercial |
$619.26
|
| Rate for Payer: PHP Commercial |
$641.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.87
|
| Rate for Payer: Priority Health HMO/PPO |
$657.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$505.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$664.57
|
| Rate for Payer: UHC Core |
$630.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$566.39
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
OP
|
$755.19
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.36 |
| Max. Negotiated Rate |
$679.67 |
| Rate for Payer: Aetna Commercial |
$641.91
|
| Rate for Payer: Aetna Medicare |
$196.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.00
|
| Rate for Payer: BCBS Complete |
$302.08
|
| Rate for Payer: BCBS MAPPO |
$188.80
|
| Rate for Payer: BCBS Trust/PPO |
$620.84
|
| Rate for Payer: BCN Commercial |
$587.16
|
| Rate for Payer: BCN Medicare Advantage |
$188.80
|
| Rate for Payer: Cash Price |
$604.15
|
| Rate for Payer: Cofinity Commercial |
$649.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.80
|
| Rate for Payer: Healthscope Commercial |
$679.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$566.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$641.91
|
| Rate for Payer: Nomi Health Commercial |
$619.26
|
| Rate for Payer: PACE Senior Care Partners |
$179.36
|
| Rate for Payer: PACE SWMI |
$188.80
|
| Rate for Payer: PHP Commercial |
$641.91
|
| Rate for Payer: PHP Medicare Advantage |
$188.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.87
|
| Rate for Payer: Priority Health HMO/PPO |
$657.02
|
| Rate for Payer: Priority Health Medicare |
$190.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$505.98
|
| Rate for Payer: Railroad Medicare Medicare |
$188.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$664.57
|
| Rate for Payer: UHC Core |
$630.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.80
|
| Rate for Payer: UHC Exchange |
$188.80
|
| Rate for Payer: UHC Medicare Advantage |
$188.80
|
| Rate for Payer: VA VA |
$188.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$566.39
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
OP
|
$922.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.04 |
| Max. Negotiated Rate |
$830.03 |
| Rate for Payer: Aetna Commercial |
$783.92
|
| Rate for Payer: Aetna Medicare |
$239.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.21
|
| Rate for Payer: BCBS Complete |
$368.90
|
| Rate for Payer: BCBS MAPPO |
$230.56
|
| Rate for Payer: BCBS Trust/PPO |
$758.19
|
| Rate for Payer: BCN Commercial |
$717.06
|
| Rate for Payer: BCN Medicare Advantage |
$230.56
|
| Rate for Payer: Cash Price |
$737.81
|
| Rate for Payer: Cofinity Commercial |
$793.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.56
|
| Rate for Payer: Healthscope Commercial |
$830.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.92
|
| Rate for Payer: Nomi Health Commercial |
$756.25
|
| Rate for Payer: PACE Senior Care Partners |
$219.04
|
| Rate for Payer: PACE SWMI |
$230.56
|
| Rate for Payer: PHP Commercial |
$783.92
|
| Rate for Payer: PHP Medicare Advantage |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.47
|
| Rate for Payer: Priority Health HMO/PPO |
$802.37
|
| Rate for Payer: Priority Health Medicare |
$232.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.91
|
| Rate for Payer: Railroad Medicare Medicare |
$230.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.59
|
| Rate for Payer: UHC Core |
$770.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.56
|
| Rate for Payer: UHC Exchange |
$230.56
|
| Rate for Payer: UHC Medicare Advantage |
$230.56
|
| Rate for Payer: VA VA |
$230.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.70
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
IP
|
$922.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$599.47 |
| Max. Negotiated Rate |
$830.03 |
| Rate for Payer: Aetna Commercial |
$783.92
|
| Rate for Payer: BCBS Trust/PPO |
$752.84
|
| Rate for Payer: BCN Commercial |
$712.72
|
| Rate for Payer: Cash Price |
$737.81
|
| Rate for Payer: Cofinity Commercial |
$793.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.81
|
| Rate for Payer: Healthscope Commercial |
$830.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.92
|
| Rate for Payer: Nomi Health Commercial |
$756.25
|
| Rate for Payer: PHP Commercial |
$783.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.47
|
| Rate for Payer: Priority Health HMO/PPO |
$802.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.59
|
| Rate for Payer: UHC Core |
$770.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.70
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
IP
|
$1,026.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.45 |
| Max. Negotiated Rate |
$924.16 |
| Rate for Payer: Aetna Commercial |
$872.81
|
| Rate for Payer: BCBS Trust/PPO |
$838.21
|
| Rate for Payer: BCN Commercial |
$793.54
|
| Rate for Payer: Cash Price |
$821.47
|
| Rate for Payer: Cofinity Commercial |
$883.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.47
|
| Rate for Payer: Healthscope Commercial |
