|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$881.99
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$793.79 |
| Rate for Payer: Aetna Commercial |
$749.69
|
| Rate for Payer: Aetna Medicare |
$229.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.62
|
| Rate for Payer: BCBS Complete |
$159.96
|
| Rate for Payer: BCBS MAPPO |
$220.50
|
| Rate for Payer: BCBS Trust/PPO |
$725.08
|
| Rate for Payer: BCN Commercial |
$685.75
|
| Rate for Payer: BCN Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cofinity Commercial |
$758.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.50
|
| Rate for Payer: Healthscope Commercial |
$793.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.49
|
| Rate for Payer: Mclaren Medicaid |
$152.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.52
|
| Rate for Payer: Meridian Medicaid |
$159.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.69
|
| Rate for Payer: Nomi Health Commercial |
$723.23
|
| Rate for Payer: PACE Senior Care Partners |
$209.47
|
| Rate for Payer: PACE SWMI |
$220.50
|
| Rate for Payer: PHP Commercial |
$749.69
|
| Rate for Payer: PHP Medicare Advantage |
$220.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.29
|
| Rate for Payer: Priority Health HMO/PPO |
$767.33
|
| Rate for Payer: Priority Health Medicare |
$222.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.93
|
| Rate for Payer: Railroad Medicare Medicare |
$220.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.15
|
| Rate for Payer: UHC Core |
$736.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.50
|
| Rate for Payer: UHC Exchange |
$220.50
|
| Rate for Payer: UHC Medicare Advantage |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$152.33
|
| Rate for Payer: VA VA |
$220.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.49
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
OP
|
$421.57
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$379.41 |
| Rate for Payer: Aetna Commercial |
$358.33
|
| Rate for Payer: Aetna Medicare |
$109.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.74
|
| Rate for Payer: BCBS Complete |
$227.69
|
| Rate for Payer: BCBS MAPPO |
$105.39
|
| Rate for Payer: BCBS Trust/PPO |
$346.57
|
| Rate for Payer: BCN Commercial |
$327.77
|
| Rate for Payer: BCN Medicare Advantage |
$105.39
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cofinity Commercial |
$362.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.39
|
| Rate for Payer: Healthscope Commercial |
$379.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.18
|
| Rate for Payer: Mclaren Medicaid |
$216.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.66
|
| Rate for Payer: Meridian Medicaid |
$227.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.33
|
| Rate for Payer: Nomi Health Commercial |
$345.69
|
| Rate for Payer: PACE Senior Care Partners |
$100.12
|
| Rate for Payer: PACE SWMI |
$105.39
|
| Rate for Payer: PHP Commercial |
$358.33
|
| Rate for Payer: PHP Medicare Advantage |
$105.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.02
|
| Rate for Payer: Priority Health HMO/PPO |
$366.77
|
| Rate for Payer: Priority Health Medicare |
$106.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.45
|
| Rate for Payer: Railroad Medicare Medicare |
$105.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.98
|
| Rate for Payer: UHC Core |
$352.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.39
|
| Rate for Payer: UHC Exchange |
$105.39
|
| Rate for Payer: UHC Medicare Advantage |
$105.39
|
| Rate for Payer: UHCCP Medicaid |
$216.83
|
| Rate for Payer: VA VA |
$105.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.18
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
IP
|
$421.57
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.02 |
| Max. Negotiated Rate |
$379.41 |
| Rate for Payer: Aetna Commercial |
$358.33
|
| Rate for Payer: BCBS Trust/PPO |
$344.13
|
| Rate for Payer: BCN Commercial |
$325.79
|
| Rate for Payer: Cash Price |
$337.26
|
| Rate for Payer: Cofinity Commercial |
$362.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.26
|
| Rate for Payer: Healthscope Commercial |
$379.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.33
|
| Rate for Payer: Nomi Health Commercial |
$345.69
|
| Rate for Payer: PHP Commercial |
$358.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.02
|
| Rate for Payer: Priority Health HMO/PPO |
$366.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.98
|
| Rate for Payer: UHC Core |
$352.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.18
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$155.02
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$139.52 |
| Rate for Payer: Aetna Commercial |
$131.77
|
| Rate for Payer: BCBS Trust/PPO |
$126.54
|
| Rate for Payer: BCN Commercial |
$119.80
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cofinity Commercial |
$133.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.02
|
| Rate for Payer: Healthscope Commercial |
$139.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.77
|
| Rate for Payer: Nomi Health Commercial |
$127.12
|
| Rate for Payer: PHP Commercial |
$131.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.76
|
| Rate for Payer: Priority Health HMO/PPO |
$134.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.42
