|
HC SP Z EMBOLIZATION COIL BODY
|
Facility
|
OP
|
$406.40
|
|
| Hospital Charge Code |
27800058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.52 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: Aetna Medicare |
$105.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.00
|
| Rate for Payer: BCBS Complete |
$162.56
|
| Rate for Payer: BCBS MAPPO |
$101.60
|
| Rate for Payer: BCBS Trust/PPO |
$315.98
|
| Rate for Payer: BCN Commercial |
$315.98
|
| Rate for Payer: BCN Medicare Advantage |
$101.60
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.60
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PACE Senior Care Partners |
$96.52
|
| Rate for Payer: PACE SWMI |
$101.60
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: PHP Medicare Advantage |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.57
|
| Rate for Payer: Priority Health Medicare |
$101.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.86
|
| Rate for Payer: Railroad Medicare Medicare |
$101.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.63
|
| Rate for Payer: UHC Core |
$339.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.60
|
| Rate for Payer: UHC Medicare Advantage |
$104.65
|
| Rate for Payer: VA VA |
$101.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.80
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
OP
|
$1,004.03
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.46 |
| Max. Negotiated Rate |
$903.63 |
| Rate for Payer: Aetna Commercial |
$853.43
|
| Rate for Payer: Aetna Medicare |
$261.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$313.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$313.76
|
| Rate for Payer: BCBS Complete |
$401.61
|
| Rate for Payer: BCBS MAPPO |
$251.01
|
| Rate for Payer: BCBS Trust/PPO |
$780.63
|
| Rate for Payer: BCN Commercial |
$780.63
|
| Rate for Payer: BCN Medicare Advantage |
$251.01
|
| Rate for Payer: Cash Price |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$863.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.01
|
| Rate for Payer: Healthscope Commercial |
$903.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$853.43
|
| Rate for Payer: PACE Senior Care Partners |
$238.46
|
| Rate for Payer: PACE SWMI |
$251.01
|
| Rate for Payer: PHP Commercial |
$853.43
|
| Rate for Payer: PHP Medicare Advantage |
$251.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$873.51
|
| Rate for Payer: Priority Health Medicare |
$251.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.36
|
| Rate for Payer: Railroad Medicare Medicare |
$251.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$883.55
|
| Rate for Payer: UHC Core |
$838.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.01
|
| Rate for Payer: UHC Medicare Advantage |
$258.54
|
| Rate for Payer: VA VA |
$251.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.02
|
|
|
HC SP Z EMBOLIZATION SPHERES
|
Facility
|
IP
|
$1,004.03
|
|
| Hospital Charge Code |
27800057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.36 |
| Max. Negotiated Rate |
$903.63 |
| Rate for Payer: Aetna Commercial |
$853.43
|
| Rate for Payer: BCBS Trust/PPO |
$775.91
|
| Rate for Payer: BCN Commercial |
$775.91
|
| Rate for Payer: Cash Price |
$803.22
|
| Rate for Payer: Cofinity Commercial |
$863.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$803.22
|
| Rate for Payer: Healthscope Commercial |
$903.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$753.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$853.43
|
| Rate for Payer: PHP Commercial |
$853.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$873.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$883.55
|
| Rate for Payer: UHC Core |
$838.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$753.02
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
OP
|
$1,252.58
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.49 |
| Max. Negotiated Rate |
$1,127.32 |
| Rate for Payer: Aetna Commercial |
$1,064.69
|
| Rate for Payer: Aetna Medicare |
$325.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$391.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$391.43
|
| Rate for Payer: BCBS Complete |
$501.03
|
| Rate for Payer: BCBS MAPPO |
$313.14
|
| Rate for Payer: BCBS Trust/PPO |
$973.88
|
| Rate for Payer: BCN Commercial |
$973.88
|
| Rate for Payer: BCN Medicare Advantage |
$313.14
|
| Rate for Payer: Cash Price |
$1,002.06
|
| Rate for Payer: Cofinity Commercial |
$1,077.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.14
|
| Rate for Payer: Healthscope Commercial |
$1,127.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$939.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$328.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,064.69
|
| Rate for Payer: PACE Senior Care Partners |
$297.49
|
| Rate for Payer: PACE SWMI |
$313.14
|
| Rate for Payer: PHP Commercial |
$1,064.69
|
| Rate for Payer: PHP Medicare Advantage |
$313.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,089.74
|
| Rate for Payer: Priority Health Medicare |
$313.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$763.95
|
