|
HC BOSTON SCI PERIPHERAL STENT
|
Facility
|
IP
|
$2,626.53
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.92 |
| Max. Negotiated Rate |
$2,363.88 |
| Rate for Payer: Aetna Commercial |
$2,232.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,029.78
|
| Rate for Payer: BCN Commercial |
$2,029.78
|
| Rate for Payer: Cash Price |
$2,101.22
|
| Rate for Payer: Cofinity Commercial |
$2,258.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.22
|
| Rate for Payer: Healthscope Commercial |
$2,363.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,969.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,232.55
|
| Rate for Payer: PHP Commercial |
$2,232.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,285.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,601.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,311.35
|
| Rate for Payer: UHC Core |
$2,193.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,969.90
|
|
|
HC BOSTON SCI PERIPHERAL STENT
|
Facility
|
OP
|
$2,626.53
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.80 |
| Max. Negotiated Rate |
$2,363.88 |
| Rate for Payer: Aetna Commercial |
$2,232.55
|
| Rate for Payer: Aetna Medicare |
$682.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$820.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$820.79
|
| Rate for Payer: BCBS Complete |
$1,050.61
|
| Rate for Payer: BCBS MAPPO |
$656.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,042.13
|
| Rate for Payer: BCN Commercial |
$2,042.13
|
| Rate for Payer: BCN Medicare Advantage |
$656.63
|
| Rate for Payer: Cash Price |
$2,101.22
|
| Rate for Payer: Cofinity Commercial |
$2,258.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.63
|
| Rate for Payer: Healthscope Commercial |
$2,363.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,969.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$689.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$755.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,232.55
|
| Rate for Payer: PACE Senior Care Partners |
$623.80
|
| Rate for Payer: PACE SWMI |
$656.63
|
| Rate for Payer: PHP Commercial |
$2,232.55
|
| Rate for Payer: PHP Medicare Advantage |
$656.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,285.08
|
| Rate for Payer: Priority Health Medicare |
$656.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,601.92
|
| Rate for Payer: Railroad Medicare Medicare |
$656.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,311.35
|
| Rate for Payer: UHC Core |
$2,193.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$656.63
|
| Rate for Payer: UHC Medicare Advantage |
$676.33
|
| Rate for Payer: VA VA |
$656.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,969.90
|
|
|
HC BOSTON SCI SINGLE PACEMAKER
|
Facility
|
OP
|
$13,947.49
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500005
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,312.53 |
| Max. Negotiated Rate |
$12,552.74 |
| Rate for Payer: Aetna Commercial |
$11,855.37
|
| Rate for Payer: Aetna Medicare |
$3,626.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,358.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,358.59
|
| Rate for Payer: BCBS Complete |
$5,579.00
|
| Rate for Payer: BCBS MAPPO |
$3,486.87
|
| Rate for Payer: BCBS Trust/PPO |
$10,844.17
|
| Rate for Payer: BCN Commercial |
$10,844.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,486.87
|
| Rate for Payer: Cash Price |
$11,157.99
|
| Rate for Payer: Cofinity Commercial |
$11,994.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,157.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,486.87
|
| Rate for Payer: Healthscope Commercial |
$12,552.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,460.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,661.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,009.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,855.37
|
| Rate for Payer: PACE Senior Care Partners |
$3,312.53
|
| Rate for Payer: PACE SWMI |
$3,486.87
|
| Rate for Payer: PHP Commercial |
$11,855.37
|
| Rate for Payer: PHP Medicare Advantage |
$3,486.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,763.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,134.32
|
| Rate for Payer: Priority Health Medicare |
$3,486.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,506.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3,486.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,273.79
|
| Rate for Payer: UHC Core |
$11,646.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,486.87
|
| Rate for Payer: UHC Medicare Advantage |
$3,591.48
|
| Rate for Payer: VA VA |
$3,486.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,460.62
|
|
|
HC BOSTON SCI SINGLE PACEMAKER
|
Facility
|
IP
|
$13,947.49
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500005
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,506.57 |
| Max. Negotiated Rate |
$12,552.74 |
| Rate for Payer: Aetna Commercial |
$11,855.37
|
| Rate for Payer: BCBS Trust/PPO |
$10,778.62
|
| Rate for Payer: BCN Commercial |
$10,778.62
|
| Rate for Payer: Cash Price |
$11,157.99
|
| Rate for Payer: Cofinity Commercial |
$11,994.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,157.99
|
| Rate for Payer: Healthscope Commercial |
$12,552.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,460.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,855.37
|
| Rate for Payer: PHP Commercial |
$11,855.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,763.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,134.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,506.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,273.79
|
| Rate for Payer: UHC Core |
$11,646.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,460.62
|
|
|
HC BOSTON SCI TACHY (ICD) LEAD
|
Facility
|
OP
|
$8,600.98
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,042.73 |
| Max. Negotiated Rate |
$7,740.88 |
| Rate for Payer: Aetna Commercial |
$7,310.83
|
| Rate for Payer: Aetna Medicare |
$2,236.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,687.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,687.81
