|
HC THIOPURINE METABOLITES
|
Facility
|
IP
|
$295.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.27 |
| Max. Negotiated Rate |
$266.22 |
| Rate for Payer: Aetna Commercial |
$251.43
|
| Rate for Payer: BCBS Trust/PPO |
$241.46
|
| Rate for Payer: BCN Commercial |
$228.59
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Healthscope Commercial |
$266.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.43
|
| Rate for Payer: Nomi Health Commercial |
$242.56
|
| Rate for Payer: PHP Commercial |
$251.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.27
|
| Rate for Payer: Priority Health HMO/PPO |
$257.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.30
|
| Rate for Payer: UHC Core |
$246.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.85
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$330.48
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$297.43 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$85.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.28
|
| Rate for Payer: BCBS Complete |
$16.83
|
| Rate for Payer: BCBS MAPPO |
$82.62
|
| Rate for Payer: BCBS Trust/PPO |
$271.69
|
| Rate for Payer: BCN Commercial |
$256.95
|
| Rate for Payer: BCN Medicare Advantage |
$82.62
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cofinity Commercial |
$284.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$297.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.86
|
| Rate for Payer: Mclaren Medicaid |
$16.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.75
|
| Rate for Payer: Meridian Medicaid |
$16.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.91
|
| Rate for Payer: Nomi Health Commercial |
$270.99
|
| Rate for Payer: PACE Senior Care Partners |
$78.49
|
| Rate for Payer: PACE SWMI |
$82.62
|
| Rate for Payer: PHP Commercial |
$280.91
|
| Rate for Payer: PHP Medicare Advantage |
$82.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.81
|
| Rate for Payer: Priority Health HMO/PPO |
$287.52
|
| Rate for Payer: Priority Health Medicare |
$83.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.42
|
| Rate for Payer: Railroad Medicare Medicare |
$82.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.82
|
| Rate for Payer: UHC Core |
$275.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.62
|
| Rate for Payer: UHC Exchange |
$82.62
|
| Rate for Payer: UHC Medicare Advantage |
$82.62
|
| Rate for Payer: UHCCP Medicaid |
$16.03
|
| Rate for Payer: VA VA |
$82.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.86
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$330.48
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$214.81 |
| Max. Negotiated Rate |
$297.43 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: BCBS Trust/PPO |
$269.77
|
| Rate for Payer: BCN Commercial |
$255.39
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cofinity Commercial |
$284.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.38
|
| Rate for Payer: Healthscope Commercial |
$297.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.91
|
| Rate for Payer: Nomi Health Commercial |
$270.99
|
| Rate for Payer: PHP Commercial |
$280.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.81
|
| Rate for Payer: Priority Health HMO/PPO |
$287.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.82
|
| Rate for Payer: UHC Core |
$275.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.86
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
OP
|
$142.80
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: Aetna Medicare |
$37.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.62
|
| Rate for Payer: BCBS Complete |
$18.29
|
| Rate for Payer: BCBS MAPPO |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$117.40
|
| Rate for Payer: BCN Commercial |
$111.03
|
| Rate for Payer: BCN Medicare Advantage |
$35.70
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$122.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.70
|
| Rate for Payer: Healthscope Commercial |
$128.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.10
|
| Rate for Payer: Mclaren Medicaid |
$17.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.48
|
| Rate for Payer: Meridian Medicaid |
$18.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| Rate for Payer: PACE Senior Care Partners |
$33.91
|
| Rate for Payer: PACE SWMI |
$35.70
|
| Rate for Payer: PHP Commercial |
$121.38
|
| Rate for Payer: PHP Medicare Advantage |
$35.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health HMO/PPO |
$124.24
|
| Rate for Payer: Priority Health Medicare |
$36.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.68
|
| Rate for Payer: Railroad Medicare Medicare |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.66
|
| Rate for Payer: UHC Core |
$119.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.70
|
| Rate for Payer: UHC Exchange |
$35.70
|
| Rate for Payer: UHC Medicare Advantage |
$35.70
|
| Rate for Payer: UHCCP Medicaid |
$17.42
|
| Rate for Payer: VA VA |
$35.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.10
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
IP
|
$142.80
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: BCBS Trust/PPO |
$116.57
|
| Rate for Payer: BCN Commercial |
$110.36
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$122.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Healthscope Commercial |
$128.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: Nomi Health Commercial |
$117.10
|
| Rate for Payer: PHP Commercial |
$121.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health HMO/PPO |
$124.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.66
|
| Rate for Payer: UHC Core |