| Rate for Payer: Railroad Medicare Medicare |
$313.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,102.27
|
| Rate for Payer: UHC Core |
$1,045.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.14
|
| Rate for Payer: UHC Medicare Advantage |
$322.54
|
| Rate for Payer: VA VA |
$313.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$939.44
|
|
|
HC SP Z SEL CATH SEG SUBSEG PULM ART
|
Facility
|
IP
|
$1,252.58
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
36100318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.95 |
| Max. Negotiated Rate |
$1,127.32 |
| Rate for Payer: Aetna Commercial |
$1,064.69
|
| Rate for Payer: BCBS Trust/PPO |
$967.99
|
| Rate for Payer: BCN Commercial |
$967.99
|
| Rate for Payer: Cash Price |
$1,002.06
|
| Rate for Payer: Cofinity Commercial |
$1,077.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.06
|
| Rate for Payer: Healthscope Commercial |
$1,127.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$939.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,064.69
|
| Rate for Payer: PHP Commercial |
$1,064.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,089.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$763.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,102.27
|
| Rate for Payer: UHC Core |
$1,045.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$939.44
|
|
|
HC SP Z TRUE FILL
|
Facility
|
IP
|
$6,624.52
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,040.29 |
| Max. Negotiated Rate |
$5,962.07 |
| Rate for Payer: Aetna Commercial |
$5,630.84
|
| Rate for Payer: BCBS Trust/PPO |
$5,119.43
|
| Rate for Payer: BCN Commercial |
$5,119.43
|
| Rate for Payer: Cash Price |
$5,299.62
|
| Rate for Payer: Cofinity Commercial |
$5,697.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,299.62
|
| Rate for Payer: Healthscope Commercial |
$5,962.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,968.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,630.84
|
| Rate for Payer: PHP Commercial |
$5,630.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,637.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,763.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,040.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,829.58
|
| Rate for Payer: UHC Core |
$5,531.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,968.39
|
|
|
HC SP Z TRUE FILL
|
Facility
|
OP
|
$6,624.52
|
|
| Hospital Charge Code |
27800059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.32 |
| Max. Negotiated Rate |
$5,962.07 |
| Rate for Payer: Aetna Commercial |
$5,630.84
|
| Rate for Payer: Aetna Medicare |
$1,722.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,070.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,070.16
|
| Rate for Payer: BCBS Complete |
$2,649.81
|
| Rate for Payer: BCBS MAPPO |
$1,656.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,150.56
|
| Rate for Payer: BCN Commercial |
$5,150.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,656.13
|
| Rate for Payer: Cash Price |
$5,299.62
|
| Rate for Payer: Cofinity Commercial |
$5,697.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,299.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,656.13
|
| Rate for Payer: Healthscope Commercial |
$5,962.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,968.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,738.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,904.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,630.84
|
| Rate for Payer: PACE Senior Care Partners |
$1,573.32
|
| Rate for Payer: PACE SWMI |
$1,656.13
|
| Rate for Payer: PHP Commercial |
$5,630.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,656.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,637.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,763.33
|
| Rate for Payer: Priority Health Medicare |
$1,656.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,040.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,656.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,829.58
|
| Rate for Payer: UHC Core |
$5,531.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,656.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,705.81
|
| Rate for Payer: VA VA |
$1,656.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,968.39
|
|
|
HC SQ ICD
|
Facility
|
IP
|
$55,312.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33,734.79 |
| Max. Negotiated Rate |
$49,780.80 |
| Rate for Payer: Aetna Commercial |
$47,015.20
|
| Rate for Payer: BCBS Trust/PPO |
$42,745.11
|
| Rate for Payer: BCN Commercial |
$42,745.11
|
| Rate for Payer: Cash Price |
$44,249.60
|
| Rate for Payer: Cofinity Commercial |
$47,568.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,249.60
|
| Rate for Payer: Healthscope Commercial |
$49,780.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,484.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47,015.20
|
| Rate for Payer: PHP Commercial |
$47,015.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38,718.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,121.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33,734.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,674.56
