|
HC Z NEPHROSTOMY CATH
|
Facility
|
OP
|
$791.29
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$712.16 |
| Rate for Payer: Aetna Commercial |
$672.60
|
| Rate for Payer: Aetna Medicare |
$205.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.28
|
| Rate for Payer: BCBS Complete |
$146.47
|
| Rate for Payer: BCBS MAPPO |
$197.82
|
| Rate for Payer: BCBS Trust/PPO |
$650.52
|
| Rate for Payer: BCN Commercial |
$650.52
|
| Rate for Payer: BCN Medicare Advantage |
$197.82
|
| Rate for Payer: Cash Price |
$633.03
|
| Rate for Payer: Cofinity Commercial |
$680.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.82
|
| Rate for Payer: Healthscope Commercial |
$712.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.47
|
| Rate for Payer: Mclaren Medicaid |
$139.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.71
|
| Rate for Payer: Meridian Medicaid |
$146.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.60
|
| Rate for Payer: Nomi Health Commercial |
$648.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.47
|
| Rate for Payer: PACE Senior Care Partners |
$187.93
|
| Rate for Payer: PACE SWMI |
$197.82
|
| Rate for Payer: PHP Commercial |
$672.60
|
| Rate for Payer: PHP Medicare Advantage |
$197.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$688.42
|
| Rate for Payer: Priority Health Medicare |
$199.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.74
|
| Rate for Payer: Railroad Medicare Medicare |
$197.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.34
|
| Rate for Payer: UHC Core |
$660.73
|
| Rate for Payer: UHC Exchange |
$197.82
|
| Rate for Payer: UHC Medicaid |
$139.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.82
|
| Rate for Payer: UHCCP Medicaid |
$139.50
|
| Rate for Payer: VA VA |
$197.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.47
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
IP
|
$791.29
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$550.74 |
| Max. Negotiated Rate |
$712.16 |
| Rate for Payer: Aetna Commercial |
$672.60
|
| Rate for Payer: BCBS Trust/PPO |
$653.53
|
| Rate for Payer: BCN Commercial |
$653.53
|
| Rate for Payer: Cash Price |
$633.03
|
| Rate for Payer: Cofinity Commercial |
$680.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.03
|
| Rate for Payer: Healthscope Commercial |
$712.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.60
|
| Rate for Payer: Nomi Health Commercial |
$648.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.47
|
| Rate for Payer: PHP Commercial |
$672.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$688.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.34
|
| Rate for Payer: UHC Core |
$660.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.47
|
|
|
HC ZONISAMIDE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$64.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.31
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicaid |
$13.76
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$13.76
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC ZONISAMIDE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$64.44
|
| Rate for Payer: BCN Commercial |
$64.44
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$178.29
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.09 |
| Max. Negotiated Rate |
$160.46 |
| Rate for Payer: Aetna Commercial |
$151.55
|
| Rate for Payer: BCBS Trust/PPO |
$147.25
|
| Rate for Payer: BCN Commercial |
$147.25
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$153.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$160.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.55
|
| Rate for Payer: Nomi Health Commercial |
$146.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.72
|
| Rate for Payer: PHP Commercial |
$151.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.90
|
| Rate for Payer: UHC Core |
$148.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.72
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$178.29
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.43 |
| Max. Negotiated Rate |
$160.46 |
| Rate for Payer: Aetna Commercial |
$151.55
|
| Rate for Payer: Aetna Medicare |
$46.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.72
|
| Rate for Payer: BCBS Complete |
$33.00
|
| Rate for Payer: BCBS MAPPO |
$44.57
|
| Rate for Payer: BCBS Trust/PPO |
$146.57
|
| Rate for Payer: BCN Commercial |
$146.57
|
| Rate for Payer: BCN Medicare Advantage |
$44.57
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cofinity Commercial |
