|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,444.94
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.04 |
| Max. Negotiated Rate |
$2,200.45 |
| Rate for Payer: Aetna Commercial |
$2,078.20
|
| Rate for Payer: Aetna Medicare |
$635.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$764.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$764.04
|
| Rate for Payer: BCBS Complete |
$452.56
|
| Rate for Payer: BCBS MAPPO |
$611.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.99
|
| Rate for Payer: BCN Commercial |
$2,009.99
|
| Rate for Payer: BCN Medicare Advantage |
$611.24
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cofinity Commercial |
$2,102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.24
|
| Rate for Payer: Healthscope Commercial |
$2,200.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,833.70
|
| Rate for Payer: Mclaren Medicaid |
$431.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$641.80
|
| Rate for Payer: Meridian Medicaid |
$452.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$702.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$672.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.20
|
| Rate for Payer: Nomi Health Commercial |
$2,004.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.70
|
| Rate for Payer: PACE Senior Care Partners |
$580.67
|
| Rate for Payer: PACE SWMI |
$611.24
|
| Rate for Payer: PHP Commercial |
$2,078.20
|
| Rate for Payer: PHP Medicare Advantage |
$611.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,127.10
|
| Rate for Payer: Priority Health Medicare |
$617.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,701.68
|
| Rate for Payer: Railroad Medicare Medicare |
$611.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,151.55
|
| Rate for Payer: UHC Core |
$2,041.52
|
| Rate for Payer: UHC Exchange |
$611.24
|
| Rate for Payer: UHC Medicaid |
$431.04
|
| Rate for Payer: UHC Medicare Advantage |
$611.24
|
| Rate for Payer: UHCCP Medicaid |
$431.04
|
| Rate for Payer: VA VA |
$611.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,833.70
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,444.94
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,701.68 |
| Max. Negotiated Rate |
$2,200.45 |
| Rate for Payer: Aetna Commercial |
$2,078.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,019.28
|
| Rate for Payer: BCN Commercial |
$2,019.28
|
| Rate for Payer: Cash Price |
$1,955.95
|
| Rate for Payer: Cofinity Commercial |
$2,102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,955.95
|
| Rate for Payer: Healthscope Commercial |
$2,200.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,833.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,078.20
|
| Rate for Payer: Nomi Health Commercial |
$2,004.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.70
|
| Rate for Payer: PHP Commercial |
$2,078.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,127.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,701.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,151.55
|
| Rate for Payer: UHC Core |
$2,041.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,833.70
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
IP
|
$366.18
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.86 |
| Max. Negotiated Rate |
$329.56 |
| Rate for Payer: Aetna Commercial |
$311.25
|
| Rate for Payer: BCBS Trust/PPO |
$302.43
|
| Rate for Payer: BCN Commercial |
$302.43
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cofinity Commercial |
$314.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.94
|
| Rate for Payer: Healthscope Commercial |
$329.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.25
|
| Rate for Payer: Nomi Health Commercial |
$300.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.63
|
| Rate for Payer: PHP Commercial |
$311.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$318.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.24
|
| Rate for Payer: UHC Core |
$305.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.63
|
|
|
HC RMVL FB XTRNL EYE CORNEAL W SLIT LAMP
|
Facility
|
OP
|
$366.18
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
76200521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$329.56 |
| Rate for Payer: Aetna Commercial |
$311.25
|
| Rate for Payer: Aetna Medicare |
$95.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.43
|
| Rate for Payer: BCBS Complete |
$67.78
|
| Rate for Payer: BCBS MAPPO |
$91.55
|
| Rate for Payer: BCBS Trust/PPO |
$301.04
|
| Rate for Payer: BCN Commercial |
$301.04
|
| Rate for Payer: BCN Medicare Advantage |
$91.55
|
| Rate for Payer: Cash Price |
$292.94
|
| Rate for Payer: Cofinity Commercial |
$314.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$329.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.63
|
| Rate for Payer: Mclaren Medicaid |
$64.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.12
|
| Rate for Payer: Meridian Medicaid |
$67.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.25
|
| Rate for Payer: Nomi Health Commercial |
$300.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.63
|
| Rate for Payer: PACE Senior Care Partners |
$86.97
|
| Rate for Payer: PACE SWMI |
$91.55
|
| Rate for Payer: PHP Commercial |
$311.25
|
| Rate for Payer: PHP Medicare Advantage |
$91.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$318.58
|
| Rate for Payer: Priority Health Medicare |
$92.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.86
|
| Rate for Payer: Railroad Medicare Medicare |