|
| Rate for Payer: UHC Core |
$129.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.27
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
OP
|
$155.02
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$139.52 |
| Rate for Payer: Aetna Commercial |
$131.77
|
| Rate for Payer: Aetna Medicare |
$40.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.44
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$38.76
|
| Rate for Payer: BCBS Trust/PPO |
$127.44
|
| Rate for Payer: BCN Commercial |
$120.53
|
| Rate for Payer: BCN Medicare Advantage |
$38.76
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cash Price |
$124.02
|
| Rate for Payer: Cofinity Commercial |
$133.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.76
|
| Rate for Payer: Healthscope Commercial |
$139.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.27
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.69
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.77
|
| Rate for Payer: Nomi Health Commercial |
$127.12
|
| Rate for Payer: PACE Senior Care Partners |
$36.82
|
| Rate for Payer: PACE SWMI |
$38.76
|
| Rate for Payer: PHP Commercial |
$131.77
|
| Rate for Payer: PHP Medicare Advantage |
$38.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.76
|
| Rate for Payer: Priority Health HMO/PPO |
$134.87
|
| Rate for Payer: Priority Health Medicare |
$39.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.86
|
| Rate for Payer: Railroad Medicare Medicare |
$38.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.42
|
| Rate for Payer: UHC Core |
$129.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.76
|
| Rate for Payer: UHC Exchange |
$38.76
|
| Rate for Payer: UHC Medicare Advantage |
$38.76
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$38.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.27
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$320.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$208.29 |
| Max. Negotiated Rate |
$288.40 |
| Rate for Payer: Aetna Commercial |
$272.37
|
| Rate for Payer: BCBS Trust/PPO |
$261.58
|
| Rate for Payer: BCN Commercial |
$247.64
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cofinity Commercial |
$275.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.35
|
| Rate for Payer: Healthscope Commercial |
$288.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.37
|
| Rate for Payer: Nomi Health Commercial |
$262.76
|
| Rate for Payer: PHP Commercial |
$272.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: Priority Health HMO/PPO |
$278.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.99
|
| Rate for Payer: UHC Core |
$267.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.33
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$320.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$288.40 |
| Rate for Payer: Aetna Commercial |
$272.37
|
| Rate for Payer: Aetna Medicare |
$83.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.14
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$80.11
|
| Rate for Payer: BCBS Trust/PPO |
$263.43
|
| Rate for Payer: BCN Commercial |
$249.14
|
| Rate for Payer: BCN Medicare Advantage |
$80.11
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cash Price |
$256.35
|
| Rate for Payer: Cofinity Commercial |
$275.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.11
|
| Rate for Payer: Healthscope Commercial |
$288.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.33
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.12
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.37
|
| Rate for Payer: Nomi Health Commercial |
$262.76
|
| Rate for Payer: PACE Senior Care Partners |
$76.10
|
| Rate for Payer: PACE SWMI |
$80.11
|
| Rate for Payer: PHP Commercial |
$272.37
|
| Rate for Payer: PHP Medicare Advantage |
$80.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.29
|
| Rate for Payer: Priority Health HMO/PPO |
$278.78
|
| Rate for Payer: Priority Health Medicare |
$80.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.69
|
| Rate for Payer: Railroad Medicare Medicare |
$80.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.99
|
| Rate for Payer: UHC Core |
$267.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.11
|
| Rate for Payer: UHC Exchange |
$80.11
|
| Rate for Payer: UHC Medicare Advantage |
$80.11
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$80.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.33
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$117.78
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$100.11
|
| Rate for Payer: BCBS Trust/PPO |
$96.14
|
| Rate for Payer: BCN Commercial |
$91.02
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Cofinity Commercial |
$101.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.22
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.11
|
| Rate for Payer: Nomi Health Commercial |
$96.58
|
| Rate for Payer: PHP Commercial |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: Priority Health HMO/PPO |
$102.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.65
|
| Rate for Payer: UHC Core |
$98.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.33
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$117.78
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$100.11