$153.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$160.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.72
|
| Rate for Payer: Mclaren Medicaid |
$31.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.80
|
| Rate for Payer: Meridian Medicaid |
$33.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.55
|
| Rate for Payer: Nomi Health Commercial |
$146.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.72
|
| Rate for Payer: PACE Senior Care Partners |
$42.34
|
| Rate for Payer: PACE SWMI |
$44.57
|
| Rate for Payer: PHP Commercial |
$151.55
|
| Rate for Payer: PHP Medicare Advantage |
$44.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.11
|
| Rate for Payer: Priority Health Medicare |
$45.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.09
|
| Rate for Payer: Railroad Medicare Medicare |
$44.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.90
|
| Rate for Payer: UHC Core |
$148.87
|
| Rate for Payer: UHC Exchange |
$44.57
|
| Rate for Payer: UHC Medicaid |
$31.43
|
| Rate for Payer: UHC Medicare Advantage |
$44.57
|
| Rate for Payer: UHCCP Medicaid |
$31.43
|
| Rate for Payer: VA VA |
$44.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.72
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,359.49
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$946.21 |
| Max. Negotiated Rate |
$1,223.54 |
| Rate for Payer: Aetna Commercial |
$1,155.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.80
|
| Rate for Payer: BCN Commercial |
$1,122.80
|
| Rate for Payer: Cash Price |
$1,087.59
|
| Rate for Payer: Cofinity Commercial |
$1,169.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,087.59
|
| Rate for Payer: Healthscope Commercial |
$1,223.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,019.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,155.57
|
| Rate for Payer: Nomi Health Commercial |
$1,114.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,019.62
|
| Rate for Payer: PHP Commercial |
$1,155.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,182.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$946.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,196.35
|
| Rate for Payer: UHC Core |
$1,135.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,019.62
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,359.49
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.68 |
| Max. Negotiated Rate |
$1,223.54 |
| Rate for Payer: Aetna Commercial |
$1,155.57
|
| Rate for Payer: Aetna Medicare |
$353.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$424.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$424.84
|
| Rate for Payer: BCBS Complete |
$251.64
|
| Rate for Payer: BCBS MAPPO |
$339.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.64
|
| Rate for Payer: BCN Commercial |
$1,117.64
|
| Rate for Payer: BCN Medicare Advantage |
$339.87
|
| Rate for Payer: Cash Price |
$1,087.59
|
| Rate for Payer: Cofinity Commercial |
$1,169.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,087.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.87
|
| Rate for Payer: Healthscope Commercial |
$1,223.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,019.62
|
| Rate for Payer: Mclaren Medicaid |
$239.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.87
|
| Rate for Payer: Meridian Medicaid |
$251.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$390.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$373.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,155.57
|
| Rate for Payer: Nomi Health Commercial |
$1,114.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,019.62
|
| Rate for Payer: PACE Senior Care Partners |
$322.88
|
| Rate for Payer: PACE SWMI |
$339.87
|
| Rate for Payer: PHP Commercial |
$1,155.57
|
| Rate for Payer: PHP Medicare Advantage |
$339.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,182.76
|
| Rate for Payer: Priority Health Medicare |
$343.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$946.21
|
| Rate for Payer: Railroad Medicare Medicare |
$339.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,196.35
|
| Rate for Payer: UHC Core |
$1,135.17
|
| Rate for Payer: UHC Exchange |
$339.87
|
| Rate for Payer: UHC Medicaid |
$239.68
|
| Rate for Payer: UHC Medicare Advantage |
$339.87
|
| Rate for Payer: UHCCP Medicaid |
$239.68
|
| Rate for Payer: VA VA |
$339.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,019.62
|
|
|
HC Z STENT URETERAL
|
Facility
|
IP
|
$1,237.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.04 |
