|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
IP
|
$3,701.46
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,257.52 |
| Max. Negotiated Rate |
$3,331.31 |
| Rate for Payer: Aetna Commercial |
$3,146.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,860.49
|
| Rate for Payer: BCN Commercial |
$2,860.49
|
| Rate for Payer: Cash Price |
$2,961.17
|
| Rate for Payer: Cofinity Commercial |
$3,183.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,961.17
|
| Rate for Payer: Healthscope Commercial |
$3,331.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,776.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,146.24
|
| Rate for Payer: PHP Commercial |
$3,146.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,591.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,220.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,257.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,257.28
|
| Rate for Payer: UHC Core |
$3,090.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,776.10
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
IP
|
$760.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.87 |
| Max. Negotiated Rate |
$684.50 |
| Rate for Payer: Aetna Commercial |
$646.48
|
| Rate for Payer: BCBS Trust/PPO |
$587.76
|
| Rate for Payer: BCN Commercial |
$587.76
|
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Cofinity Commercial |
$654.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.45
|
| Rate for Payer: Healthscope Commercial |
$684.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.48
|
| Rate for Payer: PHP Commercial |
$646.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.29
|
| Rate for Payer: UHC Core |
$635.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.42
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
OP
|
$760.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.63 |
| Max. Negotiated Rate |
$684.50 |
| Rate for Payer: Aetna Commercial |
$646.48
|
| Rate for Payer: Aetna Medicare |
$197.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.68
|
| Rate for Payer: BCBS Complete |
$304.22
|
| Rate for Payer: BCBS MAPPO |
$190.14
|
| Rate for Payer: BCBS Trust/PPO |
$591.34
|
| Rate for Payer: BCN Commercial |
$591.34
|
| Rate for Payer: BCN Medicare Advantage |
$190.14
|
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Cofinity Commercial |
$654.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.14
|
| Rate for Payer: Healthscope Commercial |
$684.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.48
|
| Rate for Payer: PACE Senior Care Partners |
$180.63
|
| Rate for Payer: PACE SWMI |
$190.14
|
| Rate for Payer: PHP Commercial |
$646.48
|
| Rate for Payer: PHP Medicare Advantage |
$190.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.69
|
| Rate for Payer: Priority Health Medicare |
$190.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.87
|
| Rate for Payer: Railroad Medicare Medicare |
$190.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.29
|
| Rate for Payer: UHC Core |
$635.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.14
|
| Rate for Payer: UHC Medicare Advantage |
$195.84
|
| Rate for Payer: VA VA |
$190.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.42
|
|
|
HC ZONISAMIDE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC ZONISAMIDE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.44
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.31
|
| Rate for Payer: BCN Commercial |
$58.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Mclaren Medicaid |
$9.78
|
| Rate for Payer: Meridian Medicaid |
$10.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.25
|
| Rate for Payer: Priority Health Medicare |
$18.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.74
|
| Rate for Payer: Railroad Medicare Medicare |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.75
|
| Rate for Payer: UHC Medicare Advantage |
$19.31
|
| Rate for Payer: VA VA |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna Commercial |
$145.66
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$68.54
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$133.23
|
| Rate for Payer: BCN Commercial |
$133.23
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.66
|
| Rate for Payer: PACE Senior Care Partners |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$145.66
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.08
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.51
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.80
|
| Rate for Payer: UHC Core |
$143.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.52
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna Commercial |
$145.66
|
| Rate for Payer: BCBS Trust/PPO |
$132.43
|
| Rate for Payer: BCN Commercial |
$132.43
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.66
|
| Rate for Payer: PHP Commercial |
$145.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.80
|
| Rate for Payer: UHC Core |
$143.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.52
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,306.70
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$796.96 |
| Max. Negotiated Rate |
$1,176.03 |
| Rate for Payer: Aetna Commercial |
$1,110.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.82
|
| Rate for Payer: BCN Commercial |
$1,009.82
|
| Rate for Payer: Cash Price |
$1,045.36
|
| Rate for Payer: Cofinity Commercial |
$1,123.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.36
|
| Rate for Payer: Healthscope Commercial |
$1,176.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,110.70
|
| Rate for Payer: PHP Commercial |
$1,110.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$796.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,149.90
|
| Rate for Payer: UHC Core |
$1,091.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.02
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,306.70
