|
HC RO INTRSTI RADELEMENT APPL CMPLX
|
Facility
|
IP
|
$2,893.91
|
|
|
Service Code
|
CPT 77778
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,014.16 |
| Max. Negotiated Rate |
$2,604.52 |
| Rate for Payer: Aetna Commercial |
$2,459.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,390.08
|
| Rate for Payer: BCN Commercial |
$2,390.08
|
| 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: Healthscope Commercial |
$2,604.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,170.43
|
| 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: PHP Commercial |
$2,459.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,517.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,014.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,546.64
|
| Rate for Payer: UHC Core |
$2,416.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,170.43
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
IP
|
$239.56
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$166.73 |
| Max. Negotiated Rate |
$215.60 |
| Rate for Payer: Aetna Commercial |
$203.63
|
| Rate for Payer: BCBS Trust/PPO |
$197.85
|
| Rate for Payer: BCN Commercial |
$197.85
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cofinity Commercial |
$206.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.65
|
| Rate for Payer: Healthscope Commercial |
$215.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.63
|
| Rate for Payer: Nomi Health Commercial |
$196.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.67
|
| Rate for Payer: PHP Commercial |
$203.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.81
|
| Rate for Payer: UHC Core |
$200.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.67
|
|
|
HC RO ISODOSE BRACH CALC SIMPLE
|
Facility
|
OP
|
$239.56
|
|
|
Service Code
|
CPT 77316
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$42.23 |
| Max. Negotiated Rate |
$215.60 |
| Rate for Payer: Aetna Commercial |
$203.63
|
| Rate for Payer: Aetna Medicare |
$62.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.86
|
| Rate for Payer: BCBS Complete |
$44.34
|
| Rate for Payer: BCBS MAPPO |
$59.89
|
| Rate for Payer: BCBS Trust/PPO |
$196.94
|
| Rate for Payer: BCN Commercial |
$196.94
|
| Rate for Payer: BCN Medicare Advantage |
$59.89
|
| Rate for Payer: Cash Price |
$191.65
|
| Rate for Payer: Cofinity Commercial |
$206.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.89
|
| Rate for Payer: Healthscope Commercial |
$215.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.67
|
| Rate for Payer: Mclaren Medicaid |
$42.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.88
|
| Rate for Payer: Meridian Medicaid |
$44.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.63
|
| Rate for Payer: Nomi Health Commercial |
$196.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.67
|
| Rate for Payer: PACE Senior Care Partners |
$56.90
|
| Rate for Payer: PACE SWMI |
$59.89
|
| Rate for Payer: PHP Commercial |
$203.63
|
| Rate for Payer: PHP Medicare Advantage |
$59.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.42
|
| Rate for Payer: Priority Health Medicare |
$60.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.73
|
| Rate for Payer: Railroad Medicare Medicare |
$59.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.81
|
| Rate for Payer: UHC Core |
$200.03
|
| Rate for Payer: UHC Exchange |
$59.89
|
| Rate for Payer: UHC Medicaid |
$42.23
|
| Rate for Payer: UHC Medicare Advantage |
$59.89
|
| Rate for Payer: UHCCP Medicaid |
$42.23
|
| Rate for Payer: VA VA |
$59.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.67
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
OP
|
$698.64
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$123.17 |
| Max. Negotiated Rate |
$628.78 |
| Rate for Payer: Aetna Commercial |
$593.84
|
| Rate for Payer: Aetna Medicare |
$181.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.32
|
| Rate for Payer: BCBS Complete |
$129.32
|
| Rate for Payer: BCBS MAPPO |
$174.66
|
| Rate for Payer: BCBS Trust/PPO |
$574.35
|
| Rate for Payer: BCN Commercial |
$574.35
|
| Rate for Payer: BCN Medicare Advantage |
$174.66
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cofinity Commercial |
$600.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.66
|
| Rate for Payer: Healthscope Commercial |
$628.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$523.98
|
| Rate for Payer: Mclaren Medicaid |
$123.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.39
|
| Rate for Payer: Meridian Medicaid |
$129.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.84
|
| Rate for Payer: Nomi Health Commercial |
$572.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.98
|
| Rate for Payer: PACE Senior Care Partners |
$165.93
|
| Rate for Payer: PACE SWMI |
$174.66
|
| Rate for Payer: PHP Commercial |
$593.84
|
| Rate for Payer: PHP Medicare Advantage |
$174.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$607.82
|
| Rate for Payer: Priority Health Medicare |
$176.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.25
|
| Rate for Payer: Railroad Medicare Medicare |
$174.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.80
|
| Rate for Payer: UHC Core |
$583.36
|
| Rate for Payer: UHC Exchange |
$174.66
|
| Rate for Payer: UHC Medicaid |
$123.17
|
| Rate for Payer: UHC Medicare Advantage |
$174.66
|
| Rate for Payer: UHCCP Medicaid |
$123.17
|
| Rate for Payer: VA VA |
$174.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$523.98
