|
HC RO LINAC SBRT PER SESSION
|
Facility
|
OP
|
$3,546.01
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$842.18 |
| Max. Negotiated Rate |
$3,191.41 |
| Rate for Payer: Aetna Commercial |
$3,014.11
|
| Rate for Payer: Aetna Medicare |
$921.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,108.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,108.13
|
| Rate for Payer: BCBS Complete |
$1,306.14
|
| Rate for Payer: BCBS MAPPO |
$886.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.17
|
| Rate for Payer: BCN Commercial |
$2,757.02
|
| Rate for Payer: BCN Medicare Advantage |
$886.50
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cash Price |
$2,836.81
|
| Rate for Payer: Cofinity Commercial |
$3,049.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,836.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.50
|
| Rate for Payer: Healthscope Commercial |
$3,191.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,659.51
|
| Rate for Payer: Mclaren Medicaid |
$1,243.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.83
|
| Rate for Payer: Meridian Medicaid |
$1,306.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,019.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,014.11
|
| Rate for Payer: Nomi Health Commercial |
$2,907.73
|
| Rate for Payer: PACE Senior Care Partners |
$842.18
|
| Rate for Payer: PACE SWMI |
$886.50
|
| Rate for Payer: PHP Commercial |
$3,014.11
|
| Rate for Payer: PHP Medicare Advantage |
$886.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,243.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,304.91
|
| Rate for Payer: Priority Health HMO/PPO |
$3,085.03
|
| Rate for Payer: Priority Health Medicare |
$895.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,375.83
|
| Rate for Payer: Railroad Medicare Medicare |
$886.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,120.49
|
| Rate for Payer: UHC Core |
$2,960.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$886.50
|
| Rate for Payer: UHC Exchange |
$886.50
|
| Rate for Payer: UHC Medicare Advantage |
$886.50
|
| Rate for Payer: UHCCP Medicaid |
$1,243.86
|
| Rate for Payer: VA VA |
$886.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,659.51
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
IP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCN Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Nomi Health Commercial |
$9.38
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health HMO/PPO |
$9.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.07
|
| Rate for Payer: UHC Core |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.58
|
|
|
HC ROMOSOZUMAB-AQQG INJ 1 MG
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.58
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$2.86
|
| Rate for Payer: BCBS Trust/PPO |
$9.40
|
| Rate for Payer: BCN Commercial |
$8.89
|
| Rate for Payer: BCN Medicare Advantage |
$2.86
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.58
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.00
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Nomi Health Commercial |
$9.38
|
| Rate for Payer: PACE Senior Care Partners |
$2.72
|
| Rate for Payer: PACE SWMI |
$2.86
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Medicare Advantage |
$2.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health HMO/PPO |
$9.95
|
| Rate for Payer: Priority Health Medicare |
$2.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.07
|
| Rate for Payer: UHC Core |
$9.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.86
|
| Rate for Payer: UHC Exchange |
$2.86
|
| Rate for Payer: UHC Medicare Advantage |
$2.86
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| Rate for Payer: VA VA |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.58
|
|
|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,810.72
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,176.97 |
| Max. Negotiated Rate |
$2,337.50 |
| Rate for Payer: Aetna Commercial |
$1,539.11
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.09
|
| Rate for Payer: BCN Commercial |
$1,399.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cofinity Commercial |
$1,557.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$1,629.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.11
|
| Rate for Payer: Nomi Health Commercial |
$1,484.79
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$1,539.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1,575.33
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,213.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,593.43
|
| Rate for Payer: UHC Core |
$1,511.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.04
|
|
|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$3,021.16 |
| Rate for Payer: Aetna Commercial |
$2,853.31
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,740.19
|
| Rate for Payer: BCN Commercial |
$2,594.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$2,886.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$3,021.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,517.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: Nomi Health Commercial |
$2,752.61
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$2,853.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,920.45
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,249.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,954.02
|
| Rate for Payer: UHC Core |
$2,802.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,517.63
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,352.06
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,528.84 |
| Max. Negotiated Rate |
$2,337.50 |
| Rate for Payer: Aetna Commercial |
$1,999.25
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,919.99
|
| Rate for Payer: BCN Commercial |
$1,817.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,881.65
|
| Rate for Payer: Cash Price |
$1,881.65
|
| Rate for Payer: Cofinity Commercial |
