|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: BCBS Trust/PPO |
$85.78
|
| Rate for Payer: BCN Commercial |
$85.78
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.68
|
| Rate for Payer: UHC Core |
$92.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.36 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna Medicare |
$28.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.69
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$86.30
|
| Rate for Payer: BCN Commercial |
$86.30
|
| Rate for Payer: BCN Medicare Advantage |
$27.75
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.75
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: PACE Senior Care Partners |
$26.36
|
| Rate for Payer: PACE SWMI |
$27.75
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: PHP Medicare Advantage |
$27.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.57
|
| Rate for Payer: Priority Health Medicare |
$27.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.70
|
| Rate for Payer: Railroad Medicare Medicare |
$27.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.68
|
| Rate for Payer: UHC Core |
$92.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.75
|
| Rate for Payer: UHC Medicare Advantage |
$28.58
|
| Rate for Payer: VA VA |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
OP
|
$67.73
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$60.96 |
| Rate for Payer: Aetna Commercial |
$57.57
|
| Rate for Payer: Aetna Medicare |
$17.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.17
|
| Rate for Payer: BCBS Complete |
$17.78
|
| Rate for Payer: BCBS MAPPO |
$16.93
|
| Rate for Payer: BCBS Trust/PPO |
$52.66
|
| Rate for Payer: BCN Commercial |
$52.66
|
| Rate for Payer: BCN Medicare Advantage |
$16.93
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$58.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.93
|
| Rate for Payer: Healthscope Commercial |
$60.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.80
|
| Rate for Payer: Mclaren Medicaid |
$16.93
|
| Rate for Payer: Meridian Medicaid |
$17.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.57
|
| Rate for Payer: PACE Senior Care Partners |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.93
|
| Rate for Payer: PHP Commercial |
$57.57
|
| Rate for Payer: PHP Medicare Advantage |
$16.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.93
|
| Rate for Payer: Priority Health Medicare |
$16.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.31
|
| Rate for Payer: Railroad Medicare Medicare |
$16.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.60
|
| Rate for Payer: UHC Core |
$56.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.44
|
| Rate for Payer: VA VA |
$16.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.80
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
IP
|
$67.73
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$41.31 |
| Max. Negotiated Rate |
$60.96 |
| Rate for Payer: Aetna Commercial |
$57.57
|
| Rate for Payer: BCBS Trust/PPO |
$52.34
|
| Rate for Payer: BCN Commercial |
$52.34
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$58.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Healthscope Commercial |
$60.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.57
|
| Rate for Payer: PHP Commercial |
$57.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.60
|
| Rate for Payer: UHC Core |
$56.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.80
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
IP
|
$93.30
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.90 |
| Max. Negotiated Rate |
$83.97 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: BCBS Trust/PPO |
$72.10
|
| Rate for Payer: BCN Commercial |
$72.10
|
| Rate for Payer: Cash Price |
$74.64
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.64
|
| Rate for Payer: Healthscope Commercial |
$83.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.10
|
| Rate for Payer: UHC Core |
$77.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.98
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
OP
|
$93.30
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$83.97 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Medicare |
$24.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.16
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS MAPPO |
$23.32
|
| Rate for Payer: BCBS Trust/PPO |
$72.54
|
| Rate for Payer: BCN Commercial |
$72.54
|
| Rate for Payer: BCN Medicare Advantage |
$23.32
|
| Rate for Payer: Cash Price |
$74.64
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$83.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.30
|
| Rate for Payer: PACE Senior Care Partners |
$22.16
|
| Rate for Payer: PACE SWMI |
$23.32
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Medicare Advantage |
$23.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.17
|
| Rate for Payer: Priority Health Medicare |
$23.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.90
|
| Rate for Payer: Railroad Medicare Medicare |
$23.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.10
|
| Rate for Payer: UHC Core |
$77.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.32
|
| Rate for Payer: UHC Medicare Advantage |
$24.02
|
| Rate for Payer: VA VA |
$23.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.98
|
|
|
HC RLC W INTERVENTION
|
Facility
|
IP
|
$10,979.89
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,696.63 |
| Max. Negotiated Rate |
$9,881.90 |
| Rate for Payer: Aetna Commercial |
$9,332.91
|
| Rate for Payer: BCBS Trust/PPO |
$8,485.26
|
| Rate for Payer: BCN Commercial |
$8,485.26
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cofinity Commercial |
$9,442.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,783.91
|
| Rate for Payer: Healthscope Commercial |
