|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
OP
|
$102.93
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$92.64 |
| Rate for Payer: Aetna Commercial |
$87.49
|
| Rate for Payer: Aetna Medicare |
$26.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.17
|
| Rate for Payer: BCBS Complete |
$41.17
|
| Rate for Payer: BCBS MAPPO |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$80.03
|
| Rate for Payer: BCN Commercial |
$80.03
|
| Rate for Payer: BCN Medicare Advantage |
$25.73
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cofinity Commercial |
$88.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.73
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.49
|
| Rate for Payer: PACE Senior Care Partners |
$24.45
|
| Rate for Payer: PACE SWMI |
$25.73
|
| Rate for Payer: PHP Commercial |
$87.49
|
| Rate for Payer: PHP Medicare Advantage |
$25.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.55
|
| Rate for Payer: Priority Health Medicare |
$25.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.78
|
| Rate for Payer: Railroad Medicare Medicare |
$25.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.58
|
| Rate for Payer: UHC Core |
$85.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.73
|
| Rate for Payer: UHC Medicare Advantage |
$26.50
|
| Rate for Payer: VA VA |
$25.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.20
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
IP
|
$102.93
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$92.64 |
| Rate for Payer: Aetna Commercial |
$87.49
|
| Rate for Payer: BCBS Trust/PPO |
$79.54
|
| Rate for Payer: BCN Commercial |
$79.54
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cofinity Commercial |
$88.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.34
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.49
|
| Rate for Payer: PHP Commercial |
$87.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.58
|
| Rate for Payer: UHC Core |
$85.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.20
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
OP
|
$1,023.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.14 |
| Max. Negotiated Rate |
$921.38 |
| Rate for Payer: Aetna Commercial |
$870.19
|
| Rate for Payer: Aetna Medicare |
$266.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$319.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$319.92
|
| Rate for Payer: BCBS Complete |
$409.50
|
| Rate for Payer: BCBS MAPPO |
$255.94
|
| Rate for Payer: BCBS Trust/PPO |
$795.97
|
| Rate for Payer: BCN Commercial |
$795.97
|
| Rate for Payer: BCN Medicare Advantage |
$255.94
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$880.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.94
|
| Rate for Payer: Healthscope Commercial |
$921.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$767.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.19
|
| Rate for Payer: PACE Senior Care Partners |
$243.14
|
| Rate for Payer: PACE SWMI |
$255.94
|
| Rate for Payer: PHP Commercial |
$870.19
|
| Rate for Payer: PHP Medicare Advantage |
$255.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.66
|
| Rate for Payer: Priority Health Medicare |
$255.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$624.39
|
| Rate for Payer: Railroad Medicare Medicare |
$255.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$900.90
|
| Rate for Payer: UHC Core |
$854.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.94
|
| Rate for Payer: UHC Medicare Advantage |
$263.62
|
| Rate for Payer: VA VA |
$255.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$767.81
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
IP
|
$1,023.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.39 |
| Max. Negotiated Rate |
$921.38 |
| Rate for Payer: Aetna Commercial |
$870.19
|
| Rate for Payer: BCBS Trust/PPO |
$791.15
|
| Rate for Payer: BCN Commercial |
$791.15
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$880.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$819.00
|
| Rate for Payer: Healthscope Commercial |
$921.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$767.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.19
|
| Rate for Payer: PHP Commercial |
$870.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$624.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$900.90
|
| Rate for Payer: UHC Core |
$854.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$767.81
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
OP
|
$1,339.02
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,205.12 |
| Rate for Payer: Aetna Commercial |
$1,138.17
|
| Rate for Payer: Aetna Medicare |
$348.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$418.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$418.44
|
| Rate for Payer: BCBS Complete |
$535.61
|
| Rate for Payer: BCBS MAPPO |
$334.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.09
|
| Rate for Payer: BCN Commercial |
$1,041.09
|
| Rate for Payer: BCN Medicare Advantage |
$334.76
|
| Rate for Payer: Cash Price |
$1,071.22
|
| Rate for Payer: Cofinity Commercial |
$1,151.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.76
|
| Rate for Payer: Healthscope Commercial |
$1,205.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$351.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$384.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,138.17
|
| Rate for Payer: PACE Senior Care Partners |
$318.02
|
| Rate for Payer: PACE SWMI |
$334.76
|
| Rate for Payer: PHP Commercial |
$1,138.17
|
| Rate for Payer: PHP Medicare Advantage |
$334.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,164.95
|
| Rate for Payer: Priority Health Medicare |
$334.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.67