$119.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.10
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
OP
|
$69.79
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$62.81 |
| Rate for Payer: Aetna Commercial |
$59.32
|
| Rate for Payer: Aetna Medicare |
$18.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.81
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: BCBS MAPPO |
$17.45
|
| Rate for Payer: BCBS Trust/PPO |
$57.37
|
| Rate for Payer: BCN Commercial |
$54.26
|
| Rate for Payer: BCN Medicare Advantage |
$17.45
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$60.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$62.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.32
|
| Rate for Payer: Nomi Health Commercial |
$57.23
|
| Rate for Payer: PACE Senior Care Partners |
$16.58
|
| Rate for Payer: PACE SWMI |
$17.45
|
| Rate for Payer: PHP Commercial |
$59.32
|
| Rate for Payer: PHP Medicare Advantage |
$17.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.36
|
| Rate for Payer: Priority Health HMO/PPO |
$60.72
|
| Rate for Payer: Priority Health Medicare |
$17.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: Railroad Medicare Medicare |
$17.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$58.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.45
|
| Rate for Payer: UHC Exchange |
$17.45
|
| Rate for Payer: UHC Medicare Advantage |
$17.45
|
| Rate for Payer: VA VA |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.34
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
IP
|
$69.79
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$62.81 |
| Rate for Payer: Aetna Commercial |
$59.32
|
| Rate for Payer: BCBS Trust/PPO |
$56.97
|
| Rate for Payer: BCN Commercial |
$53.93
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$60.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$62.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.32
|
| Rate for Payer: Nomi Health Commercial |
$57.23
|
| Rate for Payer: PHP Commercial |
$59.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.36
|
| Rate for Payer: Priority Health HMO/PPO |
$60.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.42
|
| Rate for Payer: UHC Core |
$58.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.34
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
IP
|
$847.90
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$551.13 |
| Max. Negotiated Rate |
$763.11 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: BCBS Trust/PPO |
$692.14
|
| Rate for Payer: BCN Commercial |
$655.26
|
| Rate for Payer: Cash Price |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$729.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.32
|
| Rate for Payer: Healthscope Commercial |
$763.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$635.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.72
|
| Rate for Payer: Nomi Health Commercial |
$695.28
|
| Rate for Payer: PHP Commercial |
$720.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.13
|
| Rate for Payer: Priority Health HMO/PPO |
$737.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$568.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.15
|
| Rate for Payer: UHC Core |
$708.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$635.92
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
OP
|
$847.90
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.38 |
| Max. Negotiated Rate |
$763.11 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Aetna Medicare |
$220.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.97
|
| Rate for Payer: BCBS Complete |
$339.16
|
| Rate for Payer: BCBS MAPPO |
$211.97
|
| Rate for Payer: BCBS Trust/PPO |
$697.06
|
| Rate for Payer: BCN Commercial |
$659.24
|
| Rate for Payer: BCN Medicare Advantage |
$211.97
|
| Rate for Payer: Cash Price |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$729.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.97
|
| Rate for Payer: Healthscope Commercial |
$763.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$635.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.72
|
| Rate for Payer: Nomi Health Commercial |
$695.28
|
| Rate for Payer: PACE Senior Care Partners |
$201.38
|
| Rate for Payer: PACE SWMI |
$211.97
|
| Rate for Payer: PHP Commercial |
$720.72
|
| Rate for Payer: PHP Medicare Advantage |
$211.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.13
|
| Rate for Payer: Priority Health HMO/PPO |
$737.67
|
| Rate for Payer: Priority Health Medicare |
$214.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$568.09
|
| Rate for Payer: Railroad Medicare Medicare |
$211.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.15
|
| Rate for Payer: UHC Core |
$708.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.97
|
| Rate for Payer: UHC Exchange |
$211.97
|
| Rate for Payer: UHC Medicare Advantage |
$211.97
|
| Rate for Payer: VA VA |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$635.92
|
|
|
HC THORACENT WO TUBE
|
Facility
|
IP
|
$1,305.83
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$848.79 |
| Max. Negotiated Rate |
$1,175.25 |
| Rate for Payer: Aetna Commercial |
$1,109.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.95
|
| Rate for Payer: BCN Commercial |
$1,009.15
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cofinity Commercial |
$1,123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.66
|
| Rate for Payer: Healthscope Commercial |
$1,175.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$979.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.96
|
| Rate for Payer: Nomi Health Commercial |
$1,070.78
|
| Rate for Payer: PHP Commercial |