$9,881.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,234.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,332.91
|
| Rate for Payer: PHP Commercial |
$9,332.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,685.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,552.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,696.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,662.30
|
| Rate for Payer: UHC Core |
$9,168.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,234.92
|
|
|
HC RLC W INTERVENTION
|
Facility
|
OP
|
$10,979.89
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,137.59 |
| Max. Negotiated Rate |
$9,881.90 |
| Rate for Payer: Aetna Commercial |
$9,332.91
|
| Rate for Payer: Aetna Medicare |
$2,854.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,431.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,431.22
|
| Rate for Payer: BCBS Complete |
$2,244.47
|
| Rate for Payer: BCBS MAPPO |
$2,744.97
|
| Rate for Payer: BCBS Trust/PPO |
$8,536.86
|
| Rate for Payer: BCN Commercial |
$8,536.86
|
| Rate for Payer: BCN Medicare Advantage |
$2,744.97
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cofinity Commercial |
$9,442.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,783.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,744.97
|
| Rate for Payer: Healthscope Commercial |
$9,881.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,234.92
|
| Rate for Payer: Mclaren Medicaid |
$2,137.59
|
| Rate for Payer: Meridian Medicaid |
$2,244.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,882.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,156.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,332.91
|
| Rate for Payer: PACE Senior Care Partners |
$2,607.72
|
| Rate for Payer: PACE SWMI |
$2,744.97
|
| Rate for Payer: PHP Commercial |
$9,332.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,744.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,137.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,685.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,552.50
|
| Rate for Payer: Priority Health Medicare |
$2,744.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,696.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,744.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,662.30
|
| Rate for Payer: UHC Core |
$9,168.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,744.97
|
| Rate for Payer: UHC Medicare Advantage |
$2,827.32
|
| Rate for Payer: VA VA |
$2,744.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,234.92
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,433.26 |
| Max. Negotiated Rate |
$2,115.00 |
| Rate for Payer: Aetna Commercial |
$1,997.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.08
|
| Rate for Payer: BCN Commercial |
$1,816.08
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cofinity Commercial |
$2,021.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,880.00
|
| Rate for Payer: Healthscope Commercial |
$2,115.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,762.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,997.50
|
| Rate for Payer: PHP Commercial |
$1,997.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,645.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,044.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,433.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,068.00
|
| Rate for Payer: UHC Core |
$1,962.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,762.50
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.12 |
| Max. Negotiated Rate |
$2,115.00 |
| Rate for Payer: Aetna Commercial |
$1,997.50
|
| Rate for Payer: Aetna Medicare |
$611.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$734.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$734.38
|
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: BCBS MAPPO |
$587.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.12
|
| Rate for Payer: BCN Commercial |
$1,827.12
|
| Rate for Payer: BCN Medicare Advantage |
$587.50
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cofinity Commercial |
$2,021.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,880.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.50
|
| Rate for Payer: Healthscope Commercial |
$2,115.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,762.50
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$616.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$675.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,997.50
|
| Rate for Payer: PACE Senior Care Partners |
$558.12
|
| Rate for Payer: PACE SWMI |
$587.50
|
| Rate for Payer: PHP Commercial |
$1,997.50
|
| Rate for Payer: PHP Medicare Advantage |
$587.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,645.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,044.50
|
| Rate for Payer: Priority Health Medicare |
$587.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,433.26
|
| Rate for Payer: Railroad Medicare Medicare |
$587.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,068.00
|
| Rate for Payer: UHC Core |
$1,962.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.50
|
| Rate for Payer: UHC Medicare Advantage |
$605.12
|
| Rate for Payer: VA VA |
$587.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,762.50
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.88
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS MAPPO |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.42
|
| Rate for Payer: BCN Commercial |
$54.42
|
| Rate for Payer: BCN Medicare Advantage |
$17.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Mclaren Medicaid |
$8.51
|
| Rate for Payer: Meridian Medicaid |
$8.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PACE Senior Care Partners |
$16.62
|
| Rate for Payer: PACE SWMI |
$17.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Medicare Advantage |