$2,022.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,881.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$2,116.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.25
|
| Rate for Payer: Nomi Health Commercial |
$1,928.69
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$1,999.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,046.29
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,575.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,069.81
|
| Rate for Payer: UHC Core |
$1,963.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.04
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.71
|
| Rate for Payer: BCN Commercial |
$27.18
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO |
$30.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.95
|
| Rate for Payer: UHC Core |
$29.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.38
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$9.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.99
|
| Rate for Payer: BCBS Complete |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$8.79
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$27.34
|
| Rate for Payer: BCN Medicare Advantage |
$8.79
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.79
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.38
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.23
|
| Rate for Payer: Meridian Medicaid |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PACE Senior Care Partners |
$8.35
|
| Rate for Payer: PACE SWMI |
$8.79
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$8.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO |
$30.60
|
| Rate for Payer: Priority Health Medicare |
$8.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.95
|
| Rate for Payer: UHC Core |
$29.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.79
|
| Rate for Payer: UHC Exchange |
$8.79
|
| Rate for Payer: UHC Medicare Advantage |
$8.79
|
| Rate for Payer: UHCCP Medicaid |
$12.96
|
| Rate for Payer: VA VA |
$8.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.38
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.28
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: PACE Senior Care Partners |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health HMO/PPO |
$3.55
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.59
|
| Rate for Payer: UHC Core |
$3.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.06
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.33
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health HMO/PPO |
$3.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.59
|
| Rate for Payer: UHC Core |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.06
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: BCBS Trust/PPO |
$163.06
|
| Rate for Payer: BCN Commercial |
$154.37
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$171.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Nomi Health Commercial |
$163.80
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health HMO/PPO |
$173.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.79
|
| Rate for Payer: UHC Core |
$166.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.82
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$199.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna Medicare |
$51.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.42
|
| Rate for Payer: BCBS Complete |
$81.45
|
| Rate for Payer: BCBS MAPPO |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$164.22
|
| Rate for Payer: BCN Commercial |
$155.31
|
| Rate for Payer: BCN Medicare Advantage |
$49.94
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cash Price |
$159.81
|
| Rate for Payer: Cofinity Commercial |
$171.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.82
|
| Rate for Payer: Mclaren Medicaid |
$77.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.44
|
| Rate for Payer: Meridian Medicaid |
$81.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Nomi Health Commercial |
$163.80
|
| Rate for Payer: PACE Senior Care Partners |
$47.44
|
| Rate for Payer: PACE SWMI |
$49.94
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: PHP Medicare Advantage |
$49.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health HMO/PPO |
$173.79
|
| Rate for Payer: Priority Health Medicare |
$50.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.84
|
| Rate for Payer: Railroad Medicare Medicare |
$49.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.79
|
| Rate for Payer: UHC Core |
$166.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.94
|
| Rate for Payer: UHC Exchange |
$49.94
|
| Rate for Payer: UHC Medicare Advantage |
$49.94
|
| Rate for Payer: UHCCP Medicaid |
$77.57
|
| Rate for Payer: VA VA |
$49.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.82
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,720.06 |
| Max. Negotiated Rate |
$3,766.24 |
| Rate for Payer: Aetna Commercial |
$3,557.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,415.98
|
| Rate for Payer: BCN Commercial |
$3,233.94
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$3,598.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Healthscope Commercial |
$3,766.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,138.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: Nomi Health Commercial |
$3,431.46
|
| Rate for Payer: PHP Commercial |
$3,557.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: Priority Health HMO/PPO |
$3,640.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,803.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,682.54
|
| Rate for Payer: UHC Core |
$3,494.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,138.53
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,184.71
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.87 |
| Max. Negotiated Rate |
$3,766.24 |
| Rate for Payer: Aetna Commercial |
$3,557.00
|
| Rate for Payer: Aetna Medicare |
$1,088.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,307.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,307.72
|
| Rate for Payer: BCBS Complete |
$1,673.88