|
| Rate for Payer: Railroad Medicare Medicare |
$334.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.34
|
| Rate for Payer: UHC Core |
$1,118.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$334.76
|
| Rate for Payer: UHC Medicare Advantage |
$344.80
|
| Rate for Payer: VA VA |
$334.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.26
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
IP
|
$1,339.02
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.67 |
| Max. Negotiated Rate |
$1,205.12 |
| Rate for Payer: Aetna Commercial |
$1,138.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.79
|
| Rate for Payer: BCN Commercial |
$1,034.79
|
| Rate for Payer: Cash Price |
$1,071.22
|
| Rate for Payer: Cofinity Commercial |
$1,151.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.22
|
| Rate for Payer: Healthscope Commercial |
$1,205.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,138.17
|
| Rate for Payer: PHP Commercial |
$1,138.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,164.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.34
|
| Rate for Payer: UHC Core |
$1,118.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.26
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
IP
|
$1,456.71
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.45 |
| Max. Negotiated Rate |
$1,311.04 |
| Rate for Payer: Aetna Commercial |
$1,238.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,125.75
|
| Rate for Payer: BCN Commercial |
$1,125.75
|
| Rate for Payer: Cash Price |
$1,165.37
|
| Rate for Payer: Cofinity Commercial |
$1,252.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.37
|
| Rate for Payer: Healthscope Commercial |
$1,311.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.20
|
| Rate for Payer: PHP Commercial |
$1,238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,267.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,281.90
|
| Rate for Payer: UHC Core |
$1,216.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.53
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
OP
|
$1,456.71
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.97 |
| Max. Negotiated Rate |
$1,311.04 |
| Rate for Payer: Aetna Commercial |
$1,238.20
|
| Rate for Payer: Aetna Medicare |
$378.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$455.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$455.22
|
| Rate for Payer: BCBS Complete |
$582.68
|
| Rate for Payer: BCBS MAPPO |
$364.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.59
|
| Rate for Payer: BCN Commercial |
$1,132.59
|
| Rate for Payer: BCN Medicare Advantage |
$364.18
|
| Rate for Payer: Cash Price |
$1,165.37
|
| Rate for Payer: Cofinity Commercial |
$1,252.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.18
|
| Rate for Payer: Healthscope Commercial |
$1,311.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$382.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$418.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.20
|
| Rate for Payer: PACE Senior Care Partners |
$345.97
|
| Rate for Payer: PACE SWMI |
$364.18
|
| Rate for Payer: PHP Commercial |
$1,238.20
|
| Rate for Payer: PHP Medicare Advantage |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,267.34
|
| Rate for Payer: Priority Health Medicare |
$364.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.45
|
| Rate for Payer: Railroad Medicare Medicare |
$364.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,281.90
|
| Rate for Payer: UHC Core |
$1,216.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$364.18
|
| Rate for Payer: UHC Medicare Advantage |
$375.10
|
| Rate for Payer: VA VA |
$364.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.53
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
IP
|
$3,302.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,013.89 |
| Max. Negotiated Rate |
$2,971.80 |
| Rate for Payer: Aetna Commercial |
$2,806.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,551.79
|
| Rate for Payer: BCN Commercial |
$2,551.79
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Cofinity Commercial |
$2,839.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,641.60
|
| Rate for Payer: Healthscope Commercial |
$2,971.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,476.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,806.70
|
| Rate for Payer: PHP Commercial |
$2,806.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,872.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,013.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,905.76
|
| Rate for Payer: UHC Core |
$2,757.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,476.50
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
OP
|
$3,302.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.22 |
| Max. Negotiated Rate |
$2,971.80 |
| Rate for Payer: Aetna Commercial |
$2,806.70
|
| Rate for Payer: Aetna Medicare |
$858.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,031.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,031.88
|
| Rate for Payer: BCBS Complete |
$1,320.80
|
| Rate for Payer: BCBS MAPPO |
$825.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,567.30
|
| Rate for Payer: BCN Commercial |
$2,567.30
|
| Rate for Payer: BCN Medicare Advantage |
$825.50
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Cofinity Commercial |
$2,839.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,641.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$825.50
|
| Rate for Payer: Healthscope Commercial |
$2,971.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,476.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$866.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$949.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,806.70
|