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.34 |
| Max. Negotiated Rate |
$1,176.03 |
| Rate for Payer: Aetna Commercial |
$1,110.70
|
| Rate for Payer: Aetna Medicare |
$339.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$408.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$408.34
|
| Rate for Payer: BCBS Complete |
$522.68
|
| Rate for Payer: BCBS MAPPO |
$326.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.96
|
| Rate for Payer: BCN Commercial |
$1,015.96
|
| Rate for Payer: BCN Medicare Advantage |
$326.68
|
| Rate for Payer: Cash Price |
$1,045.36
|
| Rate for Payer: Cofinity Commercial |
$1,123.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.68
|
| Rate for Payer: Healthscope Commercial |
$1,176.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,110.70
|
| Rate for Payer: PACE Senior Care Partners |
$310.34
|
| Rate for Payer: PACE SWMI |
$326.68
|
| Rate for Payer: PHP Commercial |
$1,110.70
|
| Rate for Payer: PHP Medicare Advantage |
$326.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.83
|
| Rate for Payer: Priority Health Medicare |
$326.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$796.96
|
| Rate for Payer: Railroad Medicare Medicare |
$326.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,149.90
|
| Rate for Payer: UHC Core |
$1,091.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.68
|
| Rate for Payer: UHC Medicare Advantage |
$336.48
|
| Rate for Payer: VA VA |
$326.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.02
|
|
|
HC Z STENT URETERAL
|
Facility
|
OP
|
$1,189.08
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.41 |
| Max. Negotiated Rate |
$1,070.17 |
| Rate for Payer: Aetna Commercial |
$1,010.72
|
| Rate for Payer: Aetna Medicare |
$309.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.59
|
| Rate for Payer: BCBS Complete |
$475.63
|
| Rate for Payer: BCBS MAPPO |
$297.27
|
| Rate for Payer: BCBS Trust/PPO |
$924.51
|
| Rate for Payer: BCN Commercial |
$924.51
|
| Rate for Payer: BCN Medicare Advantage |
$297.27
|
| Rate for Payer: Cash Price |
$951.26
|
| Rate for Payer: Cofinity Commercial |
$1,022.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.27
|
| Rate for Payer: Healthscope Commercial |
$1,070.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.72
|
| Rate for Payer: PACE Senior Care Partners |
$282.41
|
| Rate for Payer: PACE SWMI |
$297.27
|
| Rate for Payer: PHP Commercial |
$1,010.72
|
| Rate for Payer: PHP Medicare Advantage |
$297.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.50
|
| Rate for Payer: Priority Health Medicare |
$297.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.22
|
| Rate for Payer: Railroad Medicare Medicare |
$297.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.39
|
| Rate for Payer: UHC Core |
$992.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.27
|
| Rate for Payer: UHC Medicare Advantage |
$306.19
|
| Rate for Payer: VA VA |
$297.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.81
|
|
|
HC Z STENT URETERAL
|
Facility
|
IP
|
$1,189.08
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.22 |
| Max. Negotiated Rate |
$1,070.17 |
| Rate for Payer: Aetna Commercial |
$1,010.72
|
| Rate for Payer: BCBS Trust/PPO |
$918.92
|
| Rate for Payer: BCN Commercial |
$918.92
|
| Rate for Payer: Cash Price |
$951.26
|
| Rate for Payer: Cofinity Commercial |
$1,022.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.26
|
| Rate for Payer: Healthscope Commercial |
$1,070.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.72
|
| Rate for Payer: PHP Commercial |
$1,010.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.39
|
| Rate for Payer: UHC Core |
$992.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.81
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
OP
|
$1,722.49
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.09 |
| Max. Negotiated Rate |
$1,550.24 |
| Rate for Payer: Aetna Commercial |
$1,464.12
|
| Rate for Payer: Aetna Medicare |
$447.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$538.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$538.28
|
| Rate for Payer: BCBS Complete |
$689.00
|
| Rate for Payer: BCBS MAPPO |
$430.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.24
|
| Rate for Payer: BCN Commercial |
$1,339.24
|
| Rate for Payer: BCN Medicare Advantage |
$430.62
|
| Rate for Payer: Cash Price |
$1,377.99
|
| Rate for Payer: Cofinity Commercial |
$1,481.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$430.62
|
| Rate for Payer: Healthscope Commercial |
$1,550.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,291.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$452.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$495.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.12
|
| Rate for Payer: PACE Senior Care Partners |
$409.09
|
| Rate for Payer: PACE SWMI |
$430.62
|
| Rate for Payer: PHP Commercial |
$1,464.12
|
| Rate for Payer: PHP Medicare Advantage |
$430.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,498.57
|
| Rate for Payer: Priority Health Medicare |
$430.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,050.55
|
| Rate for Payer: Railroad Medicare Medicare |
$430.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,515.79
|
| Rate for Payer: UHC Core |
$1,438.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$430.62
|
| Rate for Payer: UHC Medicare Advantage |
$443.54
|
| Rate for Payer: VA VA |
$430.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,291.87
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
IP
|
$1,722.49
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,050.55 |
| Max. Negotiated Rate |
$1,550.24 |
| Rate for Payer: Aetna Commercial |
$1,464.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.14
|
| Rate for Payer: BCN Commercial |
$1,331.14
|
| Rate for Payer: Cash Price |
$1,377.99
|
| Rate for Payer: Cofinity Commercial |
$1,481.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.99