$17.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Medicare |
$17.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.50
|
| Rate for Payer: UHC Medicare Advantage |
$18.02
|
| Rate for Payer: VA VA |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.10
|
| Rate for Payer: BCN Commercial |
$54.10
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.78
|
| Rate for Payer: BCBS Complete |
$13.89
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.81
|
| Rate for Payer: BCN Commercial |
$26.81
|
| Rate for Payer: BCN Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Mclaren Medicaid |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$13.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Senior Care Partners |
$8.19
|
| Rate for Payer: PACE SWMI |
$8.62
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$8.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: Railroad Medicare Medicare |
$8.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$8.88
|
| Rate for Payer: VA VA |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: BCBS Trust/PPO |
$26.65
|
| Rate for Payer: BCN Commercial |
$26.65
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.78
|
| Rate for Payer: BCBS Complete |
$13.89
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.81
|
| Rate for Payer: BCN Commercial |
$26.81
|
| Rate for Payer: BCN Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Mclaren Medicaid |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$13.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Senior Care Partners |
$8.19
|
| Rate for Payer: PACE SWMI |
$8.62
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$8.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: Railroad Medicare Medicare |
$8.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$8.88
|
| Rate for Payer: VA VA |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: BCBS Trust/PPO |
$26.65
|
| Rate for Payer: BCN Commercial |
$26.65
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: BCBS Trust/PPO |
$26.65
|
| Rate for Payer: BCN Commercial |
$26.65
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.78
|
| Rate for Payer: BCBS Complete |
$13.89
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.81
|
| Rate for Payer: BCN Commercial |
$26.81
|
| Rate for Payer: BCN Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Mclaren Medicaid |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$13.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Senior Care Partners |
$8.19
|
| Rate for Payer: PACE SWMI |
$8.62
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$8.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: Railroad Medicare Medicare |
$8.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$8.88
|
| Rate for Payer: VA VA |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$219.40
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.11 |
| Max. Negotiated Rate |
$197.46 |
| Rate for Payer: Aetna Commercial |
$186.49
|
| Rate for Payer: Aetna Commercial |
$905.25
|
| Rate for Payer: Aetna Medicare |
$276.90
|
| Rate for Payer: Aetna Medicare |
$57.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$332.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$332.81
|
| Rate for Payer: BCBS Complete |
$87.76
|
| Rate for Payer: BCBS Complete |
$426.00
|
| Rate for Payer: BCBS MAPPO |
$266.25
|
| Rate for Payer: BCBS MAPPO |
$54.85
|
| Rate for Payer: BCBS Trust/PPO |
$170.58
|
| Rate for Payer: BCBS Trust/PPO |
$828.04
|
| Rate for Payer: BCN Commercial |
$170.58
|
| Rate for Payer: BCN Commercial |
$828.04
|
| Rate for Payer: BCN Medicare Advantage |
$266.25
|
| Rate for Payer: BCN Medicare Advantage |
$54.85
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cofinity Commercial |
$915.90
|
| Rate for Payer: Cofinity Commercial |
$188.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$852.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.85
|
| Rate for Payer: Healthscope Commercial |
$958.50
|
| Rate for Payer: Healthscope Commercial |
$197.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$279.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.25
|
| Rate for Payer: PACE Senior Care Partners |
$52.11
|
| Rate for Payer: PACE Senior Care Partners |
$252.94
|
| Rate for Payer: PACE SWMI |
$266.25
|
| Rate for Payer: PACE SWMI |
$54.85
|
| Rate for Payer: PHP Commercial |
$186.49
|
| Rate for Payer: PHP Commercial |
$905.25
|
| Rate for Payer: PHP Medicare Advantage |
$54.85
|
| Rate for Payer: PHP Medicare Advantage |
$266.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$926.55
|
| Rate for Payer: Priority Health Medicare |
$266.25
|
| Rate for Payer: Priority Health Medicare |
$54.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.54
|
| Rate for Payer: Railroad Medicare Medicare |
$266.25
|
| Rate for Payer: Railroad Medicare Medicare |
$54.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$937.20
|
| Rate for Payer: UHC Core |
$889.28
|
| Rate for Payer: UHC Core |
$183.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.25
|
| Rate for Payer: UHC Medicare Advantage |
$56.50
|
| Rate for Payer: UHC Medicare Advantage |
$274.24
|
| Rate for Payer: VA VA |
$266.25
|
| Rate for Payer: VA VA |
$54.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.55
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$219.40
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$133.81 |
| Max. Negotiated Rate |
$197.46 |
| Rate for Payer: Aetna Commercial |
$186.49
|
| Rate for Payer: Aetna Commercial |
$905.25
|
| Rate for Payer: BCBS Trust/PPO |
$169.55
|
| Rate for Payer: BCBS Trust/PPO |
$823.03
|
| Rate for Payer: BCN Commercial |
$169.55
|
| Rate for Payer: BCN Commercial |
$823.03
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cofinity Commercial |
$915.90
|
| Rate for Payer: Cofinity Commercial |
