|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$151.98
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$92.69 |
| Max. Negotiated Rate |
$136.78 |
| Rate for Payer: Aetna Commercial |
$129.18
|
| Rate for Payer: BCBS Trust/PPO |
$117.45
|
| Rate for Payer: BCN Commercial |
$117.45
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cofinity Commercial |
$130.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.58
|
| Rate for Payer: Healthscope Commercial |
$136.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.18
|
| Rate for Payer: PHP Commercial |
$129.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.74
|
| Rate for Payer: UHC Core |
$126.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.98
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
OP
|
$151.98
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$136.78 |
| Rate for Payer: Aetna Commercial |
$129.18
|
| Rate for Payer: Aetna Medicare |
$39.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.49
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: BCBS MAPPO |
$38.00
|
| Rate for Payer: BCBS Trust/PPO |
$118.16
|
| Rate for Payer: BCN Commercial |
$118.16
|
| Rate for Payer: BCN Medicare Advantage |
$38.00
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cofinity Commercial |
$130.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.00
|
| Rate for Payer: Healthscope Commercial |
$136.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.98
|
| Rate for Payer: Mclaren Medicaid |
$9.50
|
| Rate for Payer: Meridian Medicaid |
$9.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.18
|
| Rate for Payer: PACE Senior Care Partners |
$36.10
|
| Rate for Payer: PACE SWMI |
$38.00
|
| Rate for Payer: PHP Commercial |
$129.18
|
| Rate for Payer: PHP Medicare Advantage |
$38.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.22
|
| Rate for Payer: Priority Health Medicare |
$38.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.69
|
| Rate for Payer: Railroad Medicare Medicare |
$38.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.74
|
| Rate for Payer: UHC Core |
$126.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.00
|
| Rate for Payer: UHC Medicare Advantage |
$39.13
|
| Rate for Payer: VA VA |
$38.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.98
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$314.16
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$282.74 |
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: BCBS Trust/PPO |
$242.78
|
| Rate for Payer: BCN Commercial |
$242.78
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cofinity Commercial |
$270.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.33
|
| Rate for Payer: Healthscope Commercial |
$282.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.04
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.46
|
| Rate for Payer: UHC Core |
$262.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.62
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$314.16
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$282.74 |
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: Aetna Medicare |
$81.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.18
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: BCBS MAPPO |
$78.54
|
| Rate for Payer: BCBS Trust/PPO |
$244.26
|
| Rate for Payer: BCN Commercial |
$244.26
|
| Rate for Payer: BCN Medicare Advantage |
$78.54
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cofinity Commercial |
$270.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.54
|
| Rate for Payer: Healthscope Commercial |
$282.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.62
|
| Rate for Payer: Mclaren Medicaid |
$9.50
|
| Rate for Payer: Meridian Medicaid |
$9.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.04
|
| Rate for Payer: PACE Senior Care Partners |
$74.61
|
| Rate for Payer: PACE SWMI |
$78.54
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: PHP Medicare Advantage |
$78.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.32
|
| Rate for Payer: Priority Health Medicare |
$78.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.61
|
| Rate for Payer: Railroad Medicare Medicare |
$78.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.46
|
| Rate for Payer: UHC Core |
$262.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.54
|
| Rate for Payer: UHC Medicare Advantage |
$80.90
|
| Rate for Payer: VA VA |
$78.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.62
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$115.47
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$103.92 |
| Rate for Payer: Aetna Commercial |
$98.15
|
| Rate for Payer: Aetna Medicare |
$30.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.08
|
| Rate for Payer: BCBS Complete |
$46.19
|
| Rate for Payer: BCBS MAPPO |
$28.87
|
| Rate for Payer: BCBS Trust/PPO |
$89.78
|
| Rate for Payer: BCN Commercial |
$89.78
|
| Rate for Payer: BCN Medicare Advantage |
$28.87
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$99.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.87
|