|
| Rate for Payer: UHC Core |
$46,185.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,484.00
|
|
|
HC SQ ICD
|
Facility
|
OP
|
$55,312.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,136.60 |
| Max. Negotiated Rate |
$49,780.80 |
| Rate for Payer: Aetna Commercial |
$47,015.20
|
| Rate for Payer: Aetna Medicare |
$14,381.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,285.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,285.00
|
| Rate for Payer: BCBS Complete |
$22,124.80
|
| Rate for Payer: BCBS MAPPO |
$13,828.00
|
| Rate for Payer: BCBS Trust/PPO |
$43,005.08
|
| Rate for Payer: BCN Commercial |
$43,005.08
|
| Rate for Payer: BCN Medicare Advantage |
$13,828.00
|
| Rate for Payer: Cash Price |
$44,249.60
|
| Rate for Payer: Cofinity Commercial |
$47,568.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44,249.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,828.00
|
| Rate for Payer: Healthscope Commercial |
$49,780.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41,484.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,519.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,902.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47,015.20
|
| Rate for Payer: PACE Senior Care Partners |
$13,136.60
|
| Rate for Payer: PACE SWMI |
$13,828.00
|
| Rate for Payer: PHP Commercial |
$47,015.20
|
| Rate for Payer: PHP Medicare Advantage |
$13,828.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38,718.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,121.44
|
| Rate for Payer: Priority Health Medicare |
$13,828.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33,734.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13,828.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,674.56
|
| Rate for Payer: UHC Core |
$46,185.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,828.00
|
| Rate for Payer: UHC Medicare Advantage |
$14,242.84
|
| Rate for Payer: VA VA |
$13,828.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41,484.00
|
|
|
HC SQ ICD LEAD
|
Facility
|
OP
|
$14,375.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,414.06 |
| Max. Negotiated Rate |
$12,937.50 |
| Rate for Payer: Aetna Commercial |
$12,218.75
|
| Rate for Payer: Aetna Medicare |
$3,737.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,492.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,492.19
|
| Rate for Payer: BCBS Complete |
$5,750.00
|
| Rate for Payer: BCBS MAPPO |
$3,593.75
|
| Rate for Payer: BCBS Trust/PPO |
$11,176.56
|
| Rate for Payer: BCN Commercial |
$11,176.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,593.75
|
| Rate for Payer: Cash Price |
$11,500.00
|
| Rate for Payer: Cofinity Commercial |
$12,362.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,500.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,593.75
|
| Rate for Payer: Healthscope Commercial |
$12,937.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,781.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,773.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,132.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,218.75
|
| Rate for Payer: PACE Senior Care Partners |
$3,414.06
|
| Rate for Payer: PACE SWMI |
$3,593.75
|
| Rate for Payer: PHP Commercial |
$12,218.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,593.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,062.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,506.25
|
| Rate for Payer: Priority Health Medicare |
$3,593.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,767.31
|
| Rate for Payer: Railroad Medicare Medicare |
$3,593.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,650.00
|
| Rate for Payer: UHC Core |
$12,003.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,593.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,701.56
|
| Rate for Payer: VA VA |
$3,593.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,781.25
|
|
|
HC SQ ICD LEAD
|
Facility
|
IP
|
$14,375.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
27800123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,767.31 |
| Max. Negotiated Rate |
$12,937.50 |
| Rate for Payer: Aetna Commercial |
$12,218.75
|
| Rate for Payer: BCBS Trust/PPO |
$11,109.00
|
| Rate for Payer: BCN Commercial |
$11,109.00
|
| Rate for Payer: Cash Price |
$11,500.00
|
| Rate for Payer: Cofinity Commercial |
$12,362.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,500.00
|
| Rate for Payer: Healthscope Commercial |
$12,937.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,781.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,218.75
|
| Rate for Payer: PHP Commercial |
$12,218.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,062.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,506.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,767.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,650.00
|
| Rate for Payer: UHC Core |
$12,003.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,781.25
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
OP
|