|
|
|
HC RO ISODOSE BRACHY CALC COMPLEX
|
Facility
|
IP
|
$698.64
|
|
|
Service Code
|
CPT 77318
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$486.25 |
| Max. Negotiated Rate |
$628.78 |
| Rate for Payer: Aetna Commercial |
$593.84
|
| Rate for Payer: BCBS Trust/PPO |
$577.01
|
| Rate for Payer: BCN Commercial |
$577.01
|
| Rate for Payer: Cash Price |
$558.91
|
| Rate for Payer: Cofinity Commercial |
$600.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$558.91
|
| Rate for Payer: Healthscope Commercial |
$628.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$523.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$593.84
|
| Rate for Payer: Nomi Health Commercial |
$572.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$523.98
|
| Rate for Payer: PHP Commercial |
$593.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$607.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.80
|
| Rate for Payer: UHC Core |
$583.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$523.98
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
OP
|
$635.12
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$111.97 |
| Max. Negotiated Rate |
$571.61 |
| Rate for Payer: Aetna Commercial |
$539.85
|
| Rate for Payer: Aetna Medicare |
$165.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$198.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$198.47
|
| Rate for Payer: BCBS Complete |
$117.56
|
| Rate for Payer: BCBS MAPPO |
$158.78
|
| Rate for Payer: BCBS Trust/PPO |
$522.13
|
| Rate for Payer: BCN Commercial |
$522.13
|
| Rate for Payer: BCN Medicare Advantage |
$158.78
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cofinity Commercial |
$546.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.78
|
| Rate for Payer: Healthscope Commercial |
$571.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.34
|
| Rate for Payer: Mclaren Medicaid |
$111.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.72
|
| Rate for Payer: Meridian Medicaid |
$117.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$174.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.85
|
| Rate for Payer: Nomi Health Commercial |
$520.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.34
|
| Rate for Payer: PACE Senior Care Partners |
$150.84
|
| Rate for Payer: PACE SWMI |
$158.78
|
| Rate for Payer: PHP Commercial |
$539.85
|
| Rate for Payer: PHP Medicare Advantage |
$158.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$552.55
|
| Rate for Payer: Priority Health Medicare |
$160.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$442.04
|
| Rate for Payer: Railroad Medicare Medicare |
$158.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.91
|
| Rate for Payer: UHC Core |
$530.33
|
| Rate for Payer: UHC Exchange |
$158.78
|
| Rate for Payer: UHC Medicaid |
$111.97
|
| Rate for Payer: UHC Medicare Advantage |
$158.78
|
| Rate for Payer: UHCCP Medicaid |
$111.97
|
| Rate for Payer: VA VA |
$158.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.34
|
|
|
HC RO ISODOSE BRACHY CALC INTRM
|
Facility
|
IP
|
$635.12
|
|
|
Service Code
|
CPT 77317
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$442.04 |
| Max. Negotiated Rate |
$571.61 |
| Rate for Payer: Aetna Commercial |
$539.85
|
| Rate for Payer: BCBS Trust/PPO |
$524.55
|
| Rate for Payer: BCN Commercial |
$524.55
|
| Rate for Payer: Cash Price |
$508.10
|
| Rate for Payer: Cofinity Commercial |
$546.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.10
|
| Rate for Payer: Healthscope Commercial |
$571.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.85
|
| Rate for Payer: Nomi Health Commercial |
$520.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$476.34
|
| Rate for Payer: PHP Commercial |
$539.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$552.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$442.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.91
|
| Rate for Payer: UHC Core |
$530.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.34
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
IP
|
$1,181.13
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$822.07 |
| Max. Negotiated Rate |
$1,063.02 |
| Rate for Payer: Aetna Commercial |
$1,003.96
|
| Rate for Payer: BCBS Trust/PPO |
$975.50
|
| Rate for Payer: BCN Commercial |
$975.50
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cofinity Commercial |
$1,015.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.90
|
| Rate for Payer: Healthscope Commercial |
$1,063.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.96
|
| Rate for Payer: Nomi Health Commercial |
$968.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$885.85
|
| Rate for Payer: PHP Commercial |
$1,003.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,027.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$822.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.39
|
| Rate for Payer: UHC Core |
$986.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.85
|
|
|
HC RO ISODOSE TELETHRPY COMPLEX
|
Facility
|
OP
|
$1,181.13
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$208.23 |
| Max. Negotiated Rate |
$1,063.02 |
| Rate for Payer: Aetna Commercial |
$1,003.96
|
| Rate for Payer: Aetna Medicare |
$307.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$369.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$369.10
|
| Rate for Payer: BCBS Complete |
$218.63
|
| Rate for Payer: BCBS MAPPO |
$295.28
|
| Rate for Payer: BCBS Trust/PPO |