|
| Rate for Payer: BCBS MAPPO |
$1,046.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,440.25
|
| Rate for Payer: BCN Commercial |
$3,253.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,046.18
|
| Rate for Payer: Cash Price |
$3,347.77
|
| Rate for Payer: Cofinity Commercial |
$3,598.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,347.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,046.18
|
| Rate for Payer: Healthscope Commercial |
$3,766.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,138.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,098.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,203.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,557.00
|
| Rate for Payer: Nomi Health Commercial |
$3,431.46
|
| Rate for Payer: PACE Senior Care Partners |
$993.87
|
| Rate for Payer: PACE SWMI |
$1,046.18
|
| Rate for Payer: PHP Commercial |
$3,557.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,046.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,720.06
|
| Rate for Payer: Priority Health HMO/PPO |
$3,640.70
|
| Rate for Payer: Priority Health Medicare |
$1,056.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,803.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,046.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,682.54
|
| Rate for Payer: UHC Core |
$3,494.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,046.18
|
| Rate for Payer: UHC Exchange |
$1,046.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,046.18
|
| Rate for Payer: VA VA |
$1,046.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,138.53
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: BCBS Trust/PPO |
$89.59
|
| Rate for Payer: BCN Commercial |
$84.81
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$90.00
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health HMO/PPO |
$95.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.58
|
| Rate for Payer: UHC Core |
$91.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna Medicare |
$28.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.30
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS MAPPO |
$27.44
|
| Rate for Payer: BCBS Trust/PPO |
$90.23
|
| Rate for Payer: BCN Commercial |
$85.33
|
| Rate for Payer: BCN Medicare Advantage |
$27.44
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.44
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Mclaren Medicaid |
$8.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.81
|
| Rate for Payer: Meridian Medicaid |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$90.00
|
| Rate for Payer: PACE Senior Care Partners |
$26.07
|
| Rate for Payer: PACE SWMI |
$27.44
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: PHP Medicare Advantage |
$27.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health HMO/PPO |
$95.48
|
| Rate for Payer: Priority Health Medicare |
$27.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.53
|
| Rate for Payer: Railroad Medicare Medicare |
$27.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.58
|
| Rate for Payer: UHC Core |
$91.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.44
|
| Rate for Payer: UHC Exchange |
$27.44
|
| Rate for Payer: UHC Medicare Advantage |
$27.44
|
| Rate for Payer: UHCCP Medicaid |
$8.66
|
| Rate for Payer: VA VA |
$27.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$160.68 |
| Rate for Payer: Aetna Commercial |
$151.75
|
| Rate for Payer: Aetna Medicare |
$46.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.79
|
| Rate for Payer: BCBS Complete |
$71.41
|
| Rate for Payer: BCBS MAPPO |
$44.63
|
| Rate for Payer: BCBS Trust/PPO |
$146.77
|
| Rate for Payer: BCN Commercial |
$138.81
|
| Rate for Payer: BCN Medicare Advantage |
$44.63
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.63
|
| Rate for Payer: Healthscope Commercial |
$160.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: Nomi Health Commercial |
$146.39
|
| Rate for Payer: PACE Senior Care Partners |
$42.40
|
| Rate for Payer: PACE SWMI |
$44.63
|
| Rate for Payer: PHP Commercial |
$151.75
|
| Rate for Payer: PHP Medicare Advantage |
$44.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: Priority Health HMO/PPO |
$155.32
|
| Rate for Payer: Priority Health Medicare |
$45.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.62
|
| Rate for Payer: Railroad Medicare Medicare |
$44.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.11
|
| Rate for Payer: UHC Core |
$149.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.63
|
| Rate for Payer: UHC Exchange |
$44.63
|
| Rate for Payer: UHC Medicare Advantage |
$44.63
|
| Rate for Payer: VA VA |
$44.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.90
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$178.53
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.04 |
| Max. Negotiated Rate |
$160.68 |
| Rate for Payer: Aetna Commercial |
$151.75
|
| Rate for Payer: BCBS Trust/PPO |
$145.73
|
| Rate for Payer: BCN Commercial |
$137.97
|
| Rate for Payer: Cash Price |
$142.82
|
| Rate for Payer: Cofinity Commercial |
$153.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.82
|
| Rate for Payer: Healthscope Commercial |
$160.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.75
|
| Rate for Payer: Nomi Health Commercial |
$146.39
|
| Rate for Payer: PHP Commercial |
$151.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.04
|
| Rate for Payer: Priority Health HMO/PPO |
$155.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.11
|
| Rate for Payer: UHC Core |
$149.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.90
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Aetna Commercial |
$65.80
|
| Rate for Payer: Aetna Medicare |
$20.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$63.64
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$66.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PACE Senior Care Partners |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$65.80
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.35
|