$226.16
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$203.54 |
| Rate for Payer: Aetna Commercial |
$192.24
|
| Rate for Payer: Aetna Medicare |
$58.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.68
|
| Rate for Payer: BCBS Complete |
$48.52
|
| Rate for Payer: BCBS MAPPO |
$56.54
|
| Rate for Payer: BCBS Trust/PPO |
$175.84
|
| Rate for Payer: BCN Commercial |
$175.84
|
| Rate for Payer: BCN Medicare Advantage |
$56.54
|
| Rate for Payer: Cash Price |
$180.93
|
| Rate for Payer: Cash Price |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$194.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$203.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.62
|
| Rate for Payer: Mclaren Medicaid |
$46.21
|
| Rate for Payer: Meridian Medicaid |
$48.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.24
|
| Rate for Payer: PACE Senior Care Partners |
$53.71
|
| Rate for Payer: PACE SWMI |
$56.54
|
| Rate for Payer: PHP Commercial |
$192.24
|
| Rate for Payer: PHP Medicare Advantage |
$56.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.76
|
| Rate for Payer: Priority Health Medicare |
$56.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.93
|
| Rate for Payer: Railroad Medicare Medicare |
$56.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.02
|
| Rate for Payer: UHC Core |
$188.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.54
|
| Rate for Payer: UHC Medicare Advantage |
$58.24
|
| Rate for Payer: VA VA |
$56.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.62
|
|
|
HC SQ IM CHEMO HORMONAL
|
Facility
|
IP
|
$226.16
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
33100002
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$137.93 |
| Max. Negotiated Rate |
$203.54 |
| Rate for Payer: Aetna Commercial |
$192.24
|
| Rate for Payer: BCBS Trust/PPO |
$174.78
|
| Rate for Payer: BCN Commercial |
$174.78
|
| Rate for Payer: Cash Price |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$194.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.93
|
| Rate for Payer: Healthscope Commercial |
$203.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.24
|
| Rate for Payer: PHP Commercial |
$192.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.02
|
| Rate for Payer: UHC Core |
$188.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.62
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
OP
|
$470.70
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$423.63 |
| Rate for Payer: Aetna Commercial |
$400.10
|
| Rate for Payer: Aetna Medicare |
$122.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.09
|
| Rate for Payer: BCBS Complete |
$48.52
|
| Rate for Payer: BCBS MAPPO |
$117.68
|
| Rate for Payer: BCBS Trust/PPO |
$365.97
|
| Rate for Payer: BCN Commercial |
$365.97
|
| Rate for Payer: BCN Medicare Advantage |
$117.68
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cofinity Commercial |
$404.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.68
|
| Rate for Payer: Healthscope Commercial |
$423.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.02
|
| Rate for Payer: Mclaren Medicaid |
$46.21
|
| Rate for Payer: Meridian Medicaid |
$48.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.10
|
| Rate for Payer: PACE Senior Care Partners |
$111.79
|
| Rate for Payer: PACE SWMI |
$117.68
|
| Rate for Payer: PHP Commercial |
$400.10
|
| Rate for Payer: PHP Medicare Advantage |
$117.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.51
|
| Rate for Payer: Priority Health Medicare |
$117.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.08
|
| Rate for Payer: Railroad Medicare Medicare |
$117.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.22
|
| Rate for Payer: UHC Core |
$393.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.68
|
| Rate for Payer: UHC Medicare Advantage |
$121.21
|
| Rate for Payer: VA VA |
$117.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.02
|
|
|
HC SQ IM CHEMO NON-HORMONAL
|
Facility
|
IP
|
$470.70
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
33100001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$287.08 |
| Max. Negotiated Rate |
$423.63 |
| Rate for Payer: Aetna Commercial |
$400.10
|
| Rate for Payer: BCBS Trust/PPO |
$363.76
|
| Rate for Payer: BCN Commercial |
$363.76
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Cofinity Commercial |
$404.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.56
|
| Rate for Payer: Healthscope Commercial |
$423.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.10
|
| Rate for Payer: PHP Commercial |
$400.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.22
|
| Rate for Payer: UHC Core |
$393.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.02
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
OP
|
$146.85
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.88 |
| Max. Negotiated Rate |
$132.16 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Aetna Medicare |
$38.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.89
|
| Rate for Payer: BCBS Complete |
$48.52
|
| Rate for Payer: BCBS MAPPO |
$36.71
|
| Rate for Payer: BCBS Trust/PPO |