|
| Rate for Payer: Healthscope Commercial |
$1,550.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.12
|
| Rate for Payer: PHP Commercial |
$1,464.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,498.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,050.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,515.79
|
| Rate for Payer: UHC Core |
$1,438.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,291.87
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
IP
|
$633.62
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.44 |
| Max. Negotiated Rate |
$570.26 |
| Rate for Payer: Aetna Commercial |
$538.58
|
| Rate for Payer: BCBS Trust/PPO |
$489.66
|
| Rate for Payer: BCN Commercial |
$489.66
|
| Rate for Payer: Cash Price |
$506.90
|
| Rate for Payer: Cofinity Commercial |
$544.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.90
|
| Rate for Payer: Healthscope Commercial |
$570.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.58
|
| Rate for Payer: PHP Commercial |
$538.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$551.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.59
|
| Rate for Payer: UHC Core |
$529.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.22
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
OP
|
$633.62
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$570.26 |
| Rate for Payer: Aetna Commercial |
$538.58
|
| Rate for Payer: Aetna Medicare |
$164.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$198.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$198.01
|
| Rate for Payer: BCBS Complete |
$253.45
|
| Rate for Payer: BCBS MAPPO |
$158.40
|
| Rate for Payer: BCBS Trust/PPO |
$492.64
|
| Rate for Payer: BCN Commercial |
$492.64
|
| Rate for Payer: BCN Medicare Advantage |
$158.40
|
| Rate for Payer: Cash Price |
$506.90
|
| Rate for Payer: Cofinity Commercial |
$544.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$570.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$166.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.58
|
| Rate for Payer: PACE Senior Care Partners |
$150.48
|
| Rate for Payer: PACE SWMI |
$158.40
|
| Rate for Payer: PHP Commercial |
$538.58
|
| Rate for Payer: PHP Medicare Advantage |
$158.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$551.25
|
| Rate for Payer: Priority Health Medicare |
$158.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.44
|
| Rate for Payer: Railroad Medicare Medicare |
$158.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.59
|
| Rate for Payer: UHC Core |
$529.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.40
|
| Rate for Payer: UHC Medicare Advantage |
$163.16
|
| Rate for Payer: VA VA |
$158.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.22
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
OP
|
$1,000.88
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.71 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$850.75
|
| Rate for Payer: Aetna Medicare |
$260.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.78
|
| Rate for Payer: BCBS Complete |
$400.35
|
| Rate for Payer: BCBS MAPPO |
$250.22
|
| Rate for Payer: BCBS Trust/PPO |
$778.18
|
| Rate for Payer: BCN Commercial |
$778.18
|
| Rate for Payer: BCN Medicare Advantage |
$250.22
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cofinity Commercial |
$860.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.22
|
| Rate for Payer: Healthscope Commercial |
$900.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.75
|
| Rate for Payer: PACE Senior Care Partners |
$237.71
|
| Rate for Payer: PACE SWMI |
$250.22
|
| Rate for Payer: PHP Commercial |
$850.75
|
| Rate for Payer: PHP Medicare Advantage |
$250.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.77
|
| Rate for Payer: Priority Health Medicare |
$250.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.44
|
| Rate for Payer: Railroad Medicare Medicare |
$250.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.77
|
| Rate for Payer: UHC Core |
$835.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.22
|
| Rate for Payer: UHC Medicare Advantage |
$257.73
|
| Rate for Payer: VA VA |
$250.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.66
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
IP
|
$1,000.88
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.44 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$850.75
|
| Rate for Payer: BCBS Trust/PPO |
$773.48
|
| Rate for Payer: BCN Commercial |
$773.48
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cofinity Commercial |
$860.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.70
|
| Rate for Payer: Healthscope Commercial |
$900.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.75
|
| Rate for Payer: PHP Commercial |
$850.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.77
|
| Rate for Payer: UHC Core |
$835.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.66
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
IP
|
$5,756.21
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,510.71 |
| Max. Negotiated Rate |
$5,180.59 |
| Rate for Payer: Aetna Commercial |
$4,892.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,448.40
|
| Rate for Payer: BCN Commercial |
$4,448.40
|
| Rate for Payer: Cash Price |
$4,604.97
|
| Rate for Payer: Cofinity Commercial |
$4,950.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,604.97
|
| Rate for Payer: Healthscope Commercial |
$5,180.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,317.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,892.78
|
| Rate for Payer: PHP Commercial |
$4,892.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,029.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,007.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,510.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,065.46
|
| Rate for Payer: UHC Core |