$971.01
|
| Rate for Payer: BCN Commercial |
$971.01
|
| Rate for Payer: BCN Medicare Advantage |
$295.28
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cofinity Commercial |
$1,015.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.28
|
| Rate for Payer: Healthscope Commercial |
$1,063.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.85
|
| Rate for Payer: Mclaren Medicaid |
$208.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.05
|
| Rate for Payer: Meridian Medicaid |
$218.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$324.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,003.96
|
| Rate for Payer: Nomi Health Commercial |
$968.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$885.85
|
| Rate for Payer: PACE Senior Care Partners |
$280.52
|
| Rate for Payer: PACE SWMI |
$295.28
|
| Rate for Payer: PHP Commercial |
$1,003.96
|
| Rate for Payer: PHP Medicare Advantage |
$295.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,027.58
|
| Rate for Payer: Priority Health Medicare |
$298.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$822.07
|
| Rate for Payer: Railroad Medicare Medicare |
$295.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.39
|
| Rate for Payer: UHC Core |
$986.24
|
| Rate for Payer: UHC Exchange |
$295.28
|
| Rate for Payer: UHC Medicaid |
$208.23
|
| Rate for Payer: UHC Medicare Advantage |
$295.28
|
| Rate for Payer: UHCCP Medicaid |
$208.23
|
| Rate for Payer: VA VA |
$295.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.85
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
OP
|
$257.88
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$232.09 |
| Rate for Payer: Aetna Commercial |
$219.20
|
| Rate for Payer: Aetna Medicare |
$67.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.59
|
| Rate for Payer: BCBS Complete |
$47.73
|
| Rate for Payer: BCBS MAPPO |
$64.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.00
|
| Rate for Payer: BCN Commercial |
$212.00
|
| Rate for Payer: BCN Medicare Advantage |
$64.47
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Commercial |
$221.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.47
|
| Rate for Payer: Healthscope Commercial |
$232.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.41
|
| Rate for Payer: Mclaren Medicaid |
$45.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.69
|
| Rate for Payer: Meridian Medicaid |
$47.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$211.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PACE Senior Care Partners |
$61.25
|
| Rate for Payer: PACE SWMI |
$64.47
|
| Rate for Payer: PHP Commercial |
$219.20
|
| Rate for Payer: PHP Medicare Advantage |
$64.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.36
|
| Rate for Payer: Priority Health Medicare |
$65.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.48
|
| Rate for Payer: Railroad Medicare Medicare |
$64.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.93
|
| Rate for Payer: UHC Core |
$215.33
|
| Rate for Payer: UHC Exchange |
$64.47
|
| Rate for Payer: UHC Medicaid |
$45.46
|
| Rate for Payer: UHC Medicare Advantage |
$64.47
|
| Rate for Payer: UHCCP Medicaid |
$45.46
|
| Rate for Payer: VA VA |
$64.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.41
|
|
|
HC RO ISODOSE TELETHRPY SIMPLE
|
Facility
|
IP
|
$257.88
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.48 |
| Max. Negotiated Rate |
$232.09 |
| Rate for Payer: Aetna Commercial |
$219.20
|
| Rate for Payer: BCBS Trust/PPO |
$212.98
|
| Rate for Payer: BCN Commercial |
$212.98
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Commercial |
$221.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Healthscope Commercial |
$232.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$211.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PHP Commercial |
$219.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.93
|
| Rate for Payer: UHC Core |
$215.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.41
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,616.93
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$3,255.24 |
| Rate for Payer: Aetna Commercial |
$3,074.39
|
| Rate for Payer: Aetna Medicare |
$940.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,130.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,130.29
|
| Rate for Payer: BCBS Complete |
$669.49
|
| Rate for Payer: BCBS MAPPO |
$904.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,973.48
|
| Rate for Payer: BCN Commercial |
$2,973.48
|
| Rate for Payer: BCN Medicare Advantage |
$904.23
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cofinity Commercial |
$3,110.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,893.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$904.23
|
| Rate for Payer: Healthscope Commercial |
$3,255.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,712.70
|
| Rate for Payer: Mclaren Medicaid |
$637.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$949.44
|
| Rate for Payer: Meridian Medicaid |
$669.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,074.39
|
| Rate for Payer: Nomi Health Commercial |
$2,965.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,712.70
|
| Rate for Payer: PACE Senior Care Partners |
$859.02
|
| Rate for Payer: PACE SWMI |
$904.23
|
| Rate for Payer: PHP Commercial |
$3,074.39
|
| Rate for Payer: PHP Medicare Advantage |
$904.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,146.73
|