| Rate for Payer: PACE Senior Care Partners |
$784.22
|
| Rate for Payer: PACE SWMI |
$825.50
|
| Rate for Payer: PHP Commercial |
$2,806.70
|
| Rate for Payer: PHP Medicare Advantage |
$825.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,872.74
|
| Rate for Payer: Priority Health Medicare |
$825.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,013.89
|
| Rate for Payer: Railroad Medicare Medicare |
$825.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,905.76
|
| Rate for Payer: UHC Core |
$2,757.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$825.50
|
| Rate for Payer: UHC Medicare Advantage |
$850.26
|
| Rate for Payer: VA VA |
$825.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,476.50
|
|
|
HC THROMBO EMBO CATHETER LVL 46
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,094.88 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: Aetna Medicare |
$1,198.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,440.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,440.62
|
| Rate for Payer: BCBS Complete |
$1,844.00
|
| Rate for Payer: BCBS MAPPO |
$1,152.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,584.28
|
| Rate for Payer: BCN Commercial |
$3,584.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,152.50
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,152.50
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,457.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,210.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,325.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,918.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,094.88
|
| Rate for Payer: PACE SWMI |
$1,152.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,152.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,227.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,010.70
|
| Rate for Payer: Priority Health Medicare |
$1,152.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,811.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,152.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,056.80
|
| Rate for Payer: UHC Core |
$3,849.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,152.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.08
|
| Rate for Payer: VA VA |
$1,152.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,457.50
|
|
|
HC THROMBO EMBO CATHETER LVL 46
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,811.64 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,562.61
|
| Rate for Payer: BCN Commercial |
$3,562.61
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,457.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,918.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,227.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,010.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,811.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,056.80
|
| Rate for Payer: UHC Core |
$3,849.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,457.50
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
IP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,357.83 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: BCBS Trust/PPO |
$5,521.77
|
| Rate for Payer: BCN Commercial |
$5,521.77
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,358.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,073.38
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,001.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,216.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,357.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,287.73
|
| Rate for Payer: UHC Core |
$5,966.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,358.86
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
OP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,696.97 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna Medicare |
$1,857.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,232.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,232.86
|
| Rate for Payer: BCBS Complete |
$2,858.06
|
| Rate for Payer: BCBS MAPPO |
$1,786.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,555.35
|
| Rate for Payer: BCN Commercial |
$5,555.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,786.29
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,786.29
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,358.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,875.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,054.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,073.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,696.97
|
| Rate for Payer: PACE SWMI |
$1,786.29
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,786.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,001.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,216.28
|
| Rate for Payer: Priority Health Medicare |
$1,786.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,357.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,786.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,287.73
|
| Rate for Payer: UHC Core |
$5,966.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,786.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,839.88
|
| Rate for Payer: VA VA |
$1,786.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,358.86
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
OP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,362.96 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna Medicare |
$3,681.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,424.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,424.95
|
| Rate for Payer: BCBS Complete |
$5,663.94
|
| Rate for Payer: BCBS MAPPO |
$3,539.96
|
| Rate for Payer: BCBS Trust/PPO |
$11,009.28
|
| Rate for Payer: BCN Commercial |
