|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.06 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: BCBS Trust/PPO |
$212.32
|
| Rate for Payer: BCN Commercial |
$201.01
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health HMO/PPO |
$226.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.89
|
| Rate for Payer: UHC Core |
$217.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.07
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
OP
|
$3,098.41
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$735.87 |
| Max. Negotiated Rate |
$2,788.57 |
| Rate for Payer: Aetna Commercial |
$2,633.65
|
| Rate for Payer: Aetna Medicare |
$805.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$968.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$968.25
|
| Rate for Payer: BCBS Complete |
$1,239.36
|
| Rate for Payer: BCBS MAPPO |
$774.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.20
|
| Rate for Payer: BCN Commercial |
$2,409.01
|
| Rate for Payer: BCN Medicare Advantage |
$774.60
|
| Rate for Payer: Cash Price |
$2,478.73
|
| Rate for Payer: Cofinity Commercial |
$2,664.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,478.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.60
|
| Rate for Payer: Healthscope Commercial |
$2,788.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,323.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$813.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,633.65
|
| Rate for Payer: Nomi Health Commercial |
$2,540.70
|
| Rate for Payer: PACE Senior Care Partners |
$735.87
|
| Rate for Payer: PACE SWMI |
$774.60
|
| Rate for Payer: PHP Commercial |
$2,633.65
|
| Rate for Payer: PHP Medicare Advantage |
$774.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2,695.62
|
| Rate for Payer: Priority Health Medicare |
$782.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,075.93
|
| Rate for Payer: Railroad Medicare Medicare |
$774.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,726.60
|
| Rate for Payer: UHC Core |
$2,587.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.60
|
| Rate for Payer: UHC Exchange |
$774.60
|
| Rate for Payer: UHC Medicare Advantage |
$774.60
|
| Rate for Payer: VA VA |
$774.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,323.81
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
IP
|
$3,098.41
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,013.97 |
| Max. Negotiated Rate |
$2,788.57 |
| Rate for Payer: Aetna Commercial |
$2,633.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,529.23
|
| Rate for Payer: BCN Commercial |
$2,394.45
|
| Rate for Payer: Cash Price |
$2,478.73
|
| Rate for Payer: Cofinity Commercial |
$2,664.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,478.73
|
| Rate for Payer: Healthscope Commercial |
$2,788.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,323.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,633.65
|
| Rate for Payer: Nomi Health Commercial |
$2,540.70
|
| Rate for Payer: PHP Commercial |
$2,633.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2,695.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,075.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,726.60
|
| Rate for Payer: UHC Core |
$2,587.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,323.81
|
|
|
HC ZINC LEVEL
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$12.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$8.65
|
| Rate for Payer: BCBS MAPPO |
$12.49
|
| Rate for Payer: BCBS Trust/PPO |
$41.09
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.49
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: Meridian Medicaid |
$8.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: Nomi Health Commercial |
$40.98
|
| Rate for Payer: PACE Senior Care Partners |
$11.87
|
| Rate for Payer: PACE SWMI |
$12.49
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicare Advantage |
$12.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health HMO/PPO |
$43.48
|
| Rate for Payer: Priority Health Medicare |
$12.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.49
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicare Advantage |
$12.49
|
| Rate for Payer: UHCCP Medicaid |
$8.23
|
| Rate for Payer: VA VA |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC ZINC LEVEL
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: BCBS Trust/PPO |
$40.80
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: Nomi Health Commercial |
$40.98
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health HMO/PPO |
$43.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$369.94
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$17.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$113.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.50
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Exchange |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$112.50
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$367.33
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC ZINC URINE
|
Facility
|
IP
|
$69.97
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$62.97 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: BCBS Trust/PPO |
$57.12
|