$1,109.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,136.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$874.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,149.13
|
| Rate for Payer: UHC Core |
$1,090.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$979.37
|
|
|
HC THORACENT WO TUBE
|
Facility
|
OP
|
$1,305.83
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
36100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$1,175.25 |
| Rate for Payer: Aetna Commercial |
$1,109.96
|
| Rate for Payer: Aetna Medicare |
$339.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$408.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$408.07
|
| Rate for Payer: BCBS Complete |
$469.38
|
| Rate for Payer: BCBS MAPPO |
$326.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.52
|
| Rate for Payer: BCN Commercial |
$1,015.28
|
| Rate for Payer: BCN Medicare Advantage |
$326.46
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cash Price |
$1,044.66
|
| Rate for Payer: Cofinity Commercial |
$1,123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.46
|
| Rate for Payer: Healthscope Commercial |
$1,175.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$979.37
|
| Rate for Payer: Mclaren Medicaid |
$447.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$342.78
|
| Rate for Payer: Meridian Medicaid |
$469.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.96
|
| Rate for Payer: Nomi Health Commercial |
$1,070.78
|
| Rate for Payer: PACE Senior Care Partners |
$310.13
|
| Rate for Payer: PACE SWMI |
$326.46
|
| Rate for Payer: PHP Commercial |
$1,109.96
|
| Rate for Payer: PHP Medicare Advantage |
$326.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,136.07
|
| Rate for Payer: Priority Health Medicare |
$329.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$874.91
|
| Rate for Payer: Railroad Medicare Medicare |
$326.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,149.13
|
| Rate for Payer: UHC Core |
$1,090.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.46
|
| Rate for Payer: UHC Exchange |
$326.46
|
| Rate for Payer: UHC Medicare Advantage |
$326.46
|
| Rate for Payer: UHCCP Medicaid |
$447.00
|
| Rate for Payer: VA VA |
$326.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$979.37
|
|
|
HC THORACENT W TUBE
|
Facility
|
IP
|
$1,414.47
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$919.41 |
| Max. Negotiated Rate |
$1,273.02 |
| Rate for Payer: Aetna Commercial |
$1,202.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.63
|
| Rate for Payer: BCN Commercial |
$1,093.10
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cofinity Commercial |
$1,216.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.58
|
| Rate for Payer: Healthscope Commercial |
$1,273.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,060.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.30
|
| Rate for Payer: Nomi Health Commercial |
$1,159.87
|
| Rate for Payer: PHP Commercial |
$1,202.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,230.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$947.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,244.73
|
| Rate for Payer: UHC Core |
$1,181.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,060.85
|
|
|
HC THORACENT W TUBE
|
Facility
|
OP
|
$1,414.47
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
36100384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.94 |
| Max. Negotiated Rate |
$1,273.02 |
| Rate for Payer: Aetna Commercial |
$1,202.30
|
| Rate for Payer: Aetna Medicare |
$367.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.02
|
| Rate for Payer: BCBS Complete |
$1,179.37
|
| Rate for Payer: BCBS MAPPO |
$353.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.84
|
| Rate for Payer: BCN Commercial |
$1,099.75
|
| Rate for Payer: BCN Medicare Advantage |
$353.62
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cash Price |
$1,131.58
|
| Rate for Payer: Cofinity Commercial |
$1,216.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.62
|
| Rate for Payer: Healthscope Commercial |
$1,273.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,060.85
|
| Rate for Payer: Mclaren Medicaid |
$1,123.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.30
|
| Rate for Payer: Meridian Medicaid |
$1,179.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$406.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.30
|
| Rate for Payer: Nomi Health Commercial |
$1,159.87
|
| Rate for Payer: PACE Senior Care Partners |
$335.94
|
| Rate for Payer: PACE SWMI |
$353.62
|
| Rate for Payer: PHP Commercial |
$1,202.30
|
| Rate for Payer: PHP Medicare Advantage |
$353.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,123.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,230.59
|
| Rate for Payer: Priority Health Medicare |
$357.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$947.69
|
| Rate for Payer: Railroad Medicare Medicare |
$353.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,244.73
|
| Rate for Payer: UHC Core |
$1,181.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.62
|
| Rate for Payer: UHC Exchange |
$353.62
|
| Rate for Payer: UHC Medicare Advantage |
$353.62
|
| Rate for Payer: UHCCP Medicaid |
$1,123.14
|
| Rate for Payer: VA VA |
$353.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,060.85
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
OP
|
$704.90
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$167.41 |
| Max. Negotiated Rate |
$634.41 |
| Rate for Payer: Aetna Commercial |
$599.16
|
| Rate for Payer: Aetna Medicare |
$183.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.28
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$176.22
|
| Rate for Payer: BCBS Trust/PPO |