$91.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.24
|
| Rate for Payer: UHC Core |
$305.76
|
| Rate for Payer: UHC Exchange |
$91.55
|
| Rate for Payer: UHC Medicaid |
$64.56
|
| Rate for Payer: UHC Medicare Advantage |
$91.55
|
| Rate for Payer: UHCCP Medicaid |
$64.56
|
| Rate for Payer: VA VA |
$91.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.63
|
|
|
HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
IP
|
$10,002.80
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
48100138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,961.95 |
| Max. Negotiated Rate |
$9,002.52 |
| Rate for Payer: Aetna Commercial |
$8,502.38
|
| Rate for Payer: BCBS Trust/PPO |
$8,261.31
|
| Rate for Payer: BCN Commercial |
$8,261.31
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cofinity Commercial |
$8,602.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,002.24
|
| Rate for Payer: Healthscope Commercial |
$9,002.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,502.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,502.38
|
| Rate for Payer: Nomi Health Commercial |
$8,202.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,502.10
|
| Rate for Payer: PHP Commercial |
$8,502.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,702.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,961.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,802.46
|
| Rate for Payer: UHC Core |
$8,352.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,502.10
|
|
|
HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
OP
|
$10,002.80
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
48100138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,763.49 |
| Max. Negotiated Rate |
$9,002.52 |
| Rate for Payer: Aetna Commercial |
$8,502.38
|
| Rate for Payer: Aetna Medicare |
$2,600.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,125.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,125.88
|
| Rate for Payer: BCBS Complete |
$1,851.52
|
| Rate for Payer: BCBS MAPPO |
$2,500.70
|
| Rate for Payer: BCBS Trust/PPO |
$8,223.30
|
| Rate for Payer: BCN Commercial |
$8,223.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,500.70
|
| Rate for Payer: Cash Price |
$8,002.24
|
| Rate for Payer: Cofinity Commercial |
$8,602.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,002.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,500.70
|
| Rate for Payer: Healthscope Commercial |
$9,002.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,502.10
|
| Rate for Payer: Mclaren Medicaid |
$1,763.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,625.74
|
| Rate for Payer: Meridian Medicaid |
$1,851.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,875.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,750.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,502.38
|
| Rate for Payer: Nomi Health Commercial |
$8,202.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,502.10
|
| Rate for Payer: PACE Senior Care Partners |
$2,375.66
|
| Rate for Payer: PACE SWMI |
$2,500.70
|
| Rate for Payer: PHP Commercial |
$8,502.38
|
| Rate for Payer: PHP Medicare Advantage |
$2,500.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,763.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,702.44
|
| Rate for Payer: Priority Health Medicare |
$2,525.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,961.95
|
| Rate for Payer: Railroad Medicare Medicare |
$2,500.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,802.46
|
| Rate for Payer: UHC Core |
$8,352.34
|
| Rate for Payer: UHC Exchange |
$2,500.70
|
| Rate for Payer: UHC Medicaid |
$1,763.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,500.70
|
| Rate for Payer: UHCCP Medicaid |
$1,763.49
|
| Rate for Payer: VA VA |
$2,500.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,502.10
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: BCBS Trust/PPO |
$60.15
|
| Rate for Payer: BCN Commercial |
$60.15
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.09
|
| Rate for Payer: UHC Core |
$60.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.76
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.87
|
| Rate for Payer: BCN Commercial |
$59.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Mclaren Medicaid |
$12.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: Meridian Medicaid |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.36
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.69
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.09
|
| Rate for Payer: UHC Core |
$60.81
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.84
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$9.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$8.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.49
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.97
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.52
|
| Rate for Payer: PACE SWMI |
$8.97
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Medicare |
$9.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: UHC Exchange |
$8.97
|
| Rate for Payer: UHC Medicaid |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.97
|
| Rate for Payer: UHCCP Medicaid |
$6.32
|
| Rate for Payer: VA VA |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$9.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$8.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.49
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.97
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.52
|
| Rate for Payer: PACE SWMI |