| Rate for Payer: Priority Health Medicare |
$913.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,517.38
|
| Rate for Payer: Railroad Medicare Medicare |
$904.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,182.90
|
| Rate for Payer: UHC Core |
$3,020.14
|
| Rate for Payer: UHC Exchange |
$904.23
|
| Rate for Payer: UHC Medicaid |
$637.66
|
| Rate for Payer: UHC Medicare Advantage |
$904.23
|
| Rate for Payer: UHCCP Medicaid |
$637.66
|
| Rate for Payer: VA VA |
$904.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,712.70
|
|
|
HC RO LINAC SBRT PER SESSION
|
Facility
|
IP
|
$3,616.93
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,517.38 |
| Max. Negotiated Rate |
$3,255.24 |
| Rate for Payer: Aetna Commercial |
$3,074.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,987.22
|
| Rate for Payer: BCN Commercial |
$2,987.22
|
| Rate for Payer: Cash Price |
$2,893.54
|
| Rate for Payer: Cofinity Commercial |
$3,110.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,893.54
|
| Rate for Payer: Healthscope Commercial |
$3,255.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,712.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,074.39
|
| Rate for Payer: Nomi Health Commercial |
$2,965.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,712.70
|
| Rate for Payer: PHP Commercial |
$3,074.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,146.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,517.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,182.90
|
| Rate for Payer: UHC Core |
$3,020.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,712.70
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.67
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.27
|
| Rate for Payer: UHC Core |
$9.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.75
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.67
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.92
|
| Rate for Payer: Aetna Medicare |
$3.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.65
|
| Rate for Payer: BCBS Complete |
$2.16
|
| Rate for Payer: BCBS MAPPO |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.59
|
| Rate for Payer: BCN Commercial |
$9.59
|
| Rate for Payer: BCN Medicare Advantage |
$2.92
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.75
|
| Rate for Payer: Mclaren Medicaid |
$2.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.06
|
| Rate for Payer: Meridian Medicaid |
$2.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: PACE Senior Care Partners |
$2.77
|
| Rate for Payer: PACE SWMI |
$2.92
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: PHP Medicare Advantage |
$2.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.15
|
| Rate for Payer: Priority Health Medicare |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.12
|
| Rate for Payer: Railroad Medicare Medicare |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.27
|
| Rate for Payer: UHC Core |
$9.74
|
| Rate for Payer: UHC Exchange |
$2.92
|
| Rate for Payer: UHC Medicaid |
$2.06
|
| Rate for Payer: UHC Medicare Advantage |
$2.92
|
| Rate for Payer: UHCCP Medicaid |
$2.06
|
| Rate for Payer: VA VA |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.75
|
|
|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,846.93
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,285.46 |
| Max. Negotiated Rate |
$2,393.75 |
| Rate for Payer: Aetna Commercial |
$1,569.89
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.38
|
| Rate for Payer: BCN Commercial |
$1,525.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cofinity Commercial |
$1,588.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$1,662.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.89
|
| Rate for Payer: Nomi Health Commercial |
$1,514.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.20
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$1,569.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,606.83
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,285.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC Core |
$1,542.19
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.20
|
|
|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,423.98
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$3,081.58 |
| Rate for Payer: Aetna Commercial |
$2,910.38
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,827.87
|
| Rate for Payer: BCN Commercial |
$2,827.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$2,739.18
|
| Rate for Payer: Cash Price |
$2,739.18
|
| Rate for Payer: Cofinity Commercial |
$2,944.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,739.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$3,081.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,567.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,910.38
|
| Rate for Payer: Nomi Health Commercial |
$2,807.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,567.99
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$2,910.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,978.86
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,383.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,013.10
|
| Rate for Payer: UHC Core |
$2,859.02
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,567.99
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,399.10
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,669.77 |
| Max. Negotiated Rate |
$2,393.75 |
| Rate for Payer: Aetna Commercial |