$579.50
|
| Rate for Payer: BCN Commercial |
$548.06
|
| Rate for Payer: BCN Medicare Advantage |
$176.22
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cofinity Commercial |
$606.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.22
|
| Rate for Payer: Healthscope Commercial |
$634.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.67
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.04
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.16
|
| Rate for Payer: Nomi Health Commercial |
$578.02
|
| Rate for Payer: PACE Senior Care Partners |
$167.41
|
| Rate for Payer: PACE SWMI |
$176.22
|
| Rate for Payer: PHP Commercial |
$599.16
|
| Rate for Payer: PHP Medicare Advantage |
$176.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.19
|
| Rate for Payer: Priority Health HMO/PPO |
$613.26
|
| Rate for Payer: Priority Health Medicare |
$177.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$472.28
|
| Rate for Payer: Railroad Medicare Medicare |
$176.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.31
|
| Rate for Payer: UHC Core |
$588.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.22
|
| Rate for Payer: UHC Exchange |
$176.22
|
| Rate for Payer: UHC Medicare Advantage |
$176.22
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$176.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.67
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
IP
|
$704.90
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$458.19 |
| Max. Negotiated Rate |
$634.41 |
| Rate for Payer: Aetna Commercial |
$599.16
|
| Rate for Payer: BCBS Trust/PPO |
$575.41
|
| Rate for Payer: BCN Commercial |
$544.75
|
| Rate for Payer: Cash Price |
$563.92
|
| Rate for Payer: Cofinity Commercial |
$606.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.92
|
| Rate for Payer: Healthscope Commercial |
$634.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.16
|
| Rate for Payer: Nomi Health Commercial |
$578.02
|
| Rate for Payer: PHP Commercial |
$599.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.19
|
| Rate for Payer: Priority Health HMO/PPO |
$613.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$472.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.31
|
| Rate for Payer: UHC Core |
$588.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.67
|
|
|
HC THORACOTOMY
|
Facility
|
IP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,359.72 |
| Max. Negotiated Rate |
$1,882.69 |
| Rate for Payer: Aetna Commercial |
$1,778.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,707.60
|
| Rate for Payer: BCN Commercial |
$1,616.60
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,799.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Healthscope Commercial |
$1,882.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: Nomi Health Commercial |
$1,715.34
|
| Rate for Payer: PHP Commercial |
$1,778.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,819.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,401.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,840.85
|
| Rate for Payer: UHC Core |
$1,746.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.91
|
|
|
HC THORACOTOMY
|
Facility
|
OP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.82 |
| Max. Negotiated Rate |
$1,882.69 |
| Rate for Payer: Aetna Commercial |
$1,778.10
|
| Rate for Payer: Aetna Medicare |
$543.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$653.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$653.71
|
| Rate for Payer: BCBS Complete |
$836.75
|
| Rate for Payer: BCBS MAPPO |
$522.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.73
|
| Rate for Payer: BCN Commercial |
$1,626.44
|
| Rate for Payer: BCN Medicare Advantage |
$522.97
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,799.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.97
|
| Rate for Payer: Healthscope Commercial |
$1,882.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$549.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: Nomi Health Commercial |
$1,715.34
|
| Rate for Payer: PACE Senior Care Partners |
$496.82
|
| Rate for Payer: PACE SWMI |
$522.97
|
| Rate for Payer: PHP Commercial |
$1,778.10
|
| Rate for Payer: PHP Medicare Advantage |
$522.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,819.94
|
| Rate for Payer: Priority Health Medicare |
$528.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,401.56
|
| Rate for Payer: Railroad Medicare Medicare |
$522.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,840.85
|
| Rate for Payer: UHC Core |
$1,746.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$522.97
|
| Rate for Payer: UHC Exchange |
$522.97
|
| Rate for Payer: UHC Medicare Advantage |
$522.97
|
| Rate for Payer: VA VA |
$522.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.91
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
IP
|
$4,968.12
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,229.28 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,055.48
|
| Rate for Payer: BCN Commercial |
$3,839.36
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,726.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: Nomi Health Commercial |
$4,073.86
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health HMO/PPO |
$4,322.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,328.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,371.95
|
| Rate for Payer: UHC Core |
$4,148.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,726.09
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$4,968.12
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,179.93 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: Aetna Medicare |