|
| Rate for Payer: Aetna Medicare |
$30.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.81
|
| Rate for Payer: BCBS Complete |
$47.11
|
| Rate for Payer: BCBS MAPPO |
$29.45
|
| Rate for Payer: BCBS Trust/PPO |
$96.83
|
| Rate for Payer: BCN Commercial |
$91.57
|
| Rate for Payer: BCN Medicare Advantage |
$29.45
|
| Rate for Payer: Cash Price |
$94.22
|
| Rate for Payer: Cofinity Commercial |
$101.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.45
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.11
|
| Rate for Payer: Nomi Health Commercial |
$96.58
|
| Rate for Payer: PACE Senior Care Partners |
$27.97
|
| Rate for Payer: PACE SWMI |
$29.45
|
| Rate for Payer: PHP Commercial |
$100.11
|
| Rate for Payer: PHP Medicare Advantage |
$29.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.56
|
| Rate for Payer: Priority Health HMO/PPO |
$102.47
|
| Rate for Payer: Priority Health Medicare |
$29.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.91
|
| Rate for Payer: Railroad Medicare Medicare |
$29.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.65
|
| Rate for Payer: UHC Core |
$98.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.45
|
| Rate for Payer: UHC Exchange |
$29.45
|
| Rate for Payer: UHC Medicare Advantage |
$29.45
|
| Rate for Payer: VA VA |
$29.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.33
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
OP
|
$595.78
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$141.50 |
| Max. Negotiated Rate |
$536.20 |
| Rate for Payer: Aetna Commercial |
$506.41
|
| Rate for Payer: Aetna Medicare |
$154.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.18
|
| Rate for Payer: BCBS Complete |
$238.31
|
| Rate for Payer: BCBS MAPPO |
$148.94
|
| Rate for Payer: BCBS Trust/PPO |
$489.79
|
| Rate for Payer: BCN Commercial |
$463.22
|
| Rate for Payer: BCN Medicare Advantage |
$148.94
|
| Rate for Payer: Cash Price |
$476.62
|
| Rate for Payer: Cofinity Commercial |
$512.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.94
|
| Rate for Payer: Healthscope Commercial |
$536.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.41
|
| Rate for Payer: Nomi Health Commercial |
$488.54
|
| Rate for Payer: PACE Senior Care Partners |
$141.50
|
| Rate for Payer: PACE SWMI |
$148.94
|
| Rate for Payer: PHP Commercial |
$506.41
|
| Rate for Payer: PHP Medicare Advantage |
$148.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.26
|
| Rate for Payer: Priority Health HMO/PPO |
$518.33
|
| Rate for Payer: Priority Health Medicare |
$150.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.17
|
| Rate for Payer: Railroad Medicare Medicare |
$148.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.29
|
| Rate for Payer: UHC Core |
$497.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.94
|
| Rate for Payer: UHC Exchange |
$148.94
|
| Rate for Payer: UHC Medicare Advantage |
$148.94
|
| Rate for Payer: VA VA |
$148.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.83
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
IP
|
$595.78
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$387.26 |
| Max. Negotiated Rate |
$536.20 |
| Rate for Payer: Aetna Commercial |
$506.41
|
| Rate for Payer: BCBS Trust/PPO |
$486.34
|
| Rate for Payer: BCN Commercial |
$460.42
|
| Rate for Payer: Cash Price |
$476.62
|
| Rate for Payer: Cofinity Commercial |
$512.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.62
|
| Rate for Payer: Healthscope Commercial |
$536.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.41
|
| Rate for Payer: Nomi Health Commercial |
$488.54
|
| Rate for Payer: PHP Commercial |
$506.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.26
|
| Rate for Payer: Priority Health HMO/PPO |
$518.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$524.29
|
| Rate for Payer: UHC Core |
$497.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.83
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.47
|
| Rate for Payer: BCBS Complete |
$28.31
|
| Rate for Payer: BCBS MAPPO |
$26.77
|
| Rate for Payer: BCBS Trust/PPO |
$88.05
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: BCN Medicare Advantage |
$26.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.77
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: Mclaren Medicaid |
$26.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: Meridian Medicaid |
$28.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.77
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: PHP Medicare Advantage |
$26.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| Rate for Payer: Priority Health HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$27.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.76
|
| Rate for Payer: Railroad Medicare Medicare |
$26.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.77
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$26.77
|
| Rate for Payer: UHCCP Medicaid |
$26.96
|
| Rate for Payer: VA VA |
$26.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: BCBS Trust/PPO |
$87.43
|
| Rate for Payer: BCN Commercial |
$82.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| Rate for Payer: Priority Health HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.33
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