$924.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$770.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.81
|
| Rate for Payer: Nomi Health Commercial |
$842.01
|
| Rate for Payer: PHP Commercial |
$872.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.45
|
| Rate for Payer: Priority Health HMO/PPO |
$893.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$687.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$903.62
|
| Rate for Payer: UHC Core |
$857.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$770.13
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
OP
|
$1,026.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.87 |
| Max. Negotiated Rate |
$924.16 |
| Rate for Payer: Aetna Commercial |
$872.81
|
| Rate for Payer: Aetna Medicare |
$266.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.89
|
| Rate for Payer: BCBS Complete |
$410.74
|
| Rate for Payer: BCBS MAPPO |
$256.71
|
| Rate for Payer: BCBS Trust/PPO |
$844.17
|
| Rate for Payer: BCN Commercial |
$798.37
|
| Rate for Payer: BCN Medicare Advantage |
$256.71
|
| Rate for Payer: Cash Price |
$821.47
|
| Rate for Payer: Cofinity Commercial |
$883.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.71
|
| Rate for Payer: Healthscope Commercial |
$924.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$770.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.81
|
| Rate for Payer: Nomi Health Commercial |
$842.01
|
| Rate for Payer: PACE Senior Care Partners |
$243.87
|
| Rate for Payer: PACE SWMI |
$256.71
|
| Rate for Payer: PHP Commercial |
$872.81
|
| Rate for Payer: PHP Medicare Advantage |
$256.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.45
|
| Rate for Payer: Priority Health HMO/PPO |
$893.35
|
| Rate for Payer: Priority Health Medicare |
$259.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$687.98
|
| Rate for Payer: Railroad Medicare Medicare |
$256.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$903.62
|
| Rate for Payer: UHC Core |
$857.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.71
|
| Rate for Payer: UHC Exchange |
$256.71
|
| Rate for Payer: UHC Medicare Advantage |
$256.71
|
| Rate for Payer: VA VA |
$256.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$770.13
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
IP
|
$1,143.29
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$743.14 |
| Max. Negotiated Rate |
$1,028.96 |
| Rate for Payer: Aetna Commercial |
$971.80
|
| Rate for Payer: BCBS Trust/PPO |
$933.27
|
| Rate for Payer: BCN Commercial |
$883.53
|
| Rate for Payer: Cash Price |
$914.63
|
| Rate for Payer: Cofinity Commercial |
$983.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.63
|
| Rate for Payer: Healthscope Commercial |
$1,028.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.80
|
| Rate for Payer: Nomi Health Commercial |
$937.50
|
| Rate for Payer: PHP Commercial |
$971.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.14
|
| Rate for Payer: Priority Health HMO/PPO |
$994.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$766.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.10
|
| Rate for Payer: UHC Core |
$954.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.47
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
OP
|
$1,143.29
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$1,028.96 |
| Rate for Payer: Aetna Commercial |
$971.80
|
| Rate for Payer: Aetna Medicare |
$297.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$357.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$357.28
|
| Rate for Payer: BCBS Complete |
$457.32
|
| Rate for Payer: BCBS MAPPO |
$285.82
|
| Rate for Payer: BCBS Trust/PPO |
$939.90
|
| Rate for Payer: BCN Commercial |
$888.91
|
| Rate for Payer: BCN Medicare Advantage |
$285.82
|
| Rate for Payer: Cash Price |
$914.63
|
| Rate for Payer: Cofinity Commercial |
$983.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.82
|
| Rate for Payer: Healthscope Commercial |
$1,028.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.80
|
| Rate for Payer: Nomi Health Commercial |
$937.50
|
| Rate for Payer: PACE Senior Care Partners |
$271.53
|
| Rate for Payer: PACE SWMI |
$285.82
|
| Rate for Payer: PHP Commercial |
$971.80
|
| Rate for Payer: PHP Medicare Advantage |
$285.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.14
|
| Rate for Payer: Priority Health HMO/PPO |
$994.66
|
| Rate for Payer: Priority Health Medicare |
$288.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$766.00
|
| Rate for Payer: Railroad Medicare Medicare |
$285.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.10
|
| Rate for Payer: UHC Core |
$954.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.82
|
| Rate for Payer: UHC Exchange |
$285.82
|
| Rate for Payer: UHC Medicare Advantage |
$285.82
|
| Rate for Payer: VA VA |
$285.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.47
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
OP
|
$1,272.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.32 |
| Max. Negotiated Rate |
$1,145.64 |
| Rate for Payer: Aetna Commercial |
$1,081.99
|
| Rate for Payer: Aetna Medicare |