| Rate for Payer: BCN Commercial |
$54.07
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.98
|
| Rate for Payer: Healthscope Commercial |
$62.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$57.38
|
| Rate for Payer: PHP Commercial |
$59.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.48
|
| Rate for Payer: Priority Health HMO/PPO |
$60.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.57
|
| Rate for Payer: UHC Core |
$58.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.48
|
|
|
HC ZINC URINE
|
Facility
|
OP
|
$69.97
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$62.97 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Aetna Medicare |
$18.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.87
|
| Rate for Payer: BCBS Complete |
$8.65
|
| Rate for Payer: BCBS MAPPO |
$17.49
|
| Rate for Payer: BCBS Trust/PPO |
$57.52
|
| Rate for Payer: BCN Commercial |
$54.40
|
| Rate for Payer: BCN Medicare Advantage |
$17.49
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.49
|
| Rate for Payer: Healthscope Commercial |
$62.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.48
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$8.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$57.38
|
| Rate for Payer: PACE Senior Care Partners |
$16.62
|
| Rate for Payer: PACE SWMI |
$17.49
|
| Rate for Payer: PHP Commercial |
$59.47
|
| Rate for Payer: PHP Medicare Advantage |
$17.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.48
|
| Rate for Payer: Priority Health HMO/PPO |
$60.87
|
| Rate for Payer: Priority Health Medicare |
$17.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.88
|
| Rate for Payer: Railroad Medicare Medicare |
$17.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.57
|
| Rate for Payer: UHC Core |
$58.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.49
|
| Rate for Payer: UHC Exchange |
$17.49
|
| Rate for Payer: UHC Medicare Advantage |
$17.49
|
| Rate for Payer: UHCCP Medicaid |
$8.23
|
| Rate for Payer: VA VA |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.48
|
|
|
HC Z INFUSION WIRE
|
Facility
|
OP
|
$874.85
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$207.78 |
| Max. Negotiated Rate |
$787.37 |
| Rate for Payer: Aetna Commercial |
$743.62
|
| Rate for Payer: Aetna Medicare |
$227.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.39
|
| Rate for Payer: BCBS Complete |
$349.94
|
| Rate for Payer: BCBS MAPPO |
$218.71
|
| Rate for Payer: BCBS Trust/PPO |
$719.21
|
| Rate for Payer: BCN Commercial |
$680.20
|
| Rate for Payer: BCN Medicare Advantage |
$218.71
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$752.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.71
|
| Rate for Payer: Healthscope Commercial |
$787.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: PACE Senior Care Partners |
$207.78
|
| Rate for Payer: PACE SWMI |
$218.71
|
| Rate for Payer: PHP Commercial |
$743.62
|
| Rate for Payer: PHP Medicare Advantage |
$218.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health HMO/PPO |
$761.12
|
| Rate for Payer: Priority Health Medicare |
$220.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.15
|
| Rate for Payer: Railroad Medicare Medicare |
$218.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.87
|
| Rate for Payer: UHC Core |
$730.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.71
|
| Rate for Payer: UHC Exchange |
$218.71
|
| Rate for Payer: UHC Medicare Advantage |
$218.71
|
| Rate for Payer: VA VA |
$218.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.14
|
|
|
HC Z INFUSION WIRE
|
Facility
|
IP
|
$874.85
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$568.65 |
| Max. Negotiated Rate |
$787.37 |
| Rate for Payer: Aetna Commercial |
$743.62
|
| Rate for Payer: BCBS Trust/PPO |
$714.14
|
| Rate for Payer: BCN Commercial |
$676.08
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$752.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Healthscope Commercial |
$787.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: PHP Commercial |
$743.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health HMO/PPO |
$761.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.87
|
| Rate for Payer: UHC Core |
$730.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.14
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
IP
|
$13,138.47
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,540.01 |
| Max. Negotiated Rate |
$11,824.62 |
| Rate for Payer: Aetna Commercial |
$11,167.70
|
| Rate for Payer: BCBS Trust/PPO |
$10,724.93
|
| Rate for Payer: BCN Commercial |
$10,153.41
|
| Rate for Payer: Cash Price |
$10,510.78
|
| Rate for Payer: Cofinity Commercial |
$11,299.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,510.78
|
| Rate for Payer: Healthscope Commercial |
$11,824.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,853.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,167.70
|
| Rate for Payer: Nomi Health Commercial |
$10,773.55
|
| Rate for Payer: PHP Commercial |
$11,167.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,540.01
|
| Rate for Payer: Priority Health HMO/PPO |
$11,430.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,802.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,561.85