IP
|
$346.80
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$225.42 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$294.78
|
| Rate for Payer: BCBS Trust/PPO |
$283.09
|
| Rate for Payer: BCN Commercial |
$268.01
|
| Rate for Payer: Cash Price |
$277.44
|
| Rate for Payer: Cofinity Commercial |
$298.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.44
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.78
|
| Rate for Payer: Nomi Health Commercial |
$284.38
|
| Rate for Payer: PHP Commercial |
$294.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.42
|
| Rate for Payer: Priority Health HMO/PPO |
$301.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.18
|
| Rate for Payer: UHC Core |
$289.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.10
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
OP
|
$346.80
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$294.78
|
| Rate for Payer: Aetna Medicare |
$90.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.38
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$285.10
|
| Rate for Payer: BCN Commercial |
$269.64
|
| Rate for Payer: BCN Medicare Advantage |
$86.70
|
| Rate for Payer: Cash Price |
$277.44
|
| Rate for Payer: Cash Price |
$277.44
|
| Rate for Payer: Cofinity Commercial |
$298.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.70
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.10
|
| Rate for Payer: Mclaren Medicaid |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.03
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.78
|
| Rate for Payer: Nomi Health Commercial |
$284.38
|
| Rate for Payer: PACE Senior Care Partners |
$82.36
|
| Rate for Payer: PACE SWMI |
$86.70
|
| Rate for Payer: PHP Commercial |
$294.78
|
| Rate for Payer: PHP Medicare Advantage |
$86.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.42
|
| Rate for Payer: Priority Health HMO/PPO |
$301.72
|
| Rate for Payer: Priority Health Medicare |
$87.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.36
|
| Rate for Payer: Railroad Medicare Medicare |
$86.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.18
|
| Rate for Payer: UHC Core |
$289.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.70
|
| Rate for Payer: UHC Exchange |
$86.70
|
| Rate for Payer: UHC Medicare Advantage |
$86.70
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| Rate for Payer: VA VA |
$86.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.10
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS EA 30 DAY
|
Facility
|
OP
|
$114.75
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$103.28 |
| Rate for Payer: Aetna Commercial |
$97.54
|
| Rate for Payer: Aetna Medicare |
$29.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.86
|
| Rate for Payer: BCBS Complete |
$28.31
|
| Rate for Payer: BCBS MAPPO |
$28.69
|
| Rate for Payer: BCBS Trust/PPO |
$94.34
|
| Rate for Payer: BCN Commercial |
$89.22
|
| Rate for Payer: BCN Medicare Advantage |
$28.69
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cofinity Commercial |
$98.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.69
|
| Rate for Payer: Healthscope Commercial |
$103.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.06
|
| Rate for Payer: Mclaren Medicaid |
$26.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.12
|
| Rate for Payer: Meridian Medicaid |
$28.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.54
|
| Rate for Payer: Nomi Health Commercial |
$94.09
|
| Rate for Payer: PACE Senior Care Partners |
$27.25
|
| Rate for Payer: PACE SWMI |
$28.69
|
| Rate for Payer: PHP Commercial |
$97.54
|
| Rate for Payer: PHP Medicare Advantage |
$28.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.59
|
| Rate for Payer: Priority Health HMO/PPO |
$99.83
|
| Rate for Payer: Priority Health Medicare |
$28.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.88
|
| Rate for Payer: Railroad Medicare Medicare |
$28.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.98
|
| Rate for Payer: UHC Core |
$95.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.69
|
| Rate for Payer: UHC Exchange |
$28.69
|
| Rate for Payer: UHC Medicare Advantage |
$28.69
|
| Rate for Payer: UHCCP Medicaid |
$26.96
|
| Rate for Payer: VA VA |
$28.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.06
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS EA 30 DAY
|
Facility
|
IP
|
$114.75
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.59 |
| Max. Negotiated Rate |
$103.28 |
| Rate for Payer: Aetna Commercial |
$97.54
|
| Rate for Payer: BCBS Trust/PPO |
$93.67
|
| Rate for Payer: BCN Commercial |
$88.68
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cofinity Commercial |
$98.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.80
|
| Rate for Payer: Healthscope Commercial |
$103.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.54
|
| Rate for Payer: Nomi Health Commercial |
$94.09
|
| Rate for Payer: PHP Commercial |
$97.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.59
|
| Rate for Payer: Priority Health HMO/PPO |
$99.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.98
|
| Rate for Payer: UHC Core |
$95.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.06
|
|
|
HC REMOTE THER MON SETUP & EDU
|
Facility
|
OP
|
$366.14
|
|
|
Service Code
|
CPT 98975