| Rate for Payer: Healthscope Commercial |
$103.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.15
|
| Rate for Payer: PACE Senior Care Partners |
$27.42
|
| Rate for Payer: PACE SWMI |
$28.87
|
| Rate for Payer: PHP Commercial |
$98.15
|
| Rate for Payer: PHP Medicare Advantage |
$28.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.46
|
| Rate for Payer: Priority Health Medicare |
$28.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.43
|
| Rate for Payer: Railroad Medicare Medicare |
$28.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.61
|
| Rate for Payer: UHC Core |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.87
|
| Rate for Payer: UHC Medicare Advantage |
$29.73
|
| Rate for Payer: VA VA |
$28.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.60
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$115.47
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$103.92 |
| Rate for Payer: Aetna Commercial |
$98.15
|
| Rate for Payer: BCBS Trust/PPO |
$89.24
|
| Rate for Payer: BCN Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$99.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$103.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.15
|
| Rate for Payer: PHP Commercial |
$98.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.61
|
| Rate for Payer: UHC Core |
$96.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.60
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
IP
|
$584.10
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$356.24 |
| Max. Negotiated Rate |
$525.69 |
| Rate for Payer: Aetna Commercial |
$496.48
|
| Rate for Payer: BCBS Trust/PPO |
$451.39
|
| Rate for Payer: BCN Commercial |
$451.39
|
| Rate for Payer: Cash Price |
$467.28
|
| Rate for Payer: Cofinity Commercial |
$502.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.28
|
| Rate for Payer: Healthscope Commercial |
$525.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.48
|
| Rate for Payer: PHP Commercial |
$496.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.01
|
| Rate for Payer: UHC Core |
$487.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.08
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
OP
|
$584.10
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$525.69 |
| Rate for Payer: Aetna Commercial |
$496.48
|
| Rate for Payer: Aetna Medicare |
$151.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.53
|
| Rate for Payer: BCBS Complete |
$233.64
|
| Rate for Payer: BCBS MAPPO |
$146.02
|
| Rate for Payer: BCBS Trust/PPO |
$454.14
|
| Rate for Payer: BCN Commercial |
$454.14
|
| Rate for Payer: BCN Medicare Advantage |
$146.02
|
| Rate for Payer: Cash Price |
$467.28
|
| Rate for Payer: Cofinity Commercial |
$502.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.02
|
| Rate for Payer: Healthscope Commercial |
$525.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.48
|
| Rate for Payer: PACE Senior Care Partners |
$138.72
|
| Rate for Payer: PACE SWMI |
$146.02
|
| Rate for Payer: PHP Commercial |
$496.48
|
| Rate for Payer: PHP Medicare Advantage |
$146.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.17
|
| Rate for Payer: Priority Health Medicare |
$146.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.24
|
| Rate for Payer: Railroad Medicare Medicare |
$146.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.01
|
| Rate for Payer: UHC Core |
$487.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.02
|
| Rate for Payer: UHC Medicare Advantage |
$150.41
|
| Rate for Payer: VA VA |
$146.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.08
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.14
|
| Rate for Payer: BCN Commercial |
$81.14
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$25.97
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCN Commercial |
$81.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$24.74
|
| Rate for Payer: Meridian Medicaid |
$25.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Medicare |
$26.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.04
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$289.00
|
| Rate for Payer: Aetna Medicare |
$88.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.25
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$85.00
|
| Rate for Payer: BCBS Trust/PPO |
$264.35
|
| Rate for Payer: BCN Commercial |
$264.35
|
| Rate for Payer: BCN Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.00
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.00
|
| Rate for Payer: Mclaren Medicaid |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.00
|
| Rate for Payer: PACE Senior Care Partners |
$80.75
|
| Rate for Payer: PACE SWMI |
$85.00
|
| Rate for Payer: PHP Commercial |
$289.00
|
| Rate for Payer: PHP Medicare Advantage |
$85.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.80
|
| Rate for Payer: Priority Health Medicare |
$85.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.37
|
| Rate for Payer: Railroad Medicare Medicare |
$85.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.20
|
| Rate for Payer: UHC Core |