$8.97
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Medicare |
$9.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: UHC Exchange |
$8.97
|
| Rate for Payer: UHC Medicaid |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.97
|
| Rate for Payer: UHCCP Medicaid |
$6.32
|
| Rate for Payer: VA VA |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC RNP ANTIBODIES, IGG
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC RNP U1 ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$9.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$8.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.49
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.97
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.52
|
| Rate for Payer: PACE SWMI |
$8.97
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Medicare |
$9.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: UHC Exchange |
$8.97
|
| Rate for Payer: UHC Medicaid |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.97
|
| Rate for Payer: UHCCP Medicaid |
$6.32
|
| Rate for Payer: VA VA |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
OP
|
$228.27
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$194.03
|
| Rate for Payer: Aetna Medicare |
$59.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.33
|
| Rate for Payer: BCBS Complete |
$42.25
|
| Rate for Payer: BCBS MAPPO |
$57.07
|
| Rate for Payer: BCBS Trust/PPO |
$187.66
|
| Rate for Payer: BCN Commercial |
$187.66
|
| Rate for Payer: BCN Medicare Advantage |
$57.07
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Cofinity Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.07
|
| Rate for Payer: Healthscope Commercial |
$205.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.20
|
| Rate for Payer: Mclaren Medicaid |
$40.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.92
|
| Rate for Payer: Meridian Medicaid |
$42.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.03
|
| Rate for Payer: Nomi Health Commercial |
$187.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.20
|
| Rate for Payer: PACE Senior Care Partners |
$54.21
|
| Rate for Payer: PACE SWMI |
$57.07
|
| Rate for Payer: PHP Commercial |
$194.03
|
| Rate for Payer: PHP Medicare Advantage |
$57.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.59
|
| Rate for Payer: Priority Health Medicare |
$57.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.88
|
| Rate for Payer: Railroad Medicare Medicare |
$57.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.88
|
| Rate for Payer: UHC Core |
$190.61
|
| Rate for Payer: UHC Exchange |
$57.07
|
| Rate for Payer: UHC Medicaid |
$40.24
|
| Rate for Payer: UHC Medicare Advantage |
$57.07
|
| Rate for Payer: UHCCP Medicaid |
$40.24
|
| Rate for Payer: VA VA |
$57.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.20
|
|
|
HC RO GUIDE LOC TARGET VOL TX DEL
|
Facility
|
IP
|
$228.27
|
|
|
Service Code
|
CPT 77387
|
| Hospital Charge Code |
33300061
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$194.03
|
| Rate for Payer: BCBS Trust/PPO |
$188.53
|
| Rate for Payer: BCN Commercial |
$188.53
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Cofinity Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.62
|
| Rate for Payer: Healthscope Commercial |
$205.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.03
|
| Rate for Payer: Nomi Health Commercial |
$187.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.20
|
| Rate for Payer: PHP Commercial |
$194.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.88
|
| Rate for Payer: UHC Core |
$190.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.20
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
IP
|
$3,353.76
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,334.22 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,769.87
|
| Rate for Payer: BCN Commercial |
$2,769.87
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,515.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,917.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,334.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,951.31
|
| Rate for Payer: UHC Core |
$2,800.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,515.32
|
|
|
HC RO IMRT DEL COMPLEX
|
Facility
|
OP
|
$3,353.76
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
33300051
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$591.27 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: Aetna Medicare |
$871.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,048.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,048.05
|
| Rate for Payer: BCBS Complete |
$620.78
|
| Rate for Payer: BCBS MAPPO |
$838.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,757.13
|
| Rate for Payer: BCN Commercial |
$2,757.13
|
| Rate for Payer: BCN Medicare Advantage |
$838.44
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.44
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,515.32
|
| Rate for Payer: Mclaren Medicaid |
$591.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$880.36
|
| Rate for Payer: Meridian Medicaid |
$620.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$964.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$922.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PACE Senior Care Partners |
$796.52
|
| Rate for Payer: PACE SWMI |
$838.44
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: PHP Medicare Advantage |
$838.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,917.77
|
| Rate for Payer: Priority Health Medicare |