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$329.53 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Medicare |
$95.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.42
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$91.53
|
| Rate for Payer: BCBS Trust/PPO |
$301.00
|
| Rate for Payer: BCN Commercial |
$284.67
|
| Rate for Payer: BCN Medicare Advantage |
$91.53
|
| Rate for Payer: Cash Price |
$292.91
|
| Rate for Payer: Cash Price |
$292.91
|
| Rate for Payer: Cofinity Commercial |
$314.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.53
|
| Rate for Payer: Healthscope Commercial |
$329.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.61
|
| Rate for Payer: Mclaren Medicaid |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.11
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.22
|
| Rate for Payer: Nomi Health Commercial |
$300.23
|
| Rate for Payer: PACE Senior Care Partners |
$86.96
|
| Rate for Payer: PACE SWMI |
$91.53
|
| Rate for Payer: PHP Commercial |
$311.22
|
| Rate for Payer: PHP Medicare Advantage |
$91.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.99
|
| Rate for Payer: Priority Health HMO/PPO |
$318.54
|
| Rate for Payer: Priority Health Medicare |
$92.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.31
|
| Rate for Payer: Railroad Medicare Medicare |
$91.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.20
|
| Rate for Payer: UHC Core |
$305.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.53
|
| Rate for Payer: UHC Exchange |
$91.53
|
| Rate for Payer: UHC Medicare Advantage |
$91.53
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| Rate for Payer: VA VA |
$91.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.61
|
|
|
HC REMOTE THER MON SETUP & EDU
|
Facility
|
IP
|
$366.14
|
|
|
Service Code
|
CPT 98975
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$237.99 |
| Max. Negotiated Rate |
$329.53 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: BCBS Trust/PPO |
$298.88
|
| Rate for Payer: BCN Commercial |
$282.95
|
| Rate for Payer: Cash Price |
$292.91
|
| Rate for Payer: Cofinity Commercial |
$314.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.91
|
| Rate for Payer: Healthscope Commercial |
$329.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.22
|
| Rate for Payer: Nomi Health Commercial |
$300.23
|
| Rate for Payer: PHP Commercial |
$311.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.99
|
| Rate for Payer: Priority Health HMO/PPO |
$318.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.20
|
| Rate for Payer: UHC Core |
$305.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.61
|
|
|
HC REMOVAL BILIARY STONE
|
Facility
|
OP
|
$662.41
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
36100516
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.32 |
| Max. Negotiated Rate |
$596.17 |
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: Aetna Medicare |
$172.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.00
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: BCBS MAPPO |
$165.60
|
| Rate for Payer: BCBS Trust/PPO |
$544.57
|
| Rate for Payer: BCN Commercial |
$515.02
|
| Rate for Payer: BCN Medicare Advantage |
$165.60
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.60
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: PACE Senior Care Partners |
$157.32
|
| Rate for Payer: PACE SWMI |
$165.60
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: PHP Medicare Advantage |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO |
$576.30
|
| Rate for Payer: Priority Health Medicare |
$167.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.81
|
| Rate for Payer: Railroad Medicare Medicare |
$165.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.92
|
| Rate for Payer: UHC Core |
$553.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.60
|
| Rate for Payer: UHC Exchange |
$165.60
|
| Rate for Payer: UHC Medicare Advantage |
$165.60
|
| Rate for Payer: VA VA |
$165.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.81
|
|
|
HC REMOVAL BILIARY STONE
|
Facility
|
IP
|
$662.41
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
36100516
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.57 |
| Max. Negotiated Rate |
$596.17 |
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: BCBS Trust/PPO |
$540.73
|
| Rate for Payer: BCN Commercial |
$511.91
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO |
$576.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.92
|
| Rate for Payer: UHC Core |
$553.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.81
|
|
|
HC REMOVAL CHEST PORT OR PUMP
|
Facility
|
IP
|
$2,180.57
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36100141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,417.37 |
| Max. Negotiated Rate |
$1,962.51 |
| Rate for Payer: Aetna Commercial |
$1,853.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.00
|
| Rate for Payer: BCN Commercial |
$1,685.14
|
| Rate for Payer: Cash Price |
$1,744.46
|
| Rate for Payer: Cofinity Commercial |
$1,875.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,744.46
|
| Rate for Payer: Healthscope Commercial |
$1,962.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,635.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,853.48
|