$2,039.23
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,981.42
|
| Rate for Payer: BCN Commercial |
$1,981.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,919.28
|
| Rate for Payer: Cash Price |
$1,919.28
|
| Rate for Payer: Cofinity Commercial |
$2,063.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,919.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$2,159.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,799.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,039.23
|
| Rate for Payer: Nomi Health Commercial |
$1,967.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,799.33
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$2,039.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,087.22
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,669.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,111.21
|
| Rate for Payer: UHC Core |
$2,003.25
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,799.33
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
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 RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
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 ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.30
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.42
|
| Rate for Payer: BCN Commercial |
$3.42
|
| Rate for Payer: BCN Medicare Advantage |
$1.04
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.04
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: Mclaren Medicaid |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.09
|
| Rate for Payer: Meridian Medicaid |
$0.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: PACE Senior Care Partners |
$0.99
|
| Rate for Payer: PACE SWMI |
$1.04
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$1.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.62
|
| Rate for Payer: Priority Health Medicare |
$1.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Exchange |
$1.04
|
| Rate for Payer: UHC Medicaid |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$1.04
|
| Rate for Payer: UHCCP Medicaid |
$0.73
|
| Rate for Payer: VA VA |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.44
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.82 |
| Max. Negotiated Rate |
$183.38 |
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: BCBS Trust/PPO |
$168.29
|
| Rate for Payer: BCN Commercial |
$168.29
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Commercial |
$175.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$183.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Nomi Health Commercial |
$167.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: PHP Commercial |
$173.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$177.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.31
|
| Rate for Payer: UHC Core |
$170.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.82
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$183.38 |
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: Aetna Medicare |
$52.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.67
|
| Rate for Payer: BCBS Complete |
$37.72
|
| Rate for Payer: BCBS MAPPO |
$50.94
|
| Rate for Payer: BCBS Trust/PPO |
$167.51
|
| Rate for Payer: BCN Commercial |
$167.51
|
| Rate for Payer: BCN Medicare Advantage |
$50.94
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Commercial |
$175.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$183.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.82
|
| Rate for Payer: Mclaren Medicaid |
$35.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.49
|
| Rate for Payer: Meridian Medicaid |
$37.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Nomi Health Commercial |
$167.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: PACE Senior Care Partners |
$48.39
|
| Rate for Payer: PACE SWMI |
$50.94
|
| Rate for Payer: PHP Commercial |
$173.20
|
| Rate for Payer: PHP Medicare Advantage |
$50.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$177.27
|
| Rate for Payer: Priority Health Medicare |
$51.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.82
|
| Rate for Payer: Railroad Medicare Medicare |
$50.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.31
|
| Rate for Payer: UHC Core |
$170.14
|
| Rate for Payer: UHC Exchange |
$50.94
|
| Rate for Payer: UHC Medicaid |
$35.92
|
| Rate for Payer: UHC Medicare Advantage |
$50.94
|
| Rate for Payer: UHCCP Medicaid |
$35.92
|
| Rate for Payer: VA VA |
$50.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.82
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,970.81 |
| Max. Negotiated Rate |
$3,841.56 |
| Rate for Payer: Aetna Commercial |
$3,628.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,525.27
|
| Rate for Payer: BCN Commercial |
$3,525.27
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Commercial |
$3,670.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Healthscope Commercial |
$3,841.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,201.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Nomi Health Commercial |
$3,500.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: PHP Commercial |
$3,628.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,713.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,970.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,756.19
|
| Rate for Payer: UHC Core |
$3,564.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,201.30
|
|