$188.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$852.00
|
| Rate for Payer: Healthscope Commercial |
$197.46
|
| Rate for Payer: Healthscope Commercial |
$958.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.49
|
| Rate for Payer: PHP Commercial |
$186.49
|
| Rate for Payer: PHP Commercial |
$905.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$926.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$937.20
|
| Rate for Payer: UHC Core |
$889.28
|
| Rate for Payer: UHC Core |
$183.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.55
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$3,223.53
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,966.03 |
| Max. Negotiated Rate |
$2,901.18 |
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna Commercial |
$4,501.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,092.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,491.14
|
| Rate for Payer: BCN Commercial |
$4,092.75
|
| Rate for Payer: BCN Commercial |
$2,491.14
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Cofinity Commercial |
$4,554.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,236.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Healthscope Commercial |
$4,766.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,972.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,417.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.60
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Commercial |
$4,501.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,607.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,804.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,966.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,230.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,660.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,836.71
|
| Rate for Payer: UHC Core |
$2,691.65
|
| Rate for Payer: UHC Core |
$4,422.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,972.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,417.65
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$5,296.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$386.16 |
| Max. Negotiated Rate |
$4,766.40 |
| Rate for Payer: Aetna Commercial |
$4,501.60
|
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna Medicare |
$1,376.96
|
| Rate for Payer: Aetna Medicare |
$838.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,655.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,655.00
|
| Rate for Payer: BCBS Complete |
$405.47
|
| Rate for Payer: BCBS Complete |
$405.47
|
| Rate for Payer: BCBS MAPPO |
$805.88
|
| Rate for Payer: BCBS MAPPO |
$1,324.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,506.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,117.64
|
| Rate for Payer: BCN Commercial |
$2,506.29
|
| Rate for Payer: BCN Commercial |
$4,117.64
|
| Rate for Payer: BCN Medicare Advantage |
$805.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,324.00
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,236.80
|
| Rate for Payer: Cofinity Commercial |
$4,554.56
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,236.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,324.00
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Healthscope Commercial |
$4,766.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,972.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,417.65
|
| Rate for Payer: Mclaren Medicaid |
$386.16
|
| Rate for Payer: Mclaren Medicaid |
$386.16
|
| Rate for Payer: Meridian Medicaid |
$405.47
|
| Rate for Payer: Meridian Medicaid |
$405.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,390.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,522.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,501.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,257.80
|
| Rate for Payer: PACE Senior Care Partners |
$765.59
|
| Rate for Payer: PACE SWMI |
$1,324.00
|
| Rate for Payer: PACE SWMI |
$805.88
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Commercial |
$4,501.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,324.00
|
| Rate for Payer: PHP Medicare Advantage |
$805.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,707.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,804.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,607.52
|
| Rate for Payer: Priority Health Medicare |
$805.88
|
| Rate for Payer: Priority Health Medicare |
$1,324.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,230.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,966.03
|
| Rate for Payer: Railroad Medicare Medicare |
$805.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,324.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,660.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,836.71
|
| Rate for Payer: UHC Core |
$2,691.65
|
| Rate for Payer: UHC Core |
$4,422.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,324.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,363.72
|
| Rate for Payer: UHC Medicare Advantage |
$830.06
|
| Rate for Payer: VA VA |
$805.88
|
| Rate for Payer: VA VA |
$1,324.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,417.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,972.00
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$5,096.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$386.16 |
| Max. Negotiated Rate |
$4,586.40 |
| Rate for Payer: Aetna Commercial |
$4,331.60
|
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna Medicare |
$838.12
|
| Rate for Payer: Aetna Medicare |
$1,324.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,592.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,592.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.35
|
| Rate for Payer: BCBS Complete |
$405.47
|
| Rate for Payer: BCBS Complete |
$405.47
|
| Rate for Payer: BCBS MAPPO |
$1,274.00
|
| Rate for Payer: BCBS MAPPO |