$114.18
|
| Rate for Payer: BCN Commercial |
$114.18
|
| Rate for Payer: BCN Medicare Advantage |
$36.71
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.71
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.14
|
| Rate for Payer: Mclaren Medicaid |
$46.21
|
| Rate for Payer: Meridian Medicaid |
$48.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PACE Senior Care Partners |
$34.88
|
| Rate for Payer: PACE SWMI |
$36.71
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: PHP Medicare Advantage |
$36.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.76
|
| Rate for Payer: Priority Health Medicare |
$36.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.56
|
| Rate for Payer: Railroad Medicare Medicare |
$36.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.23
|
| Rate for Payer: UHC Core |
$122.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.71
|
| Rate for Payer: UHC Medicare Advantage |
$37.81
|
| Rate for Payer: VA VA |
$36.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.14
|
|
|
HC SQ OR IM INJECTION
|
Facility
|
IP
|
$146.85
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$132.16 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: BCBS Trust/PPO |
$113.49
|
| Rate for Payer: BCN Commercial |
$113.49
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.48
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.23
|
| Rate for Payer: UHC Core |
$122.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.14
|
|
|
HC SRA, LMWH
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: Aetna Medicare |
$84.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.00
|
| Rate for Payer: BCBS Complete |
$14.23
|
| Rate for Payer: BCBS MAPPO |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$253.78
|
| Rate for Payer: BCN Commercial |
$253.78
|
| Rate for Payer: BCN Medicare Advantage |
$81.60
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.80
|
| Rate for Payer: Mclaren Medicaid |
$13.56
|
| Rate for Payer: Meridian Medicaid |
$14.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PACE Senior Care Partners |
$77.52
|
| Rate for Payer: PACE SWMI |
$81.60
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: PHP Medicare Advantage |
$81.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.97
|
| Rate for Payer: Priority Health Medicare |
$81.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.07
|
| Rate for Payer: Railroad Medicare Medicare |
$81.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.23
|
| Rate for Payer: UHC Core |
$272.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.60
|
| Rate for Payer: UHC Medicare Advantage |
$84.05
|
| Rate for Payer: VA VA |
$81.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.80
|
|
|
HC SRA, LMWH
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$199.07 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: BCBS Trust/PPO |
$252.24
|
| Rate for Payer: BCN Commercial |
$252.24
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.23
|
| Rate for Payer: UHC Core |
$272.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.80
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
OP
|
$3,040.62
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$722.15 |
| Max. Negotiated Rate |
$5,363.80 |
| Rate for Payer: Aetna Commercial |
$2,584.53
|
| Rate for Payer: Aetna Commercial |
$6,791.50
|
| Rate for Payer: Aetna Medicare |
$2,077.40
|
| Rate for Payer: Aetna Medicare |
$790.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,496.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$950.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$950.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,496.88
|
| Rate for Payer: BCBS Complete |
$5,363.80
|
| Rate for Payer: BCBS Complete |
$5,363.80
|
| Rate for Payer: BCBS MAPPO |
$760.16
|
| Rate for Payer: BCBS MAPPO |
$1,997.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,212.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.08
|
| Rate for Payer: BCN Commercial |
$6,212.22
|
| Rate for Payer: BCN Commercial |
$2,364.08
|
| Rate for Payer: BCN Medicare Advantage |
$760.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.50
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cofinity Commercial |
$6,871.40
|
| Rate for Payer: Cofinity Commercial |
$2,614.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.16
|
| Rate for Payer: Healthscope Commercial |
$2,736.56
|
| Rate for Payer: Healthscope Commercial |
$7,191.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,992.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,280.46
|
| Rate for Payer: Mclaren Medicaid |
$5,108.38
|
| Rate for Payer: Mclaren Medicaid |
$5,108.38
|
| Rate for Payer: Meridian Medicaid |
$5,363.80
|
| Rate for Payer: Meridian Medicaid |
$5,363.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,097.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$798.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$874.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,584.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,791.50
|
| Rate for Payer: PACE Senior Care Partners |
$722.15
|