| Max. Negotiated Rate |
$1,113.41 |
| Rate for Payer: Aetna Commercial |
$1,051.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.74
|
| Rate for Payer: BCN Commercial |
$1,021.74
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cofinity Commercial |
$1,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.70
|
| Rate for Payer: Healthscope Commercial |
$1,113.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.55
|
| Rate for Payer: Nomi Health Commercial |
$1,014.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.84
|
| Rate for Payer: PHP Commercial |
$1,051.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,076.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$861.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,088.67
|
| Rate for Payer: UHC Core |
$1,033.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.84
|
|
|
HC Z STENT URETERAL
|
Facility
|
OP
|
$1,237.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.10 |
| Max. Negotiated Rate |
$1,113.41 |
| Rate for Payer: Aetna Commercial |
$1,051.55
|
| Rate for Payer: Aetna Medicare |
$321.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$386.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$386.60
|
| Rate for Payer: BCBS Complete |
$228.99
|
| Rate for Payer: BCBS MAPPO |
$309.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,017.04
|
| Rate for Payer: BCN Commercial |
$1,017.04
|
| Rate for Payer: BCN Medicare Advantage |
$309.28
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cofinity Commercial |
$1,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.28
|
| Rate for Payer: Healthscope Commercial |
$1,113.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.84
|
| Rate for Payer: Mclaren Medicaid |
$218.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.74
|
| Rate for Payer: Meridian Medicaid |
$228.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.55
|
| Rate for Payer: Nomi Health Commercial |
$1,014.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.84
|
| Rate for Payer: PACE Senior Care Partners |
$293.82
|
| Rate for Payer: PACE SWMI |
$309.28
|
| Rate for Payer: PHP Commercial |
$1,051.55
|
| Rate for Payer: PHP Medicare Advantage |
$309.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,076.29
|
| Rate for Payer: Priority Health Medicare |
$312.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$861.04
|
| Rate for Payer: Railroad Medicare Medicare |
$309.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,088.67
|
| Rate for Payer: UHC Core |
$1,033.00
|
| Rate for Payer: UHC Exchange |
$309.28
|
| Rate for Payer: UHC Medicaid |
$218.10
|
| Rate for Payer: UHC Medicare Advantage |
$309.28
|
| Rate for Payer: UHCCP Medicaid |
$218.10
|
| Rate for Payer: VA VA |
$309.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.84
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
OP
|
$1,792.08
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.94 |
| Max. Negotiated Rate |
$1,612.87 |
| Rate for Payer: Aetna Commercial |
$1,523.27
|
| Rate for Payer: Aetna Medicare |
$465.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$560.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$560.02
|
| Rate for Payer: BCBS Complete |
$331.71
|
| Rate for Payer: BCBS MAPPO |
$448.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,473.27
|
| Rate for Payer: BCN Commercial |
$1,473.27
|
| Rate for Payer: BCN Medicare Advantage |
$448.02
|
| Rate for Payer: Cash Price |
$1,433.66
|
| Rate for Payer: Cofinity Commercial |
$1,541.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.02
|
| Rate for Payer: Healthscope Commercial |
$1,612.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.06
|
| Rate for Payer: Mclaren Medicaid |
$315.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.42
|
| Rate for Payer: Meridian Medicaid |
$331.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$515.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.27
|
| Rate for Payer: Nomi Health Commercial |
$1,469.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.06
|
| Rate for Payer: PACE Senior Care Partners |
$425.62
|
| Rate for Payer: PACE SWMI |
$448.02
|
| Rate for Payer: PHP Commercial |
$1,523.27
|
| Rate for Payer: PHP Medicare Advantage |
$448.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,559.11
|
| Rate for Payer: Priority Health Medicare |
$452.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,247.29
|
| Rate for Payer: Railroad Medicare Medicare |