$4,806.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,317.16
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
OP
|
$5,756.21
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$5,180.59 |
| Rate for Payer: Aetna Commercial |
$4,892.78
|
| Rate for Payer: Aetna Medicare |
$1,496.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,798.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,798.82
|
| Rate for Payer: BCBS Complete |
$2,302.48
|
| Rate for Payer: BCBS MAPPO |
$1,439.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,475.45
|
| Rate for Payer: BCN Commercial |
$4,475.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,439.05
|
| Rate for Payer: Cash Price |
$4,604.97
|
| Rate for Payer: Cofinity Commercial |
$4,950.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,604.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,439.05
|
| Rate for Payer: Healthscope Commercial |
$5,180.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,317.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,511.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,654.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,892.78
|
| Rate for Payer: PACE Senior Care Partners |
$1,367.10
|
| Rate for Payer: PACE SWMI |
$1,439.05
|
| Rate for Payer: PHP Commercial |
$4,892.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,439.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,029.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,007.90
|
| Rate for Payer: Priority Health Medicare |
$1,439.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,510.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,439.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,065.46
|
| Rate for Payer: UHC Core |
$4,806.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,439.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,482.22
|
| Rate for Payer: VA VA |
$1,439.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,317.16
|
|
|
HC Z ZILVER STENT
|
Facility
|
OP
|
$5,782.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,373.44 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna Commercial |
$4,915.46
|
| Rate for Payer: Aetna Medicare |
$1,503.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,807.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,807.16
|
| Rate for Payer: BCBS Complete |
$2,313.16
|
| Rate for Payer: BCBS MAPPO |
$1,445.72
|
| Rate for Payer: BCBS Trust/PPO |
$4,496.20
|
| Rate for Payer: BCN Commercial |
$4,496.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,445.72
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$4,973.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,445.72
|
| Rate for Payer: Healthscope Commercial |
$5,204.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,337.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,518.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,662.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.46
|
| Rate for Payer: PACE Senior Care Partners |
$1,373.44
|
| Rate for Payer: PACE SWMI |
$1,445.72
|
| Rate for Payer: PHP Commercial |
$4,915.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,445.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,031.12
|
| Rate for Payer: Priority Health Medicare |
$1,445.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,526.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,445.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,088.95
|
| Rate for Payer: UHC Core |
$4,828.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,445.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,489.10
|
| Rate for Payer: VA VA |
$1,445.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.18
|
|
|
HC Z ZILVER STENT
|
Facility
|
IP
|
$5,782.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.99 |
| Max. Negotiated Rate |
$5,204.61 |
| Rate for Payer: Aetna Commercial |
$4,915.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,469.03
|
| Rate for Payer: BCN Commercial |
$4,469.03
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$4,973.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,204.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,337.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.46
|
| Rate for Payer: PHP Commercial |
$4,915.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,031.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,526.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,088.95
|
| Rate for Payer: UHC Core |
$4,828.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,337.18
|
|
|
HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)
|
Facility
|
OP
|
$629.53
|
|
|
Service Code
|
CPT 46221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$599.55 |
| Max. Negotiated Rate |
$629.53 |
| Rate for Payer: BCBS Complete |
$629.53
|
| Rate for Payer: Mclaren Medicaid |
$599.55
|
| Rate for Payer: Meridian Medicaid |
$629.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.55
|
|
|
HEPARIN CELLSAVER SOLUTION (BLH INTRA-OP)
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
NDC 9900-0007-09
|
| Hospital Charge Code |
151009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.71
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
112939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$19.54 |
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.78
|
| Rate for Payer: BCN Commercial |
$16.78
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.37
|
| Rate for Payer: Healthscope Commercial |
$19.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.45
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.10
|
| Rate for Payer: UHC Core |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.28
|
|
|
HEPARIN LOCK FLUSH (PORCINE) 10 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.84
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
3626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.22
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.38
|
|