$330.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$397.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$397.79
|
| Rate for Payer: BCBS Complete |
$509.17
|
| Rate for Payer: BCBS MAPPO |
$318.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.48
|
| Rate for Payer: BCN Commercial |
$989.70
|
| Rate for Payer: BCN Medicare Advantage |
$318.23
|
| Rate for Payer: Cash Price |
$1,018.34
|
| Rate for Payer: Cofinity Commercial |
$1,094.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.23
|
| Rate for Payer: Healthscope Commercial |
$1,145.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.99
|
| Rate for Payer: Nomi Health Commercial |
$1,043.80
|
| Rate for Payer: PACE Senior Care Partners |
$302.32
|
| Rate for Payer: PACE SWMI |
$318.23
|
| Rate for Payer: PHP Commercial |
$1,081.99
|
| Rate for Payer: PHP Medicare Advantage |
$318.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,107.45
|
| Rate for Payer: Priority Health Medicare |
$321.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$852.86
|
| Rate for Payer: Railroad Medicare Medicare |
$318.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,120.18
|
| Rate for Payer: UHC Core |
$1,062.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.23
|
| Rate for Payer: UHC Exchange |
$318.23
|
| Rate for Payer: UHC Medicare Advantage |
$318.23
|
| Rate for Payer: VA VA |
$318.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.70
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
IP
|
$1,272.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.40 |
| Max. Negotiated Rate |
$1,145.64 |
| Rate for Payer: Aetna Commercial |
$1,081.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.09
|
| Rate for Payer: BCN Commercial |
$983.72
|
| Rate for Payer: Cash Price |
$1,018.34
|
| Rate for Payer: Cofinity Commercial |
$1,094.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.34
|
| Rate for Payer: Healthscope Commercial |
$1,145.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.99
|
| Rate for Payer: Nomi Health Commercial |
$1,043.80
|
| Rate for Payer: PHP Commercial |
$1,081.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,107.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$852.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,120.18
|
| Rate for Payer: UHC Core |
$1,062.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.70
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
IP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$897.04 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.54
|
| Rate for Payer: BCN Commercial |
$1,066.51
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,200.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,214.45
|
| Rate for Payer: UHC Core |
$1,152.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.05
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.76 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: Aetna Medicare |
$358.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$431.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$431.27
|
| Rate for Payer: BCBS Complete |
$552.02
|
| Rate for Payer: BCBS MAPPO |
$345.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.55
|
| Rate for Payer: BCN Commercial |
$1,073.00
|
| Rate for Payer: BCN Medicare Advantage |
$345.01
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.01
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: PACE Senior Care Partners |
$327.76
|
| Rate for Payer: PACE SWMI |
$345.01
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: PHP Medicare Advantage |
$345.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,200.65
|
| Rate for Payer: Priority Health Medicare |
$348.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.64
|
| Rate for Payer: Railroad Medicare Medicare |
$345.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,214.45
|
| Rate for Payer: UHC Core |
$1,152.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.01
|
| Rate for Payer: UHC Exchange |
$345.01
|
| Rate for Payer: UHC Medicare Advantage |
$345.01
|
| Rate for Payer: VA VA |
$345.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.05
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
OP
|
$1,475.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.51 |
| Max. Negotiated Rate |
$1,328.26 |
| Rate for Payer: Aetna Commercial |
$1,254.46
|
| Rate for Payer: Aetna Medicare |
$383.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$461.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$461.20
|
| Rate for Payer: BCBS Complete |
$590.34
|
| Rate for Payer: BCBS MAPPO |
$368.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.29
|
| Rate for Payer: BCN Commercial |
$1,147.47
|
| Rate for Payer: BCN Medicare Advantage |
$368.96
|
| Rate for Payer: Cash Price |
$1,180.67
|
| Rate for Payer: Cofinity Commercial |
$1,269.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.96
|
| Rate for Payer: Healthscope Commercial |
$1,328.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,254.46
|
| Rate for Payer: Nomi Health Commercial |
$1,210.19
|
| Rate for Payer: PACE Senior Care Partners |
$350.51
|
| Rate for Payer: PACE SWMI |
$368.96
|