|
| Rate for Payer: BCBS Complete |
$3,440.39
|
| Rate for Payer: BCBS MAPPO |
$2,150.24
|
| Rate for Payer: BCBS Trust/PPO |
$6,687.26
|
| Rate for Payer: BCN Commercial |
$6,687.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,150.24
|
| Rate for Payer: Cash Price |
$6,880.78
|
| Rate for Payer: Cofinity Commercial |
$7,396.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,880.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,150.24
|
| Rate for Payer: Healthscope Commercial |
$7,740.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,450.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,257.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,472.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,310.83
|
| Rate for Payer: PACE Senior Care Partners |
$2,042.73
|
| Rate for Payer: PACE SWMI |
$2,150.24
|
| Rate for Payer: PHP Commercial |
$7,310.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,150.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,020.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,482.85
|
| Rate for Payer: Priority Health Medicare |
$2,150.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,245.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2,150.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,568.86
|
| Rate for Payer: UHC Core |
$7,181.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,150.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,214.75
|
| Rate for Payer: VA VA |
$2,150.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,450.74
|
|
|
HC BOSTON SCI TACHY (ICD) LEAD
|
Facility
|
IP
|
$8,600.98
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,245.74 |
| Max. Negotiated Rate |
$7,740.88 |
| Rate for Payer: Aetna Commercial |
$7,310.83
|
| Rate for Payer: BCBS Trust/PPO |
$6,646.84
|
| Rate for Payer: BCN Commercial |
$6,646.84
|
| Rate for Payer: Cash Price |
$6,880.78
|
| Rate for Payer: Cofinity Commercial |
$7,396.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,880.78
|
| Rate for Payer: Healthscope Commercial |
$7,740.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,450.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,310.83
|
| Rate for Payer: PHP Commercial |
$7,310.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,020.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,482.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,245.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,568.86
|
| Rate for Payer: UHC Core |
$7,181.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,450.74
|
|
|
HC BOTRYTIS CINEREA IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200075
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC BOTRYTIS CINEREA IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200075
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC BOTTLE A/B CDI 500
|
Facility
|
IP
|
$198.00
|
|
| Hospital Charge Code |
27000684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.76 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$153.01
|
| Rate for Payer: BCN Commercial |
$153.01
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.30
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.24
|
| Rate for Payer: UHC Core |
$165.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
|
HC BOTTLE A/B CDI 500
|
Facility
|
OP
|
$198.00
|
|
| Hospital Charge Code |
27000684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Medicare |
$51.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.88
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: BCBS MAPPO |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$153.94
|
| Rate for Payer: BCN Commercial |
$153.94
|
| Rate for Payer: BCN Medicare Advantage |
$49.50
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.30
|
| Rate for Payer: PACE Senior Care Partners |
$47.02
|
| Rate for Payer: PACE SWMI |
$49.50
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.26
|
| Rate for Payer: Priority Health Medicare |
$49.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.76
|
| Rate for Payer: Railroad Medicare Medicare |
$49.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.24
|
| Rate for Payer: UHC Core |
$165.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.50
|
| Rate for Payer: UHC Medicare Advantage |
$50.98
|
| Rate for Payer: VA VA |
$49.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
|
HC BOWL
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
27000091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.23 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: BCBS Trust/PPO |
$173.88
|
| Rate for Payer: BCN Commercial |
$173.88
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.00
|
| Rate for Payer: UHC Core |
$187.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC BOWL
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
27000091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.31
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS MAPPO |
$56.25
|
| Rate for Payer: BCBS Trust/PPO |
$174.94
|
| Rate for Payer: BCN Commercial |
$174.94
|
| Rate for Payer: BCN Medicare Advantage |
$56.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.25
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PACE Senior Care Partners |
$53.44
|
| Rate for Payer: PACE SWMI |
$56.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: PHP Medicare Advantage |
$56.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.75
|
| Rate for Payer: Priority Health Medicare |
$56.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.23
|
| Rate for Payer: Railroad Medicare Medicare |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.00
|
| Rate for Payer: UHC Core |
$187.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.25
|
| Rate for Payer: UHC Medicare Advantage |
$57.94
|
| Rate for Payer: VA VA |
$56.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
IP
|
$248.50
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.56 |
| Max. Negotiated Rate |
$223.65 |
| Rate for Payer: Aetna Commercial |
$211.22
|
| Rate for Payer: BCBS Trust/PPO |
