|
HC BONE CEMENT
|
Facility
|
OP
|
$1,995.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.94 |
| Max. Negotiated Rate |
$1,795.97 |
| Rate for Payer: Aetna Commercial |
$1,696.19
|
| Rate for Payer: Aetna Medicare |
$518.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.60
|
| Rate for Payer: BCBS Complete |
$798.21
|
| Rate for Payer: BCBS MAPPO |
$498.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.52
|
| Rate for Payer: BCN Commercial |
$1,551.52
|
| Rate for Payer: BCN Medicare Advantage |
$498.88
|
| Rate for Payer: Cash Price |
$1,596.42
|
| Rate for Payer: Cofinity Commercial |
$1,716.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.88
|
| Rate for Payer: Healthscope Commercial |
$1,795.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,496.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$523.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,696.19
|
| Rate for Payer: PACE Senior Care Partners |
$473.94
|
| Rate for Payer: PACE SWMI |
$498.88
|
| Rate for Payer: PHP Commercial |
$1,696.19
|
| Rate for Payer: PHP Medicare Advantage |
$498.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,736.10
|
| Rate for Payer: Priority Health Medicare |
$498.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,217.07
|
| Rate for Payer: Railroad Medicare Medicare |
$498.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,756.06
|
| Rate for Payer: UHC Core |
$1,666.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.88
|
| Rate for Payer: UHC Medicare Advantage |
$513.85
|
| Rate for Payer: VA VA |
$498.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,496.64
|
|
|
HC BONE MARROW ASPIRATION
|
Facility
|
IP
|
$1,348.03
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
36100184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$822.16 |
| Max. Negotiated Rate |
$1,213.23 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: Aetna Commercial |
$1,806.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,642.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.76
|
| Rate for Payer: BCN Commercial |
$1,642.51
|
| Rate for Payer: BCN Commercial |
$1,041.76
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cash Price |
$1,078.42
|
| Rate for Payer: Cofinity Commercial |
$1,159.31
|
| Rate for Payer: Cofinity Commercial |
$1,827.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,700.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,078.42
|
| Rate for Payer: Healthscope Commercial |
$1,912.86
|
| Rate for Payer: Healthscope Commercial |
$1,213.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,011.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,594.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,806.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,145.83
|
| Rate for Payer: PHP Commercial |
$1,806.59
|
| Rate for Payer: PHP Commercial |
$1,145.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,172.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,849.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$822.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,296.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,186.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,870.35
|
| Rate for Payer: UHC Core |
$1,125.61
|
| Rate for Payer: UHC Core |
$1,774.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,594.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,011.02
|
|
|
HC BONE MARROW ASPIRATION
|
Facility
|
OP
|
$1,348.03
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
36100184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.16 |
| Max. Negotiated Rate |
$1,213.23 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: Aetna Commercial |
$1,806.59
|
| Rate for Payer: Aetna Medicare |
$552.60
|
| Rate for Payer: Aetna Medicare |
$350.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$664.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$664.19
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS MAPPO |
$531.35
|
| Rate for Payer: BCBS MAPPO |
$337.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,652.50
|
| Rate for Payer: BCN Commercial |
$1,652.50
|
| Rate for Payer: BCN Commercial |
$1,048.09
|
| Rate for Payer: BCN Medicare Advantage |
$531.35
|
| Rate for Payer: BCN Medicare Advantage |
$337.01
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cash Price |
$1,078.42
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cash Price |
$1,078.42
|
| Rate for Payer: Cofinity Commercial |
$1,159.31
|
| Rate for Payer: Cofinity Commercial |
$1,827.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,700.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,078.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.01
|
| Rate for Payer: Healthscope Commercial |
$1,213.23
|
| Rate for Payer: Healthscope Commercial |
$1,912.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,011.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,594.05
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$557.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$353.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$611.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,806.59
|
| Rate for Payer: PACE Senior Care Partners |
$320.16
|
| Rate for Payer: PACE Senior Care Partners |
$504.78
|
| Rate for Payer: PACE SWMI |
$337.01
|
| Rate for Payer: PACE SWMI |
$531.35
|
| Rate for Payer: PHP Commercial |
$1,145.83
|
| Rate for Payer: PHP Commercial |
$1,806.59
|
| Rate for Payer: PHP Medicare Advantage |
$337.01
|
| Rate for Payer: PHP Medicare Advantage |