| Rate for Payer: Priority Health Medicare |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.86
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.12
|
| Rate for Payer: UHC Core |
$64.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: VA VA |
$19.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Aetna Commercial |
$65.80
|
| Rate for Payer: BCBS Trust/PPO |
$63.19
|
| Rate for Payer: BCN Commercial |
$59.82
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$66.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PHP Commercial |
$65.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.12
|
| Rate for Payer: UHC Core |
$64.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.81 |
| Max. Negotiated Rate |
$469.12 |
| Rate for Payer: Aetna Commercial |
$443.05
|
| Rate for Payer: BCBS Trust/PPO |
$425.49
|
| Rate for Payer: BCN Commercial |
$402.81
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$448.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Healthscope Commercial |
$469.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: Nomi Health Commercial |
$427.42
|
| Rate for Payer: PHP Commercial |
$443.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: Priority Health HMO/PPO |
$453.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$349.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.69
|
| Rate for Payer: UHC Core |
$435.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.93
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$469.12 |
| Rate for Payer: Aetna Commercial |
$443.05
|
| Rate for Payer: Aetna Medicare |
$135.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.89
|
| Rate for Payer: BCBS Complete |
$98.76
|
| Rate for Payer: BCBS MAPPO |
$130.31
|
| Rate for Payer: BCBS Trust/PPO |
$428.51
|
| Rate for Payer: BCN Commercial |
$405.26
|
| Rate for Payer: BCN Medicare Advantage |
$130.31
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$448.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.31
|
| Rate for Payer: Healthscope Commercial |
$469.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.93
|
| Rate for Payer: Mclaren Medicaid |
$94.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.83
|
| Rate for Payer: Meridian Medicaid |
$98.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: Nomi Health Commercial |
$427.42
|
| Rate for Payer: PACE Senior Care Partners |
$123.79
|
| Rate for Payer: PACE SWMI |
$130.31
|
| Rate for Payer: PHP Commercial |
$443.05
|
| Rate for Payer: PHP Medicare Advantage |
$130.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: Priority Health HMO/PPO |
$453.48
|
| Rate for Payer: Priority Health Medicare |
$131.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$349.23
|
| Rate for Payer: Railroad Medicare Medicare |
$130.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.69
|
| Rate for Payer: UHC Core |
$435.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.31
|
| Rate for Payer: UHC Exchange |
$130.31
|
| Rate for Payer: UHC Medicare Advantage |
$130.31
|
| Rate for Payer: UHCCP Medicaid |
$94.06
|
| Rate for Payer: VA VA |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.93
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$269.15 |
| Max. Negotiated Rate |
$372.67 |
| Rate for Payer: Aetna Commercial |
$351.97
|
| Rate for Payer: BCBS Trust/PPO |
$338.01
|
| Rate for Payer: BCN Commercial |
$320.00
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$356.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Healthscope Commercial |
$372.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: Nomi Health Commercial |
$339.55
|
| Rate for Payer: PHP Commercial |
$351.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: Priority Health HMO/PPO |
$360.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.39
|
| Rate for Payer: UHC Core |
$345.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.56
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$372.67 |
| Rate for Payer: Aetna Commercial |
$351.97
|
| Rate for Payer: Aetna Medicare |
$107.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.40
|
| Rate for Payer: BCBS Complete |
$98.76
|
| Rate for Payer: BCBS MAPPO |
$103.52
|
| Rate for Payer: BCBS Trust/PPO |
$340.42
|
| Rate for Payer: BCN Commercial |
$321.95
|
| Rate for Payer: BCN Medicare Advantage |
$103.52
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$356.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.52
|
| Rate for Payer: Healthscope Commercial |
$372.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.56
|
| Rate for Payer: Mclaren Medicaid |
$94.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.70
|
| Rate for Payer: Meridian Medicaid |
$98.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: Nomi Health Commercial |
$339.55
|
| Rate for Payer: PACE Senior Care Partners |
$98.34
|
| Rate for Payer: PACE SWMI |
$103.52
|
| Rate for Payer: PHP Commercial |
$351.97
|
| Rate for Payer: PHP Medicare Advantage |
$103.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: Priority Health HMO/PPO |
$360.25
|
| Rate for Payer: Priority Health Medicare |
$104.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.43
|
| Rate for Payer: Railroad Medicare Medicare |
$103.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.39
|
| Rate for Payer: UHC Core |
$345.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.52
|
| Rate for Payer: UHC Exchange |
$103.52
|
| Rate for Payer: UHC Medicare Advantage |
$103.52
|
| Rate for Payer: UHCCP Medicaid |
$94.06
|
| Rate for Payer: VA VA |
$103.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.56
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$701.23
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$455.80 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: BCBS Trust/PPO |
$572.41
|
| Rate for Payer: BCN Commercial |
$541.91
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO |
$610.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.08
|
| Rate for Payer: UHC Core |
$585.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.92
|
|