$1,291.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,552.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,552.54
|
| Rate for Payer: BCBS Complete |
$1,987.25
|
| Rate for Payer: BCBS MAPPO |
$1,242.03
|
| Rate for Payer: BCBS Trust/PPO |
$4,084.29
|
| Rate for Payer: BCN Commercial |
$3,862.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,242.03
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,242.03
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,726.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,304.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,428.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: Nomi Health Commercial |
$4,073.86
|
| Rate for Payer: PACE Senior Care Partners |
$1,179.93
|
| Rate for Payer: PACE SWMI |
$1,242.03
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,242.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health HMO/PPO |
$4,322.26
|
| Rate for Payer: Priority Health Medicare |
$1,254.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,328.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,242.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,371.95
|
| Rate for Payer: UHC Core |
$4,148.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,242.03
|
| Rate for Payer: UHC Exchange |
$1,242.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,242.03
|
| Rate for Payer: VA VA |
$1,242.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,726.09
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$19.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.73
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$18.99
|
| Rate for Payer: BCBS Trust/PPO |
$62.44
|
| Rate for Payer: BCN Commercial |
$59.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.99
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.94
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PACE Senior Care Partners |
$18.04
|
| Rate for Payer: PACE SWMI |
$18.99
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$18.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Medicare |
$19.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: Railroad Medicare Medicare |
$18.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.99
|
| Rate for Payer: UHC Exchange |
$18.99
|
| Rate for Payer: UHC Medicare Advantage |
$18.99
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: VA VA |
$18.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: BCBS Trust/PPO |
$62.00
|
| Rate for Payer: BCN Commercial |
$58.69
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
OP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$86.31
|
| Rate for Payer: BCN Commercial |
$81.63
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$86.09
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health HMO/PPO |
$91.34
|
| Rate for Payer: Priority Health Medicare |
$26.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.34
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.39
|
| Rate for Payer: UHC Core |
$87.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.25
|
| Rate for Payer: UHC Exchange |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$26.25
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.74
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
IP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$85.70
|
| Rate for Payer: BCN Commercial |
$81.14
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$94.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$86.09
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health HMO/PPO |
$91.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.39
|
| Rate for Payer: UHC Core |
$87.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.74
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
IP
|
$1,044.23
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.75 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: BCBS Trust/PPO |
$852.40
|
| Rate for Payer: BCN Commercial |
$806.98
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Nomi Health Commercial |
$856.27
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health HMO/PPO |
$908.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$699.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.92
|
| Rate for Payer: UHC Core |
$871.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
OP
|
$1,044.23
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.00 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna Medicare |
$271.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$326.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$326.32
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: BCBS MAPPO |
$261.06
|
| Rate for Payer: BCBS Trust/PPO |
$858.46
|
| Rate for Payer: BCN Commercial |
$811.89
|
| Rate for Payer: BCN Medicare Advantage |
$261.06
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.06
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Nomi Health Commercial |
$856.27
|
| Rate for Payer: PACE Senior Care Partners |
$248.00
|
| Rate for Payer: PACE SWMI |
$261.06
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: PHP Medicare Advantage |
$261.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health HMO/PPO |
$908.48
|
| Rate for Payer: Priority Health Medicare |
$263.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$699.63
|
| Rate for Payer: Railroad Medicare Medicare |
$261.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.92
|
| Rate for Payer: UHC Core |
$871.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$261.06
|
| Rate for Payer: UHC Exchange |
$261.06
|
| Rate for Payer: UHC Medicare Advantage |
$261.06
|
| Rate for Payer: VA VA |
$261.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