$531.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,172.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,849.10
|
| Rate for Payer: Priority Health Medicare |
$531.35
|
| Rate for Payer: Priority Health Medicare |
$337.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,296.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$822.16
|
| Rate for Payer: Railroad Medicare Medicare |
$531.35
|
| Rate for Payer: Railroad Medicare Medicare |
$337.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,186.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,870.35
|
| Rate for Payer: UHC Core |
$1,125.61
|
| Rate for Payer: UHC Core |
$1,774.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.35
|
| Rate for Payer: UHC Medicare Advantage |
$547.29
|
| Rate for Payer: UHC Medicare Advantage |
$347.12
|
| Rate for Payer: VA VA |
$337.01
|
| Rate for Payer: VA VA |
$531.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,011.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,594.05
|
|
|
HC BONE MARROW BIOPSY
|
Facility
|
OP
|
$2,024.19
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
36100185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.75 |
| Max. Negotiated Rate |
$1,821.77 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Medicare |
$526.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$632.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$632.56
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS MAPPO |
$506.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,573.81
|
| Rate for Payer: BCN Commercial |
$1,573.81
|
| Rate for Payer: BCN Medicare Advantage |
$506.05
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.05
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$531.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$581.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PACE Senior Care Partners |
$480.75
|
| Rate for Payer: PACE SWMI |
$506.05
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: PHP Medicare Advantage |
$506.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,761.05
|
| Rate for Payer: Priority Health Medicare |
$506.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,234.55
|
| Rate for Payer: Railroad Medicare Medicare |
$506.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.05
|
| Rate for Payer: UHC Medicare Advantage |
$521.23
|
| Rate for Payer: VA VA |
$506.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC BONE MARROW BIOPSY
|
Facility
|
IP
|
$2,024.19
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
36100185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,234.55 |
| Max. Negotiated Rate |
$1,821.77 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.29
|
| Rate for Payer: BCN Commercial |
$1,564.29
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,761.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,234.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC BONE MARROW BX AND ASP DIAGNOSTIC
|
Facility
|
IP
|
$2,024.19
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
36100549
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,234.55 |
| Max. Negotiated Rate |
$1,821.77 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.29
|
| Rate for Payer: BCN Commercial |
$1,564.29
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,761.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,234.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC BONE MARROW BX AND ASP DIAGNOSTIC
|
Facility
|
OP
|
$2,024.19
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
36100549
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.75 |
| Max. Negotiated Rate |
$1,957.20 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Medicare |
$526.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$632.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$632.56
|
| Rate for Payer: BCBS Complete |
$1,957.20
|
| Rate for Payer: BCBS MAPPO |
$506.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,573.81
|
| Rate for Payer: BCN Commercial |
$1,573.81
|
| Rate for Payer: BCN Medicare Advantage |
$506.05
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.05
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.14
|
| Rate for Payer: Mclaren Medicaid |
$1,864.00
|
| Rate for Payer: Meridian Medicaid |
$1,957.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$531.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$581.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PACE Senior Care Partners |
$480.75
|
| Rate for Payer: PACE SWMI |
$506.05
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: PHP Medicare Advantage |
$506.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,864.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,761.05
|
| Rate for Payer: Priority Health Medicare |
$506.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,234.55
|
| Rate for Payer: Railroad Medicare Medicare |
$506.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,781.29
|
| Rate for Payer: UHC Core |
$1,690.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.05
|
| Rate for Payer: UHC Medicare Advantage |
$521.23
|
| Rate for Payer: VA VA |
$506.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.14
|
|
|
HC BONE MARROW SMEAR INTERPRETATION
|
Facility
|
IP
|
$164.44
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
30500069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.29 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: BCBS Trust/PPO |
$127.08
|
| Rate for Payer: BCN Commercial |
$127.08
|