$846.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,334.22
|
| Rate for Payer: Railroad Medicare Medicare |
$838.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,951.31
|
| Rate for Payer: UHC Core |
$2,800.39
|
| Rate for Payer: UHC Exchange |
$838.44
|
| Rate for Payer: UHC Medicaid |
$591.27
|
| Rate for Payer: UHC Medicare Advantage |
$838.44
|
| Rate for Payer: UHCCP Medicaid |
$591.27
|
| Rate for Payer: VA VA |
$838.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,515.32
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
IP
|
$3,353.76
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,334.22 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,769.87
|
| Rate for Payer: BCN Commercial |
$2,769.87
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,515.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,917.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,334.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,951.31
|
| Rate for Payer: UHC Core |
$2,800.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,515.32
|
|
|
HC RO IMRT DEL SIMPLE
|
Facility
|
OP
|
$3,353.76
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
33300050
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$591.27 |
| Max. Negotiated Rate |
$3,018.38 |
| Rate for Payer: Aetna Commercial |
$2,850.70
|
| Rate for Payer: Aetna Medicare |
$871.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,048.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,048.05
|
| Rate for Payer: BCBS Complete |
$620.78
|
| Rate for Payer: BCBS MAPPO |
$838.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,757.13
|
| Rate for Payer: BCN Commercial |
$2,757.13
|
| Rate for Payer: BCN Medicare Advantage |
$838.44
|
| Rate for Payer: Cash Price |
$2,683.01
|
| Rate for Payer: Cofinity Commercial |
$2,884.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,683.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.44
|
| Rate for Payer: Healthscope Commercial |
$3,018.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,515.32
|
| Rate for Payer: Mclaren Medicaid |
$591.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$880.36
|
| Rate for Payer: Meridian Medicaid |
$620.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$964.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$922.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,850.70
|
| Rate for Payer: Nomi Health Commercial |
$2,750.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,515.32
|
| Rate for Payer: PACE Senior Care Partners |
$796.52
|
| Rate for Payer: PACE SWMI |
$838.44
|
| Rate for Payer: PHP Commercial |
$2,850.70
|
| Rate for Payer: PHP Medicare Advantage |
$838.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,917.77
|
| Rate for Payer: Priority Health Medicare |
$846.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,334.22
|
| Rate for Payer: Railroad Medicare Medicare |
$838.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,951.31
|
| Rate for Payer: UHC Core |
$2,800.39
|
| Rate for Payer: UHC Exchange |
$838.44
|
| Rate for Payer: UHC Medicaid |
$591.27
|
| Rate for Payer: UHC Medicare Advantage |
$838.44
|
| Rate for Payer: UHCCP Medicaid |
$591.27
|
| Rate for Payer: VA VA |
$838.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,515.32
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$338.53
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.68 |
| Max. Negotiated Rate |
$304.68 |
| Rate for Payer: Aetna Commercial |
$287.75
|
| Rate for Payer: Aetna Medicare |
$88.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.79
|
| Rate for Payer: BCBS Complete |
$62.66
|
| Rate for Payer: BCBS MAPPO |
$84.63
|
| Rate for Payer: BCBS Trust/PPO |
$278.31
|
| Rate for Payer: BCN Commercial |
$278.31
|
| Rate for Payer: BCN Medicare Advantage |
$84.63
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$291.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.63
|
| Rate for Payer: Healthscope Commercial |
$304.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.90
|
| Rate for Payer: Mclaren Medicaid |
$59.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.86
|
| Rate for Payer: Meridian Medicaid |
$62.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.75
|
| Rate for Payer: Nomi Health Commercial |
$277.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.90
|
| Rate for Payer: PACE Senior Care Partners |
$80.40
|
| Rate for Payer: PACE SWMI |
$84.63
|
| Rate for Payer: PHP Commercial |
$287.75
|
| Rate for Payer: PHP Medicare Advantage |
$84.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.52
|
| Rate for Payer: Priority Health Medicare |
$85.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.62
|
| Rate for Payer: Railroad Medicare Medicare |
$84.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.91
|
| Rate for Payer: UHC Core |
$282.67
|
| Rate for Payer: UHC Exchange |
$84.63
|
| Rate for Payer: UHC Medicaid |
$59.68
|
| Rate for Payer: UHC Medicare Advantage |
$84.63
|
| Rate for Payer: UHCCP Medicaid |
$59.68
|
| Rate for Payer: VA VA |
$84.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.90
|
|
|
HC RO INFUS RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$338.53
|
|
|
Service Code
|
CPT 77750
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$304.68 |
| Rate for Payer: Aetna Commercial |
$287.75
|
| Rate for Payer: BCBS Trust/PPO |
$279.59
|
| Rate for Payer: BCN Commercial |
$279.59
|
| Rate for Payer: Cash Price |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$291.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.82