|
| Rate for Payer: UHC Core |
$10,970.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,853.85
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
OP
|
$13,138.47
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,120.39 |
| Max. Negotiated Rate |
$11,824.62 |
| Rate for Payer: Aetna Commercial |
$11,167.70
|
| Rate for Payer: Aetna Medicare |
$3,416.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,105.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,105.77
|
| Rate for Payer: BCBS Complete |
$5,255.39
|
| Rate for Payer: BCBS MAPPO |
$3,284.62
|
| Rate for Payer: BCBS Trust/PPO |
$10,801.14
|
| Rate for Payer: BCN Commercial |
$10,215.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,284.62
|
| Rate for Payer: Cash Price |
$10,510.78
|
| Rate for Payer: Cofinity Commercial |
$11,299.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,510.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,284.62
|
| Rate for Payer: Healthscope Commercial |
$11,824.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,853.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,448.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,777.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,167.70
|
| Rate for Payer: Nomi Health Commercial |
$10,773.55
|
| Rate for Payer: PACE Senior Care Partners |
$3,120.39
|
| Rate for Payer: PACE SWMI |
$3,284.62
|
| Rate for Payer: PHP Commercial |
$11,167.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,284.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,540.01
|
| Rate for Payer: Priority Health HMO/PPO |
$11,430.47
|
| Rate for Payer: Priority Health Medicare |
$3,317.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,802.77
|
| Rate for Payer: Railroad Medicare Medicare |
$3,284.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,561.85
|
| Rate for Payer: UHC Core |
$10,970.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,284.62
|
| Rate for Payer: UHC Exchange |
$3,284.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.62
|
| Rate for Payer: VA VA |
$3,284.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,853.85
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
OP
|
$329.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$296.32 |
| Rate for Payer: Aetna Commercial |
$279.86
|
| Rate for Payer: Aetna Medicare |
$85.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.89
|
| Rate for Payer: BCBS Complete |
$131.70
|
| Rate for Payer: BCBS MAPPO |
$82.31
|
| Rate for Payer: BCBS Trust/PPO |
$270.68
|
| Rate for Payer: BCN Commercial |
$255.99
|
| Rate for Payer: BCN Medicare Advantage |
$82.31
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cofinity Commercial |
$283.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.31
|
| Rate for Payer: Healthscope Commercial |
$296.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.86
|
| Rate for Payer: Nomi Health Commercial |
$269.99
|
| Rate for Payer: PACE Senior Care Partners |
$78.20
|
| Rate for Payer: PACE SWMI |
$82.31
|
| Rate for Payer: PHP Commercial |
$279.86
|
| Rate for Payer: PHP Medicare Advantage |
$82.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.01
|
| Rate for Payer: Priority Health HMO/PPO |
$286.45
|
| Rate for Payer: Priority Health Medicare |
$83.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.60
|
| Rate for Payer: Railroad Medicare Medicare |
$82.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.74
|
| Rate for Payer: UHC Core |
$274.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.31
|
| Rate for Payer: UHC Exchange |
$82.31
|
| Rate for Payer: UHC Medicare Advantage |
$82.31
|
| Rate for Payer: VA VA |
$82.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.94
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
IP
|
$329.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.01 |
| Max. Negotiated Rate |
$296.32 |
| Rate for Payer: Aetna Commercial |
$279.86
|
| Rate for Payer: BCBS Trust/PPO |
$268.77
|
| Rate for Payer: BCN Commercial |
$254.44
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cofinity Commercial |
$283.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.40
|
| Rate for Payer: Healthscope Commercial |
$296.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.86
|
| Rate for Payer: Nomi Health Commercial |
$269.99
|
| Rate for Payer: PHP Commercial |
$279.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.01
|
| Rate for Payer: Priority Health HMO/PPO |
$286.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.74
|
| Rate for Payer: UHC Core |
$274.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.94
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
OP
|
$3,775.49
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$896.68 |
| Max. Negotiated Rate |
$3,397.94 |
| Rate for Payer: Aetna Commercial |
$3,209.17
|
| Rate for Payer: Aetna Medicare |
$981.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,179.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,179.84
|
| Rate for Payer: BCBS Complete |
$1,510.20
|
| Rate for Payer: BCBS MAPPO |
$943.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,103.83
|
| Rate for Payer: BCN Commercial |
$2,935.44