| Rate for Payer: Cash Price |
$131.55
|
| Rate for Payer: Cofinity Commercial |
$141.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.55
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.71
|
| Rate for Payer: UHC Core |
$137.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.33
|
|
|
HC BONE MARROW SMEAR INTERPRETATION
|
Facility
|
OP
|
$164.44
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
30500069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$592.28 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.39
|
| Rate for Payer: BCBS Complete |
$592.28
|
| Rate for Payer: BCBS MAPPO |
$41.11
|
| Rate for Payer: BCBS Trust/PPO |
$127.85
|
| Rate for Payer: BCN Commercial |
$127.85
|
| Rate for Payer: BCN Medicare Advantage |
$41.11
|
| Rate for Payer: Cash Price |
$131.55
|
| Rate for Payer: Cash Price |
$131.55
|
| Rate for Payer: Cofinity Commercial |
$141.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.11
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.33
|
| Rate for Payer: Mclaren Medicaid |
$564.08
|
| Rate for Payer: Meridian Medicaid |
$592.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PACE Senior Care Partners |
$39.05
|
| Rate for Payer: PACE SWMI |
$41.11
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: PHP Medicare Advantage |
$41.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$564.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.06
|
| Rate for Payer: Priority Health Medicare |
$41.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.29
|
| Rate for Payer: Railroad Medicare Medicare |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.71
|
| Rate for Payer: UHC Core |
$137.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.11
|
| Rate for Payer: UHC Medicare Advantage |
$42.34
|
| Rate for Payer: VA VA |
$41.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.33
|
|
|
HC BOOT HEEL PROTECT FLUID Z-FLEX
|
Facility
|
IP
|
$145.26
|
|
| Hospital Charge Code |
27000630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.59 |
| Max. Negotiated Rate |
$130.73 |
| Rate for Payer: Aetna Commercial |
$123.47
|
| Rate for Payer: BCBS Trust/PPO |
$112.26
|
| Rate for Payer: BCN Commercial |
$112.26
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$124.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.21
|
| Rate for Payer: Healthscope Commercial |
$130.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: PHP Commercial |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.83
|
| Rate for Payer: UHC Core |
$121.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.94
|
|
|
HC BOOT HEEL PROTECT FLUID Z-FLEX
|
Facility
|
OP
|
$145.26
|
|
| Hospital Charge Code |
27000630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$130.73 |
| Rate for Payer: Aetna Commercial |
$123.47
|
| Rate for Payer: Aetna Medicare |
$37.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.39
|
| Rate for Payer: BCBS Complete |
$58.10
|
| Rate for Payer: BCBS MAPPO |
$36.32
|
| Rate for Payer: BCBS Trust/PPO |
$112.94
|
| Rate for Payer: BCN Commercial |
$112.94
|
| Rate for Payer: BCN Medicare Advantage |
$36.32
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$124.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$130.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: PACE Senior Care Partners |
$34.50
|
| Rate for Payer: PACE SWMI |
$36.32
|
| Rate for Payer: PHP Commercial |
$123.47
|
| Rate for Payer: PHP Medicare Advantage |
$36.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.38
|
| Rate for Payer: Priority Health Medicare |
$36.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.59
|
| Rate for Payer: Railroad Medicare Medicare |
$36.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.83
|
| Rate for Payer: UHC Core |
$121.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.32
|
| Rate for Payer: UHC Medicare Advantage |
$37.40
|
| Rate for Payer: VA VA |
$36.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.94
|
|
|
HC BOOT STATIC AIR W/STAB Z-FLEX
|
Facility
|
OP
|
$47.84
|
|
| Hospital Charge Code |
27000631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.95
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS MAPPO |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$37.20
|
| Rate for Payer: BCN Commercial |
$37.20
|
| Rate for Payer: BCN Medicare Advantage |
$11.96
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.96
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PACE Senior Care Partners |
$11.36
|
| Rate for Payer: PACE SWMI |
$11.96
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: PHP Medicare Advantage |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.62
|
| Rate for Payer: Priority Health Medicare |
$11.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.10
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.32
|
| Rate for Payer: VA VA |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.88
|
|
|
HC BOOT STATIC AIR W/STAB Z-FLEX
|
Facility
|
IP
|
$47.84
|
|
| Hospital Charge Code |
27000631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: BCBS Trust/PPO |
$36.97
|
| Rate for Payer: BCN Commercial |
$36.97
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.10
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.88
|
|
|
HC BOSTON SCI CRT ICD
|
Facility
|
OP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,128.92 |
| Max. Negotiated Rate |
$23,225.40 |
| Rate for Payer: Aetna Commercial |
$21,935.10
|
| Rate for Payer: Aetna Medicare |
$6,709.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,064.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,064.38