$448.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.03
|
| Rate for Payer: UHC Core |
$1,496.39
|
| Rate for Payer: UHC Exchange |
$448.02
|
| Rate for Payer: UHC Medicaid |
$315.94
|
| Rate for Payer: UHC Medicare Advantage |
$448.02
|
| Rate for Payer: UHCCP Medicaid |
$315.94
|
| Rate for Payer: VA VA |
$448.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.06
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
IP
|
$1,792.08
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.29 |
| Max. Negotiated Rate |
$1,612.87 |
| Rate for Payer: Aetna Commercial |
$1,523.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,480.08
|
| Rate for Payer: BCN Commercial |
$1,480.08
|
| Rate for Payer: Cash Price |
$1,433.66
|
| Rate for Payer: Cofinity Commercial |
$1,541.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.66
|
| Rate for Payer: Healthscope Commercial |
$1,612.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.27
|
| Rate for Payer: Nomi Health Commercial |
$1,469.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.06
|
| Rate for Payer: PHP Commercial |
$1,523.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,559.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,247.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.03
|
| Rate for Payer: UHC Core |
$1,496.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.06
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
IP
|
$659.22
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.82 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Aetna Commercial |
$560.34
|
| Rate for Payer: BCBS Trust/PPO |
$544.45
|
| Rate for Payer: BCN Commercial |
$544.45
|
| Rate for Payer: Cash Price |
$527.38
|
| Rate for Payer: Cofinity Commercial |
$566.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.38
|
| Rate for Payer: Healthscope Commercial |
$593.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.34
|
| Rate for Payer: Nomi Health Commercial |
$540.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.42
|
| Rate for Payer: PHP Commercial |
$560.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$573.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$458.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.11
|
| Rate for Payer: UHC Core |
$550.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.42
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
OP
|
$659.22
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Aetna Commercial |
$560.34
|
| Rate for Payer: Aetna Medicare |
$171.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$206.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$206.01
|
| Rate for Payer: BCBS Complete |
$122.02
|
| Rate for Payer: BCBS MAPPO |
$164.81
|
| Rate for Payer: BCBS Trust/PPO |
$541.94
|
| Rate for Payer: BCN Commercial |
$541.94
|
| Rate for Payer: BCN Medicare Advantage |
$164.81
|
| Rate for Payer: Cash Price |
$527.38
|
| Rate for Payer: Cofinity Commercial |
$566.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.81
|
| Rate for Payer: Healthscope Commercial |
$593.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$494.42
|
| Rate for Payer: Mclaren Medicaid |
$116.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.05
|
| Rate for Payer: Meridian Medicaid |
$122.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.34
|
| Rate for Payer: Nomi Health Commercial |
$540.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.42
|
| Rate for Payer: PACE Senior Care Partners |
$156.56
|
| Rate for Payer: PACE SWMI |
$164.81
|
| Rate for Payer: PHP Commercial |
$560.34
|
| Rate for Payer: PHP Medicare Advantage |
$164.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$573.52
|
| Rate for Payer: Priority Health Medicare |
$166.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$458.82
|
| Rate for Payer: Railroad Medicare Medicare |
$164.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.11
|
| Rate for Payer: UHC Core |
$550.45
|
| Rate for Payer: UHC Exchange |
$164.81
|
| Rate for Payer: UHC Medicaid |
$116.22
|
| Rate for Payer: UHC Medicare Advantage |
$164.81
|
| Rate for Payer: UHCCP Medicaid |
$116.22
|
| Rate for Payer: VA VA |
$164.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$494.42
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
IP
|
$1,041.32
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.76 |
| Max. Negotiated Rate |
$937.19 |
| Rate for Payer: Aetna Commercial |
$885.12
|
| Rate for Payer: BCBS Trust/PPO |
$860.03
|
| Rate for Payer: BCN Commercial |
$860.03
|