|
| Rate for Payer: BCN Medicare Advantage |
$943.87
|
| Rate for Payer: Cash Price |
$3,020.39
|
| Rate for Payer: Cofinity Commercial |
$3,246.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.87
|
| Rate for Payer: Healthscope Commercial |
$3,397.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,831.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$991.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,085.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.17
|
| Rate for Payer: Nomi Health Commercial |
$3,095.90
|
| Rate for Payer: PACE Senior Care Partners |
$896.68
|
| Rate for Payer: PACE SWMI |
$943.87
|
| Rate for Payer: PHP Commercial |
$3,209.17
|
| Rate for Payer: PHP Medicare Advantage |
$943.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,454.07
|
| Rate for Payer: Priority Health HMO/PPO |
$3,284.68
|
| Rate for Payer: Priority Health Medicare |
$953.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,529.58
|
| Rate for Payer: Railroad Medicare Medicare |
$943.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,322.43
|
| Rate for Payer: UHC Core |
$3,152.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$943.87
|
| Rate for Payer: UHC Exchange |
$943.87
|
| Rate for Payer: UHC Medicare Advantage |
$943.87
|
| Rate for Payer: VA VA |
$943.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,831.62
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
IP
|
$3,775.49
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,454.07 |
| Max. Negotiated Rate |
$3,397.94 |
| Rate for Payer: Aetna Commercial |
$3,209.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,081.93
|
| Rate for Payer: BCN Commercial |
$2,917.70
|
| Rate for Payer: Cash Price |
$3,020.39
|
| Rate for Payer: Cofinity Commercial |
$3,246.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.39
|
| Rate for Payer: Healthscope Commercial |
$3,397.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,831.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.17
|
| Rate for Payer: Nomi Health Commercial |
$3,095.90
|
| Rate for Payer: PHP Commercial |
$3,209.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,454.07
|
| Rate for Payer: Priority Health HMO/PPO |
$3,284.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,529.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,322.43
|
| Rate for Payer: UHC Core |
$3,152.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,831.62
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
IP
|
$775.77
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.25 |
| Max. Negotiated Rate |
$698.19 |
| Rate for Payer: Aetna Commercial |
$659.40
|
| Rate for Payer: BCBS Trust/PPO |
$633.26
|
| Rate for Payer: BCN Commercial |
$599.52
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$667.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.62
|
| Rate for Payer: Healthscope Commercial |
$698.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.40
|
| Rate for Payer: Nomi Health Commercial |
$636.13
|
| Rate for Payer: PHP Commercial |
$659.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.25
|
| Rate for Payer: Priority Health HMO/PPO |
$674.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$519.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.68
|
| Rate for Payer: UHC Core |
$647.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.83
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
OP
|
$775.77
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$698.19 |
| Rate for Payer: Aetna Commercial |
$659.40
|
| Rate for Payer: Aetna Medicare |
$201.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.43
|
| Rate for Payer: BCBS Complete |
$310.31
|
| Rate for Payer: BCBS MAPPO |
$193.94
|
| Rate for Payer: BCBS Trust/PPO |
$637.76
|
| Rate for Payer: BCN Commercial |
$603.16
|
| Rate for Payer: BCN Medicare Advantage |
$193.94
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$667.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.94
|
| Rate for Payer: Healthscope Commercial |
$698.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.40
|
| Rate for Payer: Nomi Health Commercial |
$636.13
|
| Rate for Payer: PACE Senior Care Partners |
$184.25
|
| Rate for Payer: PACE SWMI |
$193.94
|
| Rate for Payer: PHP Commercial |
$659.40
|
| Rate for Payer: PHP Medicare Advantage |
$193.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.25
|
| Rate for Payer: Priority Health HMO/PPO |
$674.92
|
| Rate for Payer: Priority Health Medicare |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$519.77
|
| Rate for Payer: Railroad Medicare Medicare |
$193.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.68
|
| Rate for Payer: UHC Core |
$647.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.94
|
| Rate for Payer: UHC Exchange |
$193.94
|
| Rate for Payer: UHC Medicare Advantage |
$193.94
|
| Rate for Payer: VA VA |
$193.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.83
|
|
|
HC ZONISAMIDE
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.89
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$9.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: Meridian Medicaid |
$10.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Exchange |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.12