| Rate for Payer: PACE Senior Care Partners |
$1,897.62
|
| Rate for Payer: PACE SWMI |
$760.16
|
| Rate for Payer: PACE SWMI |
$1,997.50
|
| Rate for Payer: PHP Commercial |
$2,584.53
|
| Rate for Payer: PHP Commercial |
$6,791.50
|
| Rate for Payer: PHP Medicare Advantage |
$760.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,108.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,108.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,593.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,645.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,951.30
|
| Rate for Payer: Priority Health Medicare |
$760.16
|
| Rate for Payer: Priority Health Medicare |
$1,997.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,854.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,873.10
|
| Rate for Payer: Railroad Medicare Medicare |
$760.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,031.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,675.75
|
| Rate for Payer: UHC Core |
$2,538.92
|
| Rate for Payer: UHC Core |
$6,671.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,057.42
|
| Rate for Payer: UHC Medicare Advantage |
$782.96
|
| Rate for Payer: VA VA |
$760.16
|
| Rate for Payer: VA VA |
$1,997.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,280.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,992.50
|
|
|
HC SRS CRANIAL LESION LIN ACC
|
Facility
|
IP
|
$7,990.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
33300032
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,873.10 |
| Max. Negotiated Rate |
$7,191.00 |
| Rate for Payer: Aetna Commercial |
$6,791.50
|
| Rate for Payer: Aetna Commercial |
$2,584.53
|
| Rate for Payer: BCBS Trust/PPO |
$6,174.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,349.79
|
| Rate for Payer: BCN Commercial |
$2,349.79
|
| Rate for Payer: BCN Commercial |
$6,174.67
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$6,392.00
|
| Rate for Payer: Cofinity Commercial |
$6,871.40
|
| Rate for Payer: Cofinity Commercial |
$2,614.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,392.00
|
| Rate for Payer: Healthscope Commercial |
$7,191.00
|
| Rate for Payer: Healthscope Commercial |
$2,736.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,280.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,992.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,584.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,791.50
|
| Rate for Payer: PHP Commercial |
$6,791.50
|
| Rate for Payer: PHP Commercial |
$2,584.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,593.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,645.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,951.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,873.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,854.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,031.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,675.75
|
| Rate for Payer: UHC Core |
$6,671.65
|
| Rate for Payer: UHC Core |
$2,538.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,992.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,280.46
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
IP
|
$5,202.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,172.70 |
| Max. Negotiated Rate |
$4,681.80 |
| Rate for Payer: Aetna Commercial |
$4,421.70
|
| Rate for Payer: Aetna Commercial |
$12,665.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,020.11
|
| Rate for Payer: BCBS Trust/PPO |
$11,514.72
|
| Rate for Payer: BCN Commercial |
$11,514.72
|
| Rate for Payer: BCN Commercial |
$4,020.11
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cofinity Commercial |
$12,814.00
|
| Rate for Payer: Cofinity Commercial |
$4,473.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,161.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,920.00
|
| Rate for Payer: Healthscope Commercial |
$13,410.00
|
| Rate for Payer: Healthscope Commercial |
$4,681.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,901.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,175.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,421.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,665.00
|
| Rate for Payer: PHP Commercial |
$12,665.00
|
| Rate for Payer: PHP Commercial |
$4,421.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,430.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,641.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,963.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,525.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,087.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,172.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,577.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,112.00
|
| Rate for Payer: UHC Core |
$12,441.50
|
| Rate for Payer: UHC Core |
$4,343.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,175.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,901.50
|
|
|
HC SRT UP TO 5 FRACTIONS
|
Facility
|
OP
|
$14,900.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,170.53 |
| Max. Negotiated Rate |
$13,410.00 |