|
| Rate for Payer: Healthscope Commercial |
$304.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.75
|
| Rate for Payer: Nomi Health Commercial |
$277.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.90
|
| Rate for Payer: PHP Commercial |
$287.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.91
|
| Rate for Payer: UHC Core |
$282.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.90
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
OP
|
$561.41
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$505.27 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: Aetna Medicare |
$145.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.44
|
| Rate for Payer: BCBS Complete |
$103.92
|
| Rate for Payer: BCBS MAPPO |
$140.35
|
| Rate for Payer: BCBS Trust/PPO |
$461.54
|
| Rate for Payer: BCN Commercial |
$461.54
|
| Rate for Payer: BCN Medicare Advantage |
$140.35
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cofinity Commercial |
$482.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.35
|
| Rate for Payer: Healthscope Commercial |
$505.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.06
|
| Rate for Payer: Mclaren Medicaid |
$98.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.37
|
| Rate for Payer: Meridian Medicaid |
$103.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$154.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.20
|
| Rate for Payer: Nomi Health Commercial |
$460.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.06
|
| Rate for Payer: PACE Senior Care Partners |
$133.33
|
| Rate for Payer: PACE SWMI |
$140.35
|
| Rate for Payer: PHP Commercial |
$477.20
|
| Rate for Payer: PHP Medicare Advantage |
$140.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$488.43
|
| Rate for Payer: Priority Health Medicare |
$141.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$390.74
|
| Rate for Payer: Railroad Medicare Medicare |
$140.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.04
|
| Rate for Payer: UHC Core |
$468.78
|
| Rate for Payer: UHC Exchange |
$140.35
|
| Rate for Payer: UHC Medicaid |
$98.98
|
| Rate for Payer: UHC Medicare Advantage |
$140.35
|
| Rate for Payer: UHCCP Medicaid |
$98.98
|
| Rate for Payer: VA VA |
$140.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.06
|
|
|
HC RO INS VAG BRACHTHER DEVICE
|
Facility
|
IP
|
$561.41
|
|
|
Service Code
|
CPT 57156
|
| Hospital Charge Code |
36100444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$390.74 |
| Max. Negotiated Rate |
$505.27 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: BCBS Trust/PPO |
$463.67
|
| Rate for Payer: BCN Commercial |
$463.67
|
| Rate for Payer: Cash Price |
$449.13
|
| Rate for Payer: Cofinity Commercial |
$482.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.13
|
| Rate for Payer: Healthscope Commercial |
$505.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.20
|
| Rate for Payer: Nomi Health Commercial |
$460.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.06
|
| Rate for Payer: PHP Commercial |
$477.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$488.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$390.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.04
|
| Rate for Payer: UHC Core |
$468.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.06
|
|
|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
OP
|
$2,893.91
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$510.20 |
| Max. Negotiated Rate |
$2,604.52 |
| Rate for Payer: Aetna Commercial |
$2,459.82
|
| Rate for Payer: Aetna Medicare |
$752.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$904.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$904.35
|
| Rate for Payer: BCBS Complete |
$535.66
|
| Rate for Payer: BCBS MAPPO |
$723.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.08
|
| Rate for Payer: BCN Commercial |
$2,379.08
|
| Rate for Payer: BCN Medicare Advantage |
$723.48
|
| Rate for Payer: Cash Price |
$2,315.13
|
| Rate for Payer: Cofinity Commercial |
$2,488.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,315.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$723.48
|
| Rate for Payer: Healthscope Commercial |
$2,604.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,170.43
|
| Rate for Payer: Mclaren Medicaid |
$510.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.65
|
| Rate for Payer: Meridian Medicaid |
$535.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$832.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$795.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,459.82
|
| Rate for Payer: Nomi Health Commercial |
$2,373.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,170.43
|
| Rate for Payer: PACE Senior Care Partners |
$687.30
|
| Rate for Payer: PACE SWMI |
$723.48
|
| Rate for Payer: PHP Commercial |
$2,459.82
|
| Rate for Payer: PHP Medicare Advantage |
$723.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,517.70
|
| Rate for Payer: Priority Health Medicare |
$730.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,014.16
|
| Rate for Payer: Railroad Medicare Medicare |
$723.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,546.64
|
| Rate for Payer: UHC Core |
$2,416.41
|
| Rate for Payer: UHC Exchange |
$723.48
|
| Rate for Payer: UHC Medicaid |
$510.20
|
| Rate for Payer: UHC Medicare Advantage |
$723.48
|
| Rate for Payer: UHCCP Medicaid |
$510.20
|
| Rate for Payer: VA VA |
$723.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,170.43
|
|