| Rate for Payer: Nomi Health Commercial |
$1,788.07
|
| Rate for Payer: PHP Commercial |
$1,853.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,897.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,460.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,918.90
|
| Rate for Payer: UHC Core |
$1,820.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,635.43
|
|
|
HC REMOVAL CHEST PORT OR PUMP
|
Facility
|
OP
|
$2,180.57
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36100141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.89 |
| Max. Negotiated Rate |
$1,962.51 |
| Rate for Payer: Aetna Commercial |
$1,853.48
|
| Rate for Payer: Aetna Medicare |
$566.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$681.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$681.43
|
| Rate for Payer: BCBS Complete |
$1,179.37
|
| Rate for Payer: BCBS MAPPO |
$545.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,792.65
|
| Rate for Payer: BCN Commercial |
$1,695.39
|
| Rate for Payer: BCN Medicare Advantage |
$545.14
|
| Rate for Payer: Cash Price |
$1,744.46
|
| Rate for Payer: Cash Price |
$1,744.46
|
| Rate for Payer: Cofinity Commercial |
$1,875.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,744.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$545.14
|
| Rate for Payer: Healthscope Commercial |
$1,962.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,635.43
|
| Rate for Payer: Mclaren Medicaid |
$1,123.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$572.40
|
| Rate for Payer: Meridian Medicaid |
$1,179.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,853.48
|
| Rate for Payer: Nomi Health Commercial |
$1,788.07
|
| Rate for Payer: PACE Senior Care Partners |
$517.89
|
| Rate for Payer: PACE SWMI |
$545.14
|
| Rate for Payer: PHP Commercial |
$1,853.48
|
| Rate for Payer: PHP Medicare Advantage |
$545.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,123.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,897.10
|
| Rate for Payer: Priority Health Medicare |
$550.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,460.98
|
| Rate for Payer: Railroad Medicare Medicare |
$545.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,918.90
|
| Rate for Payer: UHC Core |
$1,820.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$545.14
|
| Rate for Payer: UHC Exchange |
$545.14
|
| Rate for Payer: UHC Medicare Advantage |
$545.14
|
| Rate for Payer: UHCCP Medicaid |
$1,123.14
|
| Rate for Payer: VA VA |
$545.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,635.43
|
|
|
HC REMOVAL DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$343.33
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.16 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna Commercial |
$291.83
|
| Rate for Payer: BCBS Trust/PPO |
$280.26
|
| Rate for Payer: BCN Commercial |
$265.33
|
| Rate for Payer: Cash Price |
$274.66
|
| Rate for Payer: Cofinity Commercial |
$295.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.66
|
| Rate for Payer: Healthscope Commercial |
$309.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.83
|
| Rate for Payer: Nomi Health Commercial |
$281.53
|
| Rate for Payer: PHP Commercial |
$291.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.16
|
| Rate for Payer: Priority Health HMO/PPO |
$298.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.13
|
| Rate for Payer: UHC Core |
$286.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.50
|
|
|
HC REMOVAL DRUG IMPLANT DEVICE
|
Facility
|
OP
|
$343.33
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna Commercial |
$291.83
|
| Rate for Payer: Aetna Medicare |
$89.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.29
|
| Rate for Payer: BCBS Complete |
$302.95
|
| Rate for Payer: BCBS MAPPO |
$85.83
|
| Rate for Payer: BCBS Trust/PPO |
$282.25
|
| Rate for Payer: BCN Commercial |
$266.94
|
| Rate for Payer: BCN Medicare Advantage |
$85.83
|
| Rate for Payer: Cash Price |
$274.66
|
| Rate for Payer: Cash Price |
$274.66
|
| Rate for Payer: Cofinity Commercial |
$295.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.83
|
| Rate for Payer: Healthscope Commercial |
$309.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.50
|
| Rate for Payer: Mclaren Medicaid |
$288.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.12
|
| Rate for Payer: Meridian Medicaid |
$302.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.83
|
| Rate for Payer: Nomi Health Commercial |
$281.53
|
| Rate for Payer: PACE Senior Care Partners |
$81.54
|
| Rate for Payer: PACE SWMI |
$85.83
|
| Rate for Payer: PHP Commercial |
$291.83
|
| Rate for Payer: PHP Medicare Advantage |
$85.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.16
|
| Rate for Payer: Priority Health HMO/PPO |
$298.70
|
| Rate for Payer: Priority Health Medicare |
$86.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.03
|
| Rate for Payer: Railroad Medicare Medicare |
$85.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.13
|
| Rate for Payer: UHC Core |
$286.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.83
|
| Rate for Payer: UHC Exchange |
$85.83
|
| Rate for Payer: UHC Medicare Advantage |
$85.83
|
| Rate for Payer: UHCCP Medicaid |
$288.51
|
| Rate for Payer: VA VA |
$85.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.50
|
|