|
| Rate for Payer: BCBS Complete |
$10,322.40
|
| Rate for Payer: BCBS MAPPO |
$6,451.50
|
| Rate for Payer: BCBS Trust/PPO |
$20,064.16
|
| Rate for Payer: BCN Commercial |
$20,064.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,451.50
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$22,193.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,451.50
|
| Rate for Payer: Healthscope Commercial |
$23,225.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,774.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,419.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: PACE Senior Care Partners |
$6,128.92
|
| Rate for Payer: PACE SWMI |
$6,451.50
|
| Rate for Payer: PHP Commercial |
$21,935.10
|
| Rate for Payer: PHP Medicare Advantage |
$6,451.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,451.22
|
| Rate for Payer: Priority Health Medicare |
$6,451.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,739.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6,451.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,709.28
|
| Rate for Payer: UHC Core |
$21,548.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,451.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,645.04
|
| Rate for Payer: VA VA |
$6,451.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
|
HC BOSTON SCI CRT ICD
|
Facility
|
IP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$15,739.08 |
| Max. Negotiated Rate |
$23,225.40 |
| Rate for Payer: Aetna Commercial |
$21,935.10
|
| Rate for Payer: BCBS Trust/PPO |
$19,942.88
|
| Rate for Payer: BCN Commercial |
$19,942.88
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$22,193.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Healthscope Commercial |
$23,225.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: PHP Commercial |
$21,935.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,451.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,739.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,709.28
|
| Rate for Payer: UHC Core |
$21,548.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
|
HC BOSTON SCI CRT LEAD
|
Facility
|
OP
|
$6,751.77
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,603.55 |
| Max. Negotiated Rate |
$6,076.59 |
| Rate for Payer: Aetna Commercial |
$5,739.00
|
| Rate for Payer: Aetna Medicare |
$1,755.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,109.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,109.93
|
| Rate for Payer: BCBS Complete |
$2,700.71
|
| Rate for Payer: BCBS MAPPO |
$1,687.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,249.50
|
| Rate for Payer: BCN Commercial |
$5,249.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,687.94
|
| Rate for Payer: Cash Price |
$5,401.42
|
| Rate for Payer: Cofinity Commercial |
$5,806.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,401.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,687.94
|
| Rate for Payer: Healthscope Commercial |
$6,076.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,063.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,772.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,941.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,739.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,603.55
|
| Rate for Payer: PACE SWMI |
$1,687.94
|
| Rate for Payer: PHP Commercial |
$5,739.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,687.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,726.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,874.04
|
| Rate for Payer: Priority Health Medicare |
$1,687.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,117.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,687.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,941.56
|
| Rate for Payer: UHC Core |
$5,637.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,687.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,738.58
|
| Rate for Payer: VA VA |
$1,687.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,063.83
|
|
|
HC BOSTON SCI CRT LEAD
|
Facility
|
IP
|
$6,751.77
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,117.90 |
| Max. Negotiated Rate |
$6,076.59 |
| Rate for Payer: Aetna Commercial |
$5,739.00
|
| Rate for Payer: BCBS Trust/PPO |
$5,217.77
|
| Rate for Payer: BCN Commercial |
$5,217.77
|
| Rate for Payer: Cash Price |
$5,401.42
|
| Rate for Payer: Cofinity Commercial |
$5,806.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,401.42
|
| Rate for Payer: Healthscope Commercial |
$6,076.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,063.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,739.00
|
| Rate for Payer: PHP Commercial |
$5,739.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,726.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,874.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,117.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,941.56
|
| Rate for Payer: UHC Core |
$5,637.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,063.83
|
|
|
HC BOSTON SCI DUAL PACEMAKER
|
Facility
|
IP
|
$8,404.80
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,126.09 |
| Max. Negotiated Rate |
$7,564.32 |
| Rate for Payer: Aetna Commercial |
$7,144.08
|
| Rate for Payer: BCBS Trust/PPO |
$6,495.23
|
| Rate for Payer: BCN Commercial |
$6,495.23
|
| Rate for Payer: Cash Price |
$6,723.84
|
| Rate for Payer: Cofinity Commercial |
$7,228.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,723.84
|