| Rate for Payer: PHP Commercial |
$1,254.46
|
| Rate for Payer: PHP Medicare Advantage |
$368.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,283.98
|
| Rate for Payer: Priority Health Medicare |
$372.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$988.81
|
| Rate for Payer: Railroad Medicare Medicare |
$368.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.74
|
| Rate for Payer: UHC Core |
$1,232.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$368.96
|
| Rate for Payer: UHC Exchange |
$368.96
|
| Rate for Payer: UHC Medicare Advantage |
$368.96
|
| Rate for Payer: VA VA |
$368.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.88
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
IP
|
$1,475.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.30 |
| Max. Negotiated Rate |
$1,328.26 |
| Rate for Payer: Aetna Commercial |
$1,254.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,204.73
|
| Rate for Payer: BCN Commercial |
$1,140.53
|
| Rate for Payer: Cash Price |
$1,180.67
|
| Rate for Payer: Cofinity Commercial |
$1,269.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.67
|
| Rate for Payer: Healthscope Commercial |
$1,328.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,254.46
|
| Rate for Payer: Nomi Health Commercial |
$1,210.19
|
| Rate for Payer: PHP Commercial |
$1,254.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,283.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$988.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.74
|
| Rate for Payer: UHC Core |
$1,232.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.88
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.01 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.44
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$377.34
|
| Rate for Payer: BCN Commercial |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PACE Senior Care Partners |
$109.01
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.75
|
| Rate for Payer: UHC Exchange |
$114.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.75
|
| Rate for Payer: VA VA |
$114.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: BCBS Trust/PPO |
$374.68
|
| Rate for Payer: BCN Commercial |
$354.72
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
OP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: Aetna Medicare |
$154.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.05
|
| Rate for Payer: BCBS Complete |
$238.14
|
| Rate for Payer: BCBS MAPPO |
$148.84
|
| Rate for Payer: BCBS Trust/PPO |
$489.44
|
| Rate for Payer: BCN Commercial |
$462.88
|
| Rate for Payer: BCN Medicare Advantage |
$148.84
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.84
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.05
|
| Rate for Payer: Nomi Health Commercial |
$488.19
|
| Rate for Payer: PACE Senior Care Partners |
$141.40
|
| Rate for Payer: PACE SWMI |
$148.84
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: PHP Medicare Advantage |
$148.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.98
|
| Rate for Payer: Priority Health HMO/PPO |
$517.95
|
| Rate for Payer: Priority Health Medicare |
$150.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.88
|
| Rate for Payer: Railroad Medicare Medicare |
$148.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.91
|
| Rate for Payer: UHC Core |
$497.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.84
|
| Rate for Payer: UHC Exchange |
$148.84
|
| Rate for Payer: UHC Medicare Advantage |
$148.84
|
| Rate for Payer: VA VA |
$148.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
IP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.98 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: BCBS Trust/PPO |
$485.98
|
| Rate for Payer: BCN Commercial |
$460.09
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.05
|
| Rate for Payer: Nomi Health Commercial |
$488.19
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.98
|
| Rate for Payer: Priority Health HMO/PPO |
$517.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.91
|
| Rate for Payer: UHC Core |
$497.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.33 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Medicare |
$219.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.60
|
| Rate for Payer: BCBS Complete |
$337.40
|
| Rate for Payer: BCBS MAPPO |
$210.88
|
| Rate for Payer: BCBS Trust/PPO |
$693.45
|
| Rate for Payer: BCN Commercial |
$655.83
|
| Rate for Payer: BCN Medicare Advantage |
$210.88
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$725.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.88
|
| Rate for Payer: Healthscope Commercial |
$759.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: Nomi Health Commercial |
$691.68
|
| Rate for Payer: PACE Senior Care Partners |
$200.33
|
| Rate for Payer: PACE SWMI |
$210.88
|
| Rate for Payer: PHP Commercial |
$716.98
|
| Rate for Payer: PHP Medicare Advantage |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health HMO/PPO |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$212.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.15
|
| Rate for Payer: Railroad Medicare Medicare |