| Rate for Payer: Aetna Commercial |
$12,665.00
|
| Rate for Payer: Aetna Commercial |
$4,421.70
|
| Rate for Payer: Aetna Medicare |
$1,352.52
|
| Rate for Payer: Aetna Medicare |
$3,874.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,656.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,625.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,625.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,656.25
|
| Rate for Payer: BCBS Complete |
$1,229.05
|
| Rate for Payer: BCBS Complete |
$1,229.05
|
| Rate for Payer: BCBS MAPPO |
$1,300.50
|
| Rate for Payer: BCBS MAPPO |
$3,725.00
|
| Rate for Payer: BCBS Trust/PPO |
$11,584.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,044.56
|
| Rate for Payer: BCN Commercial |
$11,584.75
|
| Rate for Payer: BCN Commercial |
$4,044.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,300.50
|
| Rate for Payer: BCN Medicare Advantage |
$3,725.00
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cash Price |
$11,920.00
|
| Rate for Payer: Cash Price |
$4,161.60
|
| Rate for Payer: Cofinity Commercial |
$4,473.72
|
| Rate for Payer: Cofinity Commercial |
$12,814.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,920.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,161.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,725.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,300.50
|
| Rate for Payer: Healthscope Commercial |
$13,410.00
|
| Rate for Payer: Healthscope Commercial |
$4,681.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,901.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,175.00
|
| Rate for Payer: Mclaren Medicaid |
$1,170.53
|
| Rate for Payer: Mclaren Medicaid |
$1,170.53
|
| Rate for Payer: Meridian Medicaid |
$1,229.05
|
| Rate for Payer: Meridian Medicaid |
$1,229.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,365.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,911.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,283.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,495.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,421.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,665.00
|
| Rate for Payer: PACE Senior Care Partners |
$3,538.75
|
| Rate for Payer: PACE Senior Care Partners |
$1,235.48
|
| Rate for Payer: PACE SWMI |
$1,300.50
|
| Rate for Payer: PACE SWMI |
$3,725.00
|
| Rate for Payer: PHP Commercial |
$4,421.70
|
| Rate for Payer: PHP Commercial |
$12,665.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,725.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,300.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,170.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,170.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,430.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,641.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,525.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,963.00
|
| Rate for Payer: Priority Health Medicare |
$1,300.50
|
| Rate for Payer: Priority Health Medicare |
$3,725.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,087.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,172.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,725.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,300.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,577.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,112.00
|
| Rate for Payer: UHC Core |
$4,343.67
|
| Rate for Payer: UHC Core |
$12,441.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,725.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,300.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,836.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,339.52
|
| Rate for Payer: VA VA |
$3,725.00
|
| Rate for Payer: VA VA |
$1,300.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,901.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,175.00
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$28.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.38
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$27.50
|
| Rate for Payer: BCBS Trust/PPO |
$85.52
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$27.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.50
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PACE Senior Care Partners |
$26.12
|
| Rate for Payer: PACE SWMI |
$27.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: PHP Medicare Advantage |
$27.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.70
|
| Rate for Payer: Priority Health Medicare |
$27.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.09
|
| Rate for Payer: Railroad Medicare Medicare |
$27.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.80
|
| Rate for Payer: UHC Core |
$91.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.50
|
| Rate for Payer: UHC Medicare Advantage |
$28.32
|
| Rate for Payer: VA VA |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: BCBS Trust/PPO |
$85.01
|
| Rate for Payer: BCN Commercial |
$85.01
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.80
|
| Rate for Payer: UHC Core |
$91.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