$11,009.28
|
| Rate for Payer: BCN Medicare Advantage |
$3,539.96
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,539.96
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,619.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,716.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,070.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,035.87
|
| Rate for Payer: PACE Senior Care Partners |
$3,362.96
|
| Rate for Payer: PACE SWMI |
$3,539.96
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: PHP Medicare Advantage |
$3,539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,911.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,319.07
|
| Rate for Payer: Priority Health Medicare |
$3,539.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,636.09
|
| Rate for Payer: Railroad Medicare Medicare |
$3,539.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,460.67
|
| Rate for Payer: UHC Core |
$11,823.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,539.96
|
| Rate for Payer: UHC Medicare Advantage |
$3,646.16
|
| Rate for Payer: VA VA |
$3,539.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,619.89
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
IP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,636.09 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: BCBS Trust/PPO |
$10,942.73
|
| Rate for Payer: BCN Commercial |
$10,942.73
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,619.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,035.87
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,911.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,319.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,636.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,460.67
|
| Rate for Payer: UHC Core |
$11,823.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,619.89
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$509.61
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.03 |
| Max. Negotiated Rate |
$458.65 |
| Rate for Payer: Aetna Commercial |
$433.17
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.25
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$127.40
|
| Rate for Payer: BCBS Trust/PPO |
$396.22
|
| Rate for Payer: BCN Commercial |
$396.22
|
| Rate for Payer: BCN Medicare Advantage |
$127.40
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cofinity Commercial |
$438.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.40
|
| Rate for Payer: Healthscope Commercial |
$458.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.21
|
| Rate for Payer: Mclaren Medicaid |
$222.16
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.17
|
| Rate for Payer: PACE Senior Care Partners |
$121.03
|
| Rate for Payer: PACE SWMI |
$127.40
|
| Rate for Payer: PHP Commercial |
$433.17
|
| Rate for Payer: PHP Medicare Advantage |
$127.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$443.36
|
| Rate for Payer: Priority Health Medicare |
$127.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.81
|
| Rate for Payer: Railroad Medicare Medicare |
$127.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.46
|
| Rate for Payer: UHC Core |
$425.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.40
|
| Rate for Payer: UHC Medicare Advantage |
$131.22
|
| Rate for Payer: VA VA |
$127.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.21
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$509.61
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.81 |
| Max. Negotiated Rate |
$458.65 |
| Rate for Payer: Aetna Commercial |
$433.17
|
| Rate for Payer: BCBS Trust/PPO |
$393.83
|
| Rate for Payer: BCN Commercial |
$393.83
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cofinity Commercial |
$438.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.69
|
| Rate for Payer: Healthscope Commercial |
$458.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.17
|
| Rate for Payer: PHP Commercial |
$433.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$443.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.46
|
| Rate for Payer: UHC Core |
$425.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.21
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,553.46
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,081.45 |
| Max. Negotiated Rate |
$4,098.11 |
| Rate for Payer: Aetna Commercial |
$3,870.44
|
| Rate for Payer: Aetna Medicare |
$1,183.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,422.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,422.96
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$1,138.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,540.32
|
| Rate for Payer: BCN Commercial |
$3,540.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,138.36
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$3,915.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,138.36
|
| Rate for Payer: Healthscope Commercial |
$4,098.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,415.10
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,195.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,309.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
| Rate for Payer: PACE Senior Care Partners |
$1,081.45
|
| Rate for Payer: PACE SWMI |
$1,138.36
|
| Rate for Payer: PHP Commercial |
$3,870.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,138.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,961.51
|
| Rate for Payer: Priority Health Medicare |
$1,138.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,777.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,138.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,007.04
|
| Rate for Payer: UHC Core |
$3,802.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,138.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,172.52