|
| Rate for Payer: UHCCP Medicaid |
$9.58
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC ZONISAMIDE
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$62.45
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$174.79
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$157.31 |
| Rate for Payer: Aetna Commercial |
$148.57
|
| Rate for Payer: Aetna Medicare |
$45.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.62
|
| Rate for Payer: BCBS Complete |
$69.92
|
| Rate for Payer: BCBS MAPPO |
$43.70
|
| Rate for Payer: BCBS Trust/PPO |
$143.69
|
| Rate for Payer: BCN Commercial |
$135.90
|
| Rate for Payer: BCN Medicare Advantage |
$43.70
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.70
|
| Rate for Payer: Healthscope Commercial |
$157.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.57
|
| Rate for Payer: Nomi Health Commercial |
$143.33
|
| Rate for Payer: PACE Senior Care Partners |
$41.51
|
| Rate for Payer: PACE SWMI |
$43.70
|
| Rate for Payer: PHP Commercial |
$148.57
|
| Rate for Payer: PHP Medicare Advantage |
$43.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.61
|
| Rate for Payer: Priority Health HMO/PPO |
$152.07
|
| Rate for Payer: Priority Health Medicare |
$44.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.11
|
| Rate for Payer: Railroad Medicare Medicare |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.82
|
| Rate for Payer: UHC Core |
$145.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.70
|
| Rate for Payer: UHC Exchange |
$43.70
|
| Rate for Payer: UHC Medicare Advantage |
$43.70
|
| Rate for Payer: VA VA |
$43.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.09
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$174.79
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.61 |
| Max. Negotiated Rate |
$157.31 |
| Rate for Payer: Aetna Commercial |
$148.57
|
| Rate for Payer: BCBS Trust/PPO |
$142.68
|
| Rate for Payer: BCN Commercial |
$135.08
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.83
|
| Rate for Payer: Healthscope Commercial |
$157.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.57
|
| Rate for Payer: Nomi Health Commercial |
$143.33
|
| Rate for Payer: PHP Commercial |
$148.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.61
|
| Rate for Payer: Priority Health HMO/PPO |
$152.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.82
|
| Rate for Payer: UHC Core |
$145.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.09
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,332.83
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$866.34 |
| Max. Negotiated Rate |
$1,199.55 |
| Rate for Payer: Aetna Commercial |
$1,132.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,087.99
|
| Rate for Payer: BCN Commercial |
$1,030.01
|
| Rate for Payer: Cash Price |
$1,066.26
|
| Rate for Payer: Cofinity Commercial |
$1,146.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.26
|
| Rate for Payer: Healthscope Commercial |
$1,199.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.91
|
| Rate for Payer: Nomi Health Commercial |
$1,092.92
|
| Rate for Payer: PHP Commercial |
$1,132.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1,159.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$893.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,172.89
|
| Rate for Payer: UHC Core |
$1,112.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.62
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,332.83
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.55 |
| Max. Negotiated Rate |
$1,199.55 |
| Rate for Payer: Aetna Commercial |
$1,132.91
|
| Rate for Payer: Aetna Medicare |
$346.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$416.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$416.51
|
| Rate for Payer: BCBS Complete |
$533.13
|
| Rate for Payer: BCBS MAPPO |
$333.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,095.72
|
| Rate for Payer: BCN Commercial |
$1,036.28
|
| Rate for Payer: BCN Medicare Advantage |
$333.21
|
| Rate for Payer: Cash Price |
$1,066.26
|
| Rate for Payer: Cofinity Commercial |
$1,146.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.21
|
| Rate for Payer: Healthscope Commercial |
$1,199.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.91
|
| Rate for Payer: Nomi Health Commercial |
$1,092.92
|
| Rate for Payer: PACE Senior Care Partners |
$316.55
|
| Rate for Payer: PACE SWMI |
$333.21
|
| Rate for Payer: PHP Commercial |
$1,132.91
|
| Rate for Payer: PHP Medicare Advantage |
$333.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.34
|
| Rate for Payer: Priority Health HMO/PPO |
$1,159.56
|
| Rate for Payer: Priority Health Medicare |
$336.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$893.00
|
| Rate for Payer: Railroad Medicare Medicare |
$333.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,172.89
|
| Rate for Payer: UHC Core |
$1,112.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.21
|
| Rate for Payer: UHC Exchange |
$333.21
|
| Rate for Payer: UHC Medicare Advantage |
$333.21
|
| Rate for Payer: VA VA |
$333.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.62
|
|