$210.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.29
|
| Rate for Payer: UHC Core |
$704.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.88
|
| Rate for Payer: UHC Exchange |
$210.88
|
| Rate for Payer: UHC Medicare Advantage |
$210.88
|
| Rate for Payer: VA VA |
$210.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.63
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
IP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.28 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: BCBS Trust/PPO |
$688.56
|
| Rate for Payer: BCN Commercial |
$651.86
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$725.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Healthscope Commercial |
$759.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: Nomi Health Commercial |
$691.68
|
| Rate for Payer: PHP Commercial |
$716.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health HMO/PPO |
$733.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.29
|
| Rate for Payer: UHC Core |
$704.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.63
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$58.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.12
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: BCBS MAPPO |
$56.10
|
| Rate for Payer: BCBS Trust/PPO |
$184.48
|
| Rate for Payer: BCN Commercial |
$174.47
|
| Rate for Payer: BCN Medicare Advantage |
$56.10
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$192.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.10
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: PACE Senior Care Partners |
$53.30
|
| Rate for Payer: PACE SWMI |
$56.10
|
| Rate for Payer: PHP Commercial |
$190.74
|
| Rate for Payer: PHP Medicare Advantage |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health HMO/PPO |
$195.23
|
| Rate for Payer: Priority Health Medicare |
$56.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.35
|
| Rate for Payer: Railroad Medicare Medicare |
$56.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.47
|
| Rate for Payer: UHC Core |
$187.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.10
|
| Rate for Payer: UHC Exchange |
$56.10
|
| Rate for Payer: UHC Medicare Advantage |
$56.10
|
| Rate for Payer: VA VA |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.30
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: BCBS Trust/PPO |
$183.18
|
| Rate for Payer: BCN Commercial |
$173.42
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$192.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: PHP Commercial |
$190.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health HMO/PPO |
$195.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.47
|
| Rate for Payer: UHC Core |
$187.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.30
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$929.49 |
| Max. Negotiated Rate |
$1,286.99 |
| Rate for Payer: Aetna Commercial |
$1,215.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,167.30
|
| Rate for Payer: BCN Commercial |
$1,105.10
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,229.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Healthscope Commercial |
$1,286.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: PHP Commercial |
$1,215.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,244.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.39
|
| Rate for Payer: UHC Core |
$1,194.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.49
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.62 |
| Max. Negotiated Rate |
$1,286.99 |
| Rate for Payer: Aetna Commercial |
$1,215.49
|
| Rate for Payer: Aetna Medicare |
$371.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.87
|
| Rate for Payer: BCBS Complete |
$402.83
|
| Rate for Payer: BCBS MAPPO |
$357.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.59
|
| Rate for Payer: BCN Commercial |
$1,111.82
|
| Rate for Payer: BCN Medicare Advantage |
$357.50
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,229.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.50
|
| Rate for Payer: Healthscope Commercial |
$1,286.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.49
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.37
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$411.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: PACE Senior Care Partners |
$339.62
|
| Rate for Payer: PACE SWMI |
$357.50
|
| Rate for Payer: PHP Commercial |
$1,215.49
|
| Rate for Payer: PHP Medicare Advantage |
$357.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,244.09
|
| Rate for Payer: Priority Health Medicare |
$361.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.09
|
| Rate for Payer: Railroad Medicare Medicare |
$357.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.39
|
| Rate for Payer: UHC Core |
$1,194.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.50
|
| Rate for Payer: UHC Exchange |
$357.50
|
| Rate for Payer: UHC Medicare Advantage |
$357.50
|
| Rate for Payer: UHCCP Medicaid |
$383.62
|
| Rate for Payer: VA VA |
$357.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.49
|
|