| Rate for Payer: Healthscope Commercial |
$7,564.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,303.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,144.08
|
| Rate for Payer: PHP Commercial |
$7,144.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,883.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,312.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,126.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,396.22
|
| Rate for Payer: UHC Core |
$7,018.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,303.60
|
|
|
HC BOSTON SCI DUAL PACEMAKER
|
Facility
|
OP
|
$8,404.80
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,996.14 |
| Max. Negotiated Rate |
$7,564.32 |
| Rate for Payer: Aetna Commercial |
$7,144.08
|
| Rate for Payer: Aetna Medicare |
$2,185.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,626.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,626.50
|
| Rate for Payer: BCBS Complete |
$3,361.92
|
| Rate for Payer: BCBS MAPPO |
$2,101.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,534.73
|
| Rate for Payer: BCN Commercial |
$6,534.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,101.20
|
| Rate for Payer: Cash Price |
$6,723.84
|
| Rate for Payer: Cofinity Commercial |
$7,228.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,723.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,101.20
|
| Rate for Payer: Healthscope Commercial |
$7,564.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,303.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,206.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,416.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,144.08
|
| Rate for Payer: PACE Senior Care Partners |
$1,996.14
|
| Rate for Payer: PACE SWMI |
$2,101.20
|
| Rate for Payer: PHP Commercial |
$7,144.08
|
| Rate for Payer: PHP Medicare Advantage |
$2,101.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,883.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,312.18
|
| Rate for Payer: Priority Health Medicare |
$2,101.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,126.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,101.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,396.22
|
| Rate for Payer: UHC Core |
$7,018.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,101.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,164.24
|
| Rate for Payer: VA VA |
$2,101.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,303.60
|
|
|
HC BOSTON SCI ICD DUAL
|
Facility
|
IP
|
$18,156.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,073.34 |
| Max. Negotiated Rate |
$16,340.40 |
| Rate for Payer: Aetna Commercial |
$15,432.60
|
| Rate for Payer: BCBS Trust/PPO |
$14,030.96
|
| Rate for Payer: BCN Commercial |
$14,030.96
|
| Rate for Payer: Cash Price |
$14,524.80
|
| Rate for Payer: Cofinity Commercial |
$15,614.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,524.80
|
| Rate for Payer: Healthscope Commercial |
$16,340.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,617.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,432.60
|
| Rate for Payer: PHP Commercial |
$15,432.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,709.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,795.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,073.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,977.28
|
| Rate for Payer: UHC Core |
$15,160.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,617.00
|
|
|
HC BOSTON SCI ICD DUAL
|
Facility
|
OP
|
$18,156.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,312.05 |
| Max. Negotiated Rate |
$16,340.40 |
| Rate for Payer: Aetna Commercial |
$15,432.60
|
| Rate for Payer: Aetna Medicare |
$4,720.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,673.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,673.75
|
| Rate for Payer: BCBS Complete |
$7,262.40
|
| Rate for Payer: BCBS MAPPO |
$4,539.00
|
| Rate for Payer: BCBS Trust/PPO |
$14,116.29
|
| Rate for Payer: BCN Commercial |
$14,116.29
|
| Rate for Payer: BCN Medicare Advantage |
$4,539.00
|
| Rate for Payer: Cash Price |
$14,524.80
|
| Rate for Payer: Cofinity Commercial |
$15,614.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,524.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,539.00
|
| Rate for Payer: Healthscope Commercial |
$16,340.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,617.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,765.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,219.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,432.60
|
| Rate for Payer: PACE Senior Care Partners |
$4,312.05
|
| Rate for Payer: PACE SWMI |
$4,539.00
|
| Rate for Payer: PHP Commercial |
$15,432.60
|
| Rate for Payer: PHP Medicare Advantage |
$4,539.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,709.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,795.72
|
| Rate for Payer: Priority Health Medicare |
$4,539.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,073.34
|
| Rate for Payer: Railroad Medicare Medicare |
$4,539.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,977.28
|
| Rate for Payer: UHC Core |
$15,160.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,539.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,675.17
|
| Rate for Payer: VA VA |
$4,539.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,617.00
|
|
|
HC BOSTON SCI ICD SINGLE
|
Facility
|
IP
|
$21,624.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,188.48 |
| Max. Negotiated Rate |
$19,461.60 |