| Rate for Payer: Cash Price |
$833.06
|
| Rate for Payer: Cofinity Commercial |
$895.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.06
|
| Rate for Payer: Healthscope Commercial |
$937.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.12
|
| Rate for Payer: Nomi Health Commercial |
$853.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.99
|
| Rate for Payer: PHP Commercial |
$885.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.36
|
| Rate for Payer: UHC Core |
$869.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.99
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
OP
|
$1,041.32
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.58 |
| Max. Negotiated Rate |
$937.19 |
| Rate for Payer: Aetna Commercial |
$885.12
|
| Rate for Payer: Aetna Medicare |
$270.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.41
|
| Rate for Payer: BCBS Complete |
$192.75
|
| Rate for Payer: BCBS MAPPO |
$260.33
|
| Rate for Payer: BCBS Trust/PPO |
$856.07
|
| Rate for Payer: BCN Commercial |
$856.07
|
| Rate for Payer: BCN Medicare Advantage |
$260.33
|
| Rate for Payer: Cash Price |
$833.06
|
| Rate for Payer: Cofinity Commercial |
$895.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.33
|
| Rate for Payer: Healthscope Commercial |
$937.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.99
|
| Rate for Payer: Mclaren Medicaid |
$183.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.35
|
| Rate for Payer: Meridian Medicaid |
$192.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.12
|
| Rate for Payer: Nomi Health Commercial |
$853.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.99
|
| Rate for Payer: PACE Senior Care Partners |
$247.31
|
| Rate for Payer: PACE SWMI |
$260.33
|
| Rate for Payer: PHP Commercial |
$885.12
|
| Rate for Payer: PHP Medicare Advantage |
$260.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.95
|
| Rate for Payer: Priority Health Medicare |
$262.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.76
|
| Rate for Payer: Railroad Medicare Medicare |
$260.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.36
|
| Rate for Payer: UHC Core |
$869.50
|
| Rate for Payer: UHC Exchange |
$260.33
|
| Rate for Payer: UHC Medicaid |
$183.58
|
| Rate for Payer: UHC Medicare Advantage |
$260.33
|
| Rate for Payer: UHCCP Medicaid |
$183.58
|
| Rate for Payer: VA VA |
$260.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.99
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
OP
|
$5,988.76
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.82 |
| Max. Negotiated Rate |
$5,389.88 |
| Rate for Payer: Aetna Commercial |
$5,090.45
|
| Rate for Payer: Aetna Medicare |
$1,557.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,871.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,871.49
|
| Rate for Payer: BCBS Complete |
$1,108.52
|
| Rate for Payer: BCBS MAPPO |
$1,497.19
|
| Rate for Payer: BCBS Trust/PPO |
$4,923.36
|
| Rate for Payer: BCN Commercial |
$4,923.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,497.19
|
| Rate for Payer: Cash Price |
$4,791.01
|
| Rate for Payer: Cofinity Commercial |
$5,150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,791.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,497.19
|
| Rate for Payer: Healthscope Commercial |
$5,389.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,491.57
|
| Rate for Payer: Mclaren Medicaid |
$1,055.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,572.05
|
| Rate for Payer: Meridian Medicaid |
$1,108.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,721.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,646.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,090.45
|
| Rate for Payer: Nomi Health Commercial |
$4,910.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,491.57
|
| Rate for Payer: PACE Senior Care Partners |
$1,422.33
|
| Rate for Payer: PACE SWMI |
$1,497.19
|
| Rate for Payer: PHP Commercial |
$5,090.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,497.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,055.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,210.22
|
| Rate for Payer: Priority Health Medicare |
$1,512.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,168.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,497.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,270.11
|
| Rate for Payer: UHC Core |
$5,000.61
|
| Rate for Payer: UHC Exchange |
$1,497.19
|
| Rate for Payer: UHC Medicaid |
$1,055.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,497.19