|
| Rate for Payer: VA VA |
$1,138.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,415.10
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,553.46
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,777.16 |
| Max. Negotiated Rate |
$4,098.11 |
| Rate for Payer: Aetna Commercial |
$3,870.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,518.91
|
| Rate for Payer: BCN Commercial |
$3,518.91
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$3,915.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.77
|
| Rate for Payer: Healthscope Commercial |
$4,098.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,415.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
| Rate for Payer: PHP Commercial |
$3,870.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,961.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,777.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,007.04
|
| Rate for Payer: UHC Core |
$3,802.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,415.10
|
|
|
HC THSD7
|
Facility
|
IP
|
$372.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$227.43 |
| Max. Negotiated Rate |
$335.61 |
| Rate for Payer: Aetna Commercial |
$316.96
|
| Rate for Payer: BCBS Trust/PPO |
$288.18
|
| Rate for Payer: BCN Commercial |
$288.18
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cofinity Commercial |
$320.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.32
|
| Rate for Payer: Healthscope Commercial |
$335.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.96
|
| Rate for Payer: PHP Commercial |
$316.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.15
|
| Rate for Payer: UHC Core |
$311.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.68
|
|
|
HC THSD7
|
Facility
|
OP
|
$372.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$335.61 |
| Rate for Payer: Aetna Commercial |
$316.96
|
| Rate for Payer: Aetna Medicare |
$96.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.53
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$93.22
|
| Rate for Payer: BCBS Trust/PPO |
$289.93
|
| Rate for Payer: BCN Commercial |
$289.93
|
| Rate for Payer: BCN Medicare Advantage |
$93.22
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cofinity Commercial |
$320.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.22
|
| Rate for Payer: Healthscope Commercial |
$335.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.68
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.96
|
| Rate for Payer: PACE Senior Care Partners |
$88.56
|
| Rate for Payer: PACE SWMI |
$93.22
|
| Rate for Payer: PHP Commercial |
$316.96
|
| Rate for Payer: PHP Medicare Advantage |
$93.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.42
|
| Rate for Payer: Priority Health Medicare |
$93.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.43
|
| Rate for Payer: Railroad Medicare Medicare |
$93.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.15
|
| Rate for Payer: UHC Core |
$311.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.22
|
| Rate for Payer: UHC Medicare Advantage |
$96.02
|
| Rate for Payer: VA VA |
$93.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.68
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$56.75
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna Commercial |
$48.24
|
| Rate for Payer: Aetna Medicare |
$14.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.73
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS MAPPO |
$14.19
|
| Rate for Payer: BCBS Trust/PPO |
$44.12
|
| Rate for Payer: BCN Commercial |
$44.12
|
| Rate for Payer: BCN Medicare Advantage |
$14.19
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$51.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.56
|
| Rate for Payer: Mclaren Medicaid |
$11.85
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.24
|
| Rate for Payer: PACE Senior Care Partners |
$13.48
|
| Rate for Payer: PACE SWMI |
$14.19
|
| Rate for Payer: PHP Commercial |
$48.24
|
| Rate for Payer: PHP Medicare Advantage |
$14.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.37
|
| Rate for Payer: Priority Health Medicare |
$14.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.61
|
| Rate for Payer: Railroad Medicare Medicare |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.94
|
| Rate for Payer: UHC Core |
$47.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.19
|
| Rate for Payer: UHC Medicare Advantage |
$14.61
|
| Rate for Payer: VA VA |
$14.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.56
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$56.75
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna Commercial |
$48.24
|
| Rate for Payer: BCBS Trust/PPO |
$43.86
|
| Rate for Payer: BCN Commercial |
$43.86
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.40
|
| Rate for Payer: Healthscope Commercial |
$51.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.24
|
| Rate for Payer: PHP Commercial |
$48.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.94
|
| Rate for Payer: UHC Core |
$47.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.56
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
IP
|
$59.06
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$53.15 |
| Rate for Payer: Aetna Commercial |
$50.20
|
| Rate for Payer: BCBS Trust/PPO |
$45.64
|
| Rate for Payer: BCN Commercial |
$45.64
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$50.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.25
|
| Rate for Payer: Healthscope Commercial |
$53.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.20
|
| Rate for Payer: PHP Commercial |
$50.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.97
|
| Rate for Payer: UHC Core |
$49.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.30
|
|