$283.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.00
|
| Rate for Payer: UHC Medicare Advantage |
$87.55
|
| Rate for Payer: VA VA |
$85.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.00
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$207.37 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$289.00
|
| Rate for Payer: BCBS Trust/PPO |
$262.75
|
| Rate for Payer: BCN Commercial |
$262.75
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.00
|
| Rate for Payer: PHP Commercial |
$289.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.20
|
| Rate for Payer: UHC Core |
$283.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.00
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS EA 30 DAY
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Aetna Commercial |
$95.62
|
| Rate for Payer: Aetna Medicare |
$29.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.16
|
| Rate for Payer: BCBS Complete |
$25.97
|
| Rate for Payer: BCBS MAPPO |
$28.12
|
| Rate for Payer: BCBS Trust/PPO |
$87.47
|
| Rate for Payer: BCN Commercial |
$87.47
|
| Rate for Payer: BCN Medicare Advantage |
$28.12
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.12
|
| Rate for Payer: Healthscope Commercial |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.38
|
| Rate for Payer: Mclaren Medicaid |
$24.74
|
| Rate for Payer: Meridian Medicaid |
$25.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.62
|
| Rate for Payer: PACE Senior Care Partners |
$26.72
|
| Rate for Payer: PACE SWMI |
$28.12
|
| Rate for Payer: PHP Commercial |
$95.62
|
| Rate for Payer: PHP Medicare Advantage |
$28.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.88
|
| Rate for Payer: Priority Health Medicare |
$28.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.61
|
| Rate for Payer: Railroad Medicare Medicare |
$28.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.00
|
| Rate for Payer: UHC Core |
$93.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.12
|
| Rate for Payer: UHC Medicare Advantage |
$28.97
|
| Rate for Payer: VA VA |
$28.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.38
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS EA 30 DAY
|
Facility
|
IP
|
$112.50
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Aetna Commercial |
$95.62
|
| Rate for Payer: BCBS Trust/PPO |
$86.94
|
| Rate for Payer: BCN Commercial |
$86.94
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.62
|
| Rate for Payer: PHP Commercial |
$95.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.00
|
| Rate for Payer: UHC Core |
$93.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.38
|
|
|
HC REMOTE THER MON SETUP & EDU
|
Facility
|
IP
|
$358.96
|
|
|
Service Code
|
CPT 98975
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$218.93 |
| Max. Negotiated Rate |
$323.06 |
| Rate for Payer: Aetna Commercial |
$305.12
|
| Rate for Payer: BCBS Trust/PPO |
$277.40
|
| Rate for Payer: BCN Commercial |
$277.40
|
| Rate for Payer: Cash Price |
$287.17
|
| Rate for Payer: Cofinity Commercial |
$308.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.17
|
| Rate for Payer: Healthscope Commercial |
$323.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.12
|
| Rate for Payer: PHP Commercial |
$305.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.88
|
| Rate for Payer: UHC Core |
$299.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.22
|
|
|
HC REMOTE THER MON SETUP & EDU
|
Facility
|
OP
|
$358.96
|
|
|
Service Code
|
CPT 98975
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$323.06 |
| Rate for Payer: Aetna Commercial |
$305.12
|
| Rate for Payer: Aetna Medicare |
$93.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.18
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$89.74
|
| Rate for Payer: BCBS Trust/PPO |
$279.09
|
| Rate for Payer: BCN Commercial |
$279.09
|
| Rate for Payer: BCN Medicare Advantage |
$89.74
|
| Rate for Payer: Cash Price |
$287.17
|
| Rate for Payer: Cash Price |
$287.17
|
| Rate for Payer: Cofinity Commercial |
$308.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.74
|
| Rate for Payer: Healthscope Commercial |
$323.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.22
|
| Rate for Payer: Mclaren Medicaid |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$94.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.12
|
| Rate for Payer: PACE Senior Care Partners |
$85.25
|
| Rate for Payer: PACE SWMI |
$89.74
|
| Rate for Payer: PHP Commercial |
$305.12
|
| Rate for Payer: PHP Medicare Advantage |
$89.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.30
|
| Rate for Payer: Priority Health Medicare |
$89.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.93
|
| Rate for Payer: Railroad Medicare Medicare |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.88
|
| Rate for Payer: UHC Core |
$299.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.74
|
| Rate for Payer: UHC Medicare Advantage |
$92.43
|
| Rate for Payer: VA VA |
$89.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.22
|
|
|
HC REMOVAL BILIARY STONE
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
36100516