|
| Rate for Payer: UHCCP Medicaid |
$1,055.82
|
| Rate for Payer: VA VA |
$1,497.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,491.57
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
IP
|
$5,988.76
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,168.18 |
| Max. Negotiated Rate |
$5,389.88 |
| Rate for Payer: Aetna Commercial |
$5,090.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,946.12
|
| Rate for Payer: BCN Commercial |
$4,946.12
|
| Rate for Payer: Cash Price |
$4,791.01
|
| Rate for Payer: Cofinity Commercial |
$5,150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,791.01
|
| Rate for Payer: Healthscope Commercial |
$5,389.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,491.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,090.45
|
| Rate for Payer: Nomi Health Commercial |
$4,910.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,491.57
|
| Rate for Payer: PHP Commercial |
$5,090.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,210.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,168.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,270.11
|
| Rate for Payer: UHC Core |
$5,000.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,491.57
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$4,714.16
|
|
|
Service Code
|
APR-DRG 0602
|
| Min. Negotiated Rate |
$4,489.67 |
| Max. Negotiated Rate |
$4,714.16 |
| Rate for Payer: BCBS Complete |
$4,714.16
|
| Rate for Payer: Mclaren Medicaid |
$4,489.67
|
| Rate for Payer: Meridian Medicaid |
$4,714.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,489.67
|
| Rate for Payer: UHC Medicaid |
$4,489.67
|
| Rate for Payer: UHCCP Medicaid |
$4,489.67
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$3,302.80
|
|
|
Service Code
|
APR-DRG 0601
|
| Min. Negotiated Rate |
$3,145.52 |
| Max. Negotiated Rate |
$3,302.80 |
| Rate for Payer: BCBS Complete |
$3,302.80
|
| Rate for Payer: Mclaren Medicaid |
$3,145.52
|
| Rate for Payer: Meridian Medicaid |
$3,302.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,145.52
|
| Rate for Payer: UHC Medicaid |
$3,145.52
|
| Rate for Payer: UHCCP Medicaid |
$3,145.52
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$11,373.39
|
|
|
Service Code
|
APR-DRG 0604
|
| Min. Negotiated Rate |
$10,831.80 |
| Max. Negotiated Rate |
$11,373.39 |
| Rate for Payer: BCBS Complete |
$11,373.39
|
| Rate for Payer: Mclaren Medicaid |
$10,831.80
|
| Rate for Payer: Meridian Medicaid |
$11,373.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,831.80
|
| Rate for Payer: UHC Medicaid |
$10,831.80
|
| Rate for Payer: UHCCP Medicaid |
$10,831.80
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$6,716.55
|
|
|
Service Code
|
APR-DRG 0603
|
| Min. Negotiated Rate |
$6,396.72 |
| Max. Negotiated Rate |
$6,716.55 |
| Rate for Payer: BCBS Complete |
$6,716.55
|
| Rate for Payer: Mclaren Medicaid |
$6,396.72
|
| Rate for Payer: Meridian Medicaid |
$6,716.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,396.72
|
| Rate for Payer: UHC Medicaid |
$6,396.72
|
| Rate for Payer: UHCCP Medicaid |
$6,396.72
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$13,489.37
|
|
|
Service Code
|
APR-DRG 0554
|
| Min. Negotiated Rate |
$12,847.02 |
| Max. Negotiated Rate |
$13,489.37 |
| Rate for Payer: BCBS Complete |
$13,489.37
|
| Rate for Payer: Mclaren Medicaid |
$12,847.02
|
| Rate for Payer: Meridian Medicaid |
$13,489.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,847.02
|
| Rate for Payer: UHC Medicaid |
$12,847.02
|
| Rate for Payer: UHCCP Medicaid |
$12,847.02
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$5,933.05
|
|
|
Service Code
|
APR-DRG 0552
|
| Min. Negotiated Rate |
$5,650.53 |
| Max. Negotiated Rate |
$5,933.05 |
| Rate for Payer: BCBS Complete |
$5,933.05
|
| Rate for Payer: Mclaren Medicaid |
$5,650.53
|
| Rate for Payer: Meridian Medicaid |
$5,933.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,650.53
|
| Rate for Payer: UHC Medicaid |
$5,650.53
|
| Rate for Payer: UHCCP Medicaid |
$5,650.53
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$4,119.96
|
|
|
Service Code
|
APR-DRG 0551
|
| Min. Negotiated Rate |
$3,923.77 |
| Max. Negotiated Rate |
$4,119.96 |
| Rate for Payer: BCBS Complete |
$4,119.96
|
| Rate for Payer: Mclaren Medicaid |
$3,923.77
|
| Rate for Payer: Meridian Medicaid |
$4,119.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,923.77
|
| Rate for Payer: UHC Medicaid |
$3,923.77
|
| Rate for Payer: UHCCP Medicaid |
$3,923.77
|
|