$805.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,506.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,962.14
|
| Rate for Payer: BCN Commercial |
$3,962.14
|
| Rate for Payer: BCN Commercial |
$2,506.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,274.00
|
| Rate for Payer: BCN Medicare Advantage |
$805.88
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Cofinity Commercial |
$4,382.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,076.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,274.00
|
| Rate for Payer: Healthscope Commercial |
$4,586.40
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,822.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,417.65
|
| Rate for Payer: Mclaren Medicaid |
$386.16
|
| Rate for Payer: Mclaren Medicaid |
$386.16
|
| Rate for Payer: Meridian Medicaid |
$405.47
|
| Rate for Payer: Meridian Medicaid |
$405.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,337.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,465.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,331.60
|
| Rate for Payer: PACE Senior Care Partners |
$1,210.30
|
| Rate for Payer: PACE Senior Care Partners |
$765.59
|
| Rate for Payer: PACE SWMI |
$805.88
|
| Rate for Payer: PACE SWMI |
$1,274.00
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Commercial |
$4,331.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,274.00
|
| Rate for Payer: PHP Medicare Advantage |
$805.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,804.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,433.52
|
| Rate for Payer: Priority Health Medicare |
$805.88
|
| Rate for Payer: Priority Health Medicare |
$1,274.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,966.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,108.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,274.00
|
| Rate for Payer: Railroad Medicare Medicare |
$805.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,836.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,484.48
|
| Rate for Payer: UHC Core |
$2,691.65
|
| Rate for Payer: UHC Core |
$4,255.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,274.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.22
|
| Rate for Payer: UHC Medicare Advantage |
$830.06
|
| Rate for Payer: VA VA |
$805.88
|
| Rate for Payer: VA VA |
$1,274.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,822.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,417.65
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$3,223.53
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,966.03 |
| Max. Negotiated Rate |
$2,901.18 |
| Rate for Payer: Aetna Commercial |
$2,740.00
|
| Rate for Payer: Aetna Commercial |
$4,331.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,938.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,491.14
|
| Rate for Payer: BCN Commercial |
$3,938.19
|
| Rate for Payer: BCN Commercial |
$2,491.14
|
| Rate for Payer: Cash Price |
$2,578.82
|
| Rate for Payer: Cash Price |
$4,076.80
|
| Rate for Payer: Cofinity Commercial |
$2,772.24
|
| Rate for Payer: Cofinity Commercial |
$4,382.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,076.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.82
|
| Rate for Payer: Healthscope Commercial |
$4,586.40
|
| Rate for Payer: Healthscope Commercial |
$2,901.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,417.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,822.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,740.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,331.60
|
| Rate for Payer: PHP Commercial |
$2,740.00
|
| Rate for Payer: PHP Commercial |
$4,331.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,433.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,804.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,108.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,966.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,836.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,484.48
|
| Rate for Payer: UHC Core |
$2,691.65
|
| Rate for Payer: UHC Core |
$4,255.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,822.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,417.65
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$325.38
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$292.84 |
| Rate for Payer: Aetna Commercial |
$276.57
|
| Rate for Payer: Aetna Medicare |
$84.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.68
|
| Rate for Payer: BCBS Complete |
$185.11
|
| Rate for Payer: BCBS MAPPO |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$252.98
|
| Rate for Payer: BCN Commercial |
$252.98
|
| Rate for Payer: BCN Medicare Advantage |
$81.34
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cash Price |
$260.30
|
| Rate for Payer: Cofinity Commercial |
$279.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.34
|
| Rate for Payer: Healthscope Commercial |
$292.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.04
|
| Rate for Payer: Mclaren Medicaid |
$176.29
|
| Rate for Payer: Meridian Medicaid |
$185.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.57
|
| Rate for Payer: PACE Senior Care Partners |
$77.28
|
| Rate for Payer: PACE SWMI |
$81.34
|
| Rate for Payer: PHP Commercial |
$276.57
|
| Rate for Payer: PHP Medicare Advantage |
$81.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.08
|
| Rate for Payer: Priority Health Medicare |
$81.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.45
|
| Rate for Payer: Railroad Medicare Medicare |
$81.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.33
|
| Rate for Payer: UHC Core |
$271.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.34
|
| Rate for Payer: UHC Medicare Advantage |
$83.79
|
| Rate for Payer: VA VA |
$81.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.04
|
|