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.08 |
| Max. Negotiated Rate |
$584.48 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: BCBS Trust/PPO |
$501.87
|
| Rate for Payer: BCN Commercial |
$501.87
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$584.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.49
|
| Rate for Payer: UHC Core |
$542.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.06
|
|
|
HC REMOVAL BILIARY STONE
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
36100516
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$584.48 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna Medicare |
$168.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.94
|
| Rate for Payer: BCBS Complete |
$259.77
|
| Rate for Payer: BCBS MAPPO |
$162.36
|
| Rate for Payer: BCBS Trust/PPO |
$504.92
|
| Rate for Payer: BCN Commercial |
$504.92
|
| Rate for Payer: BCN Medicare Advantage |
$162.36
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.36
|
| Rate for Payer: Healthscope Commercial |
$584.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$170.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: PACE Senior Care Partners |
$154.24
|
| Rate for Payer: PACE SWMI |
$162.36
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: PHP Medicare Advantage |
$162.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.00
|
| Rate for Payer: Priority Health Medicare |
$162.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.08
|
| Rate for Payer: Railroad Medicare Medicare |
$162.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.49
|
| Rate for Payer: UHC Core |
$542.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.36
|
| Rate for Payer: UHC Medicare Advantage |
$167.23
|
| Rate for Payer: VA VA |
$162.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.06
|
|
|
HC REMOVAL CHEST PORT OR PUMP
|
Facility
|
IP
|
$2,135.56
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36100141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,302.48 |
| Max. Negotiated Rate |
$1,922.00 |
| Rate for Payer: Aetna Commercial |
$1,815.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,650.36
|
| Rate for Payer: BCN Commercial |
$1,650.36
|
| Rate for Payer: Cash Price |
$1,708.45
|
| Rate for Payer: Cofinity Commercial |
$1,836.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,708.45
|
| Rate for Payer: Healthscope Commercial |
$1,922.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,601.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,815.23
|
| Rate for Payer: PHP Commercial |
$1,815.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,494.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,857.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,302.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,879.29
|
| Rate for Payer: UHC Core |
$1,783.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,601.67
|
|
|
HC REMOVAL CHEST PORT OR PUMP
|
Facility
|
OP
|
$2,135.56
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36100141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$1,922.00 |
| Rate for Payer: Aetna Commercial |
$1,815.23
|
| Rate for Payer: Aetna Medicare |
$555.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$667.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$667.36
|
| Rate for Payer: BCBS Complete |
$1,103.12
|
| Rate for Payer: BCBS MAPPO |
$533.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.40
|
| Rate for Payer: BCN Commercial |
$1,660.40
|
| Rate for Payer: BCN Medicare Advantage |
$533.89
|
| Rate for Payer: Cash Price |
$1,708.45
|
| Rate for Payer: Cash Price |
$1,708.45
|
| Rate for Payer: Cofinity Commercial |
$1,836.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,708.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$533.89
|
| Rate for Payer: Healthscope Commercial |
$1,922.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,601.67
|
| Rate for Payer: Mclaren Medicaid |
$1,050.59
|
| Rate for Payer: Meridian Medicaid |
$1,103.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$560.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$613.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,815.23
|
| Rate for Payer: PACE Senior Care Partners |
$507.20
|
| Rate for Payer: PACE SWMI |
$533.89
|
| Rate for Payer: PHP Commercial |
$1,815.23
|
| Rate for Payer: PHP Medicare Advantage |
$533.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,050.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,494.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,857.94
|
| Rate for Payer: Priority Health Medicare |
$533.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,302.48
|
| Rate for Payer: Railroad Medicare Medicare |
$533.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,879.29
|
| Rate for Payer: UHC Core |
$1,783.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$533.89
|
| Rate for Payer: UHC Medicare Advantage |
$549.91
|
| Rate for Payer: VA VA |
$533.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,601.67
|
|
|
HC REMOVAL DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$336.60