| Rate for Payer: Aetna Commercial |
$18,380.40
|
| Rate for Payer: BCBS Trust/PPO |
$16,711.03
|
| Rate for Payer: BCN Commercial |
$16,711.03
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cofinity Commercial |
$18,596.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,299.20
|
| Rate for Payer: Healthscope Commercial |
$19,461.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,218.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,380.40
|
| Rate for Payer: PHP Commercial |
$18,380.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,136.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,812.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,188.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,029.12
|
| Rate for Payer: UHC Core |
$18,056.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,218.00
|
|
|
HC BOSTON SCI ICD SINGLE
|
Facility
|
OP
|
$21,624.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,135.70 |
| Max. Negotiated Rate |
$19,461.60 |
| Rate for Payer: Aetna Commercial |
$18,380.40
|
| Rate for Payer: Aetna Medicare |
$5,622.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,757.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,757.50
|
| Rate for Payer: BCBS Complete |
$8,649.60
|
| Rate for Payer: BCBS MAPPO |
$5,406.00
|
| Rate for Payer: BCBS Trust/PPO |
$16,812.66
|
| Rate for Payer: BCN Commercial |
$16,812.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,406.00
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cofinity Commercial |
$18,596.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,299.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,406.00
|
| Rate for Payer: Healthscope Commercial |
$19,461.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,218.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,676.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,216.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,380.40
|
| Rate for Payer: PACE Senior Care Partners |
$5,135.70
|
| Rate for Payer: PACE SWMI |
$5,406.00
|
| Rate for Payer: PHP Commercial |
$18,380.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,406.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,136.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,812.88
|
| Rate for Payer: Priority Health Medicare |
$5,406.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,188.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5,406.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,029.12
|
| Rate for Payer: UHC Core |
$18,056.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,406.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,568.18
|
| Rate for Payer: VA VA |
$5,406.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,218.00
|
|
|
HC BOSTON SCI PACEMAKER LEAD
|
Facility
|
IP
|
$2,213.49
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.01 |
| Max. Negotiated Rate |
$1,992.14 |
| Rate for Payer: Aetna Commercial |
$1,881.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.59
|
| Rate for Payer: BCN Commercial |
$1,710.59
|
| Rate for Payer: Cash Price |
$1,770.79
|
| Rate for Payer: Cofinity Commercial |
$1,903.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,770.79
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,660.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,881.47
|
| Rate for Payer: PHP Commercial |
$1,881.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,549.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,925.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,350.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,947.87
|
| Rate for Payer: UHC Core |
$1,848.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,660.12
|
|
|
HC BOSTON SCI PACEMAKER LEAD
|
Facility
|
OP
|
$2,213.49
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.70 |
| Max. Negotiated Rate |
$1,992.14 |
| Rate for Payer: Aetna Commercial |
$1,881.47
|
| Rate for Payer: Aetna Medicare |
$575.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$691.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$691.72
|
| Rate for Payer: BCBS Complete |
$885.40
|
| Rate for Payer: BCBS MAPPO |
$553.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,720.99
|
| Rate for Payer: BCN Commercial |
$1,720.99
|
| Rate for Payer: BCN Medicare Advantage |
$553.37
|
| Rate for Payer: Cash Price |
$1,770.79
|
| Rate for Payer: Cofinity Commercial |
$1,903.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,770.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$553.37
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,660.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$581.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$636.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,881.47
|
| Rate for Payer: PACE Senior Care Partners |
$525.70
|
| Rate for Payer: PACE SWMI |
$553.37
|
| Rate for Payer: PHP Commercial |
$1,881.47
|
| Rate for Payer: PHP Medicare Advantage |
$553.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,549.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,925.74
|
| Rate for Payer: Priority Health Medicare |
$553.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,350.01
|
| Rate for Payer: Railroad Medicare Medicare |
$553.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,947.87
|
| Rate for Payer: UHC Core |
$1,848.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$553.37
|
| Rate for Payer: UHC Medicare Advantage |
$569.97
|
| Rate for Payer: VA VA |
$553.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,660.12
|
|