$192.04
|
| Rate for Payer: BCN Commercial |
$192.04
|
| Rate for Payer: Cash Price |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$213.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.80
|
| Rate for Payer: Healthscope Commercial |
$223.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.22
|
| Rate for Payer: PHP Commercial |
$211.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.68
|
| Rate for Payer: UHC Core |
$207.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.38
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
OP
|
$248.50
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$223.65 |
| Rate for Payer: Aetna Commercial |
$211.22
|
| Rate for Payer: Aetna Medicare |
$64.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.66
|
| Rate for Payer: BCBS Complete |
$99.40
|
| Rate for Payer: BCBS MAPPO |
$62.12
|
| Rate for Payer: BCBS Trust/PPO |
$193.21
|
| Rate for Payer: BCN Commercial |
$193.21
|
| Rate for Payer: BCN Medicare Advantage |
$62.12
|
| Rate for Payer: Cash Price |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$213.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.12
|
| Rate for Payer: Healthscope Commercial |
$223.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.22
|
| Rate for Payer: PACE Senior Care Partners |
$59.02
|
| Rate for Payer: PACE SWMI |
$62.12
|
| Rate for Payer: PHP Commercial |
$211.22
|
| Rate for Payer: PHP Medicare Advantage |
$62.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.20
|
| Rate for Payer: Priority Health Medicare |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.56
|
| Rate for Payer: Railroad Medicare Medicare |
$62.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.68
|
| Rate for Payer: UHC Core |
$207.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.12
|
| Rate for Payer: UHC Medicare Advantage |
$63.99
|
| Rate for Payer: VA VA |
$62.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.38
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
OP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare |
$13.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.07
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.85
|
| Rate for Payer: BCBS Trust/PPO |
$39.97
|
| Rate for Payer: BCN Commercial |
$39.97
|
| Rate for Payer: BCN Medicare Advantage |
$12.85
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.85
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PACE Senior Care Partners |
$12.21
|
| Rate for Payer: PACE SWMI |
$12.85
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.73
|
| Rate for Payer: Priority Health Medicare |
$12.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.35
|
| Rate for Payer: Railroad Medicare Medicare |
$12.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Core |
$42.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.85
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: VA VA |
$12.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
IP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: BCBS Trust/PPO |
$39.73
|
| Rate for Payer: BCN Commercial |
$39.73
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Core |
$42.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
OP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare |
$13.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.07
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.85
|
| Rate for Payer: BCBS Trust/PPO |
$39.97
|
| Rate for Payer: BCN Commercial |
$39.97
|
| Rate for Payer: BCN Medicare Advantage |
$12.85
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.85
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PACE Senior Care Partners |
$12.21
|
| Rate for Payer: PACE SWMI |
$12.85
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.73
|
| Rate for Payer: Priority Health Medicare |
$12.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.35
|
| Rate for Payer: Railroad Medicare Medicare |
$12.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Core |
$42.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.85
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: VA VA |
$12.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
IP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: BCBS Trust/PPO |
$39.73
|
| Rate for Payer: BCN Commercial |
$39.73
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Core |
$42.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
OP
|
$953.04
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.35 |
| Max. Negotiated Rate |
$857.74 |
| Rate for Payer: Aetna Commercial |
$810.08
|
| Rate for Payer: Aetna Medicare |
$247.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.82
|
| Rate for Payer: BCBS Complete |
$381.22
|
| Rate for Payer: BCBS MAPPO |
$238.26
|
| Rate for Payer: BCBS Trust/PPO |
$740.99
|
| Rate for Payer: BCN Commercial |
$740.99
|
| Rate for Payer: BCN Medicare Advantage |
$238.26
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cofinity Commercial |
$819.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.26
|
| Rate for Payer: Healthscope Commercial |
$857.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.08
|
| Rate for Payer: PACE Senior Care Partners |
$226.35
|
| Rate for Payer: PACE SWMI |
$238.26
|
| Rate for Payer: PHP Commercial |
$810.08
|
| Rate for Payer: PHP Medicare Advantage |
$238.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.14
|
| Rate for Payer: Priority Health Medicare |
$238.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$581.26
|
| Rate for Payer: Railroad Medicare Medicare |
$238.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.68
|
| Rate for Payer: UHC Core |
$795.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.26
|
| Rate for Payer: UHC Medicare Advantage |
$245.41
|
| Rate for Payer: VA VA |
$238.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.78
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
IP
|
$953.04
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$581.26 |
| Max. Negotiated Rate |
$857.74 |
| Rate for Payer: Aetna Commercial |
$810.08
|
| Rate for Payer: BCBS Trust/PPO |
$736.51
|