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.29 |
| Max. Negotiated Rate |
$302.94 |
| Rate for Payer: Aetna Commercial |
$286.11
|
| Rate for Payer: BCBS Trust/PPO |
$260.12
|
| Rate for Payer: BCN Commercial |
$260.12
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cofinity Commercial |
$289.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.28
|
| Rate for Payer: Healthscope Commercial |
$302.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.11
|
| Rate for Payer: PHP Commercial |
$286.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.21
|
| Rate for Payer: UHC Core |
$281.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.45
|
|
|
HC REMOVAL DRUG IMPLANT DEVICE
|
Facility
|
OP
|
$336.60
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.94 |
| Max. Negotiated Rate |
$302.94 |
| Rate for Payer: Aetna Commercial |
$286.11
|
| Rate for Payer: Aetna Medicare |
$87.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.19
|
| Rate for Payer: BCBS Complete |
$274.44
|
| Rate for Payer: BCBS MAPPO |
$84.15
|
| Rate for Payer: BCBS Trust/PPO |
$261.71
|
| Rate for Payer: BCN Commercial |
$261.71
|
| Rate for Payer: BCN Medicare Advantage |
$84.15
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cofinity Commercial |
$289.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.15
|
| Rate for Payer: Healthscope Commercial |
$302.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.45
|
| Rate for Payer: Mclaren Medicaid |
$261.37
|
| Rate for Payer: Meridian Medicaid |
$274.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$88.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.11
|
| Rate for Payer: PACE Senior Care Partners |
$79.94
|
| Rate for Payer: PACE SWMI |
$84.15
|
| Rate for Payer: PHP Commercial |
$286.11
|
| Rate for Payer: PHP Medicare Advantage |
$84.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.84
|
| Rate for Payer: Priority Health Medicare |
$84.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.29
|
| Rate for Payer: Railroad Medicare Medicare |
$84.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.21
|
| Rate for Payer: UHC Core |
$281.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.15
|
| Rate for Payer: UHC Medicare Advantage |
$86.67
|
| Rate for Payer: VA VA |
$84.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.45
|
|
|
HC REMOVAL FB EXTERNAL EYE CORNEAL WO SLIT LAMP
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
76100401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.89 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna Commercial |
$935.00
|
| Rate for Payer: BCBS Trust/PPO |
$850.08
|
| Rate for Payer: BCN Commercial |
$850.08
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$946.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$990.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: PHP Commercial |
$935.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$670.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$968.00
|
| Rate for Payer: UHC Core |
$918.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.00
|
|
|
HC REMOVAL FB EXTERNAL EYE CORNEAL WO SLIT LAMP
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
76100401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.25 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna Commercial |
$935.00
|
| Rate for Payer: Aetna Medicare |
$286.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.75
|
| Rate for Payer: BCBS Complete |
$274.44
|
| Rate for Payer: BCBS MAPPO |
$275.00
|
| Rate for Payer: BCBS Trust/PPO |
$855.25
|
| Rate for Payer: BCN Commercial |
$855.25
|
| Rate for Payer: BCN Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$946.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.00
|
| Rate for Payer: Healthscope Commercial |
$990.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.00
|
| Rate for Payer: Mclaren Medicaid |
$261.37
|
| Rate for Payer: Meridian Medicaid |
$274.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$288.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: PACE Senior Care Partners |
$261.25
|
| Rate for Payer: PACE SWMI |
$275.00
|
| Rate for Payer: PHP Commercial |
$935.00
|
| Rate for Payer: PHP Medicare Advantage |
$275.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.00
|
| Rate for Payer: Priority Health Medicare |
$275.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$670.89
|
| Rate for Payer: Railroad Medicare Medicare |
$275.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$968.00
|
| Rate for Payer: UHC Core |
$918.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.00
|
| Rate for Payer: UHC Medicare Advantage |
$283.25
|
| Rate for Payer: VA VA |
$275.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.00
|
|
|
HC REMOVAL FOREIGN BODY INTRANASAL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.46 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: BCBS Trust/PPO |
$270.48
|
| Rate for Payer: BCN Commercial |
$270.48
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.00
|
| Rate for Payer: UHC Core |
$292.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