| Rate for Payer: BCN Commercial |
$736.51
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cofinity Commercial |
$819.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.43
|
| Rate for Payer: Healthscope Commercial |
$857.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.08
|
| Rate for Payer: PHP Commercial |
$810.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$581.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.68
|
| Rate for Payer: UHC Core |
$795.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.78
|
|
|
HC BRACE AFO
|
Facility
|
OP
|
$584.45
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.81 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Aetna Commercial |
$496.78
|
| Rate for Payer: Aetna Medicare |
$151.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.64
|
| Rate for Payer: BCBS Complete |
$233.78
|
| Rate for Payer: BCBS MAPPO |
$146.11
|
| Rate for Payer: BCBS Trust/PPO |
$454.41
|
| Rate for Payer: BCN Commercial |
$454.41
|
| Rate for Payer: BCN Medicare Advantage |
$146.11
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cofinity Commercial |
$502.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.11
|
| Rate for Payer: Healthscope Commercial |
$526.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.78
|
| Rate for Payer: PACE Senior Care Partners |
$138.81
|
| Rate for Payer: PACE SWMI |
$146.11
|
| Rate for Payer: PHP Commercial |
$496.78
|
| Rate for Payer: PHP Medicare Advantage |
$146.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.47
|
| Rate for Payer: Priority Health Medicare |
$146.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.46
|
| Rate for Payer: Railroad Medicare Medicare |
$146.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.32
|
| Rate for Payer: UHC Core |
$488.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.11
|
| Rate for Payer: UHC Medicare Advantage |
$150.50
|
| Rate for Payer: VA VA |
$146.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.34
|
|
|
HC BRACE AFO
|
Facility
|
IP
|
$584.45
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.46 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Aetna Commercial |
$496.78
|
| Rate for Payer: BCBS Trust/PPO |
$451.66
|
| Rate for Payer: BCN Commercial |
$451.66
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cofinity Commercial |
$502.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.56
|
| Rate for Payer: Healthscope Commercial |
$526.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.78
|
| Rate for Payer: PHP Commercial |
$496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.32
|
| Rate for Payer: UHC Core |
$488.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.34
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,437.97
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$877.02 |
| Max. Negotiated Rate |
$1,294.17 |
| Rate for Payer: Aetna Commercial |
$1,222.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.26
|
| Rate for Payer: BCN Commercial |
$1,111.26
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cofinity Commercial |
$1,236.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,150.38
|
| Rate for Payer: Healthscope Commercial |
$1,294.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,078.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,222.27
|
| Rate for Payer: PHP Commercial |
$1,222.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,251.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,265.41
|
| Rate for Payer: UHC Core |
$1,200.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,078.48
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,437.97
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.52 |
| Max. Negotiated Rate |
$1,294.17 |
| Rate for Payer: Aetna Commercial |
$1,222.27
|
| Rate for Payer: Aetna Medicare |
$373.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$449.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$449.37
|
| Rate for Payer: BCBS Complete |
$575.19
|
| Rate for Payer: BCBS MAPPO |
$359.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.02
|
| Rate for Payer: BCN Commercial |
$1,118.02
|
| Rate for Payer: BCN Medicare Advantage |
$359.49
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cofinity Commercial |
$1,236.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,150.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.49
|
| Rate for Payer: Healthscope Commercial |
$1,294.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,078.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$377.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$413.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,222.27
|
| Rate for Payer: PACE Senior Care Partners |
$341.52
|
| Rate for Payer: PACE SWMI |
$359.49
|
| Rate for Payer: PHP Commercial |
$1,222.27
|
| Rate for Payer: PHP Medicare Advantage |
$359.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,251.03
|
| Rate for Payer: Priority Health Medicare |
$359.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.02
|
| Rate for Payer: Railroad Medicare Medicare |
$359.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,265.41
|
| Rate for Payer: UHC Core |
$1,200.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.49
|
| Rate for Payer: UHC Medicare Advantage |
$370.28
|
| Rate for Payer: VA VA |
$359.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,078.48
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$323.34
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.21 |
| Max. Negotiated Rate |
$291.01 |
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: BCBS Trust/PPO |
$249.88
|
| Rate for Payer: BCN Commercial |
$249.88
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cofinity Commercial |
$278.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.67
|
| Rate for Payer: Healthscope Commercial |
$291.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.84
|
| Rate for Payer: PHP Commercial |
$274.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.54
|
| Rate for Payer: UHC Core |
$269.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.50
|
|
