|
HC CATHETER NOS LVL 1
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: BCBS Trust/PPO |
$51.00
|
| Rate for Payer: BCN Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: PHP Commercial |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.08
|
| Rate for Payer: UHC Core |
$55.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.50
|
|
|
HC CATHETER NOS LVL 2
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$213.46 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: BCBS Trust/PPO |
$270.48
|
| Rate for Payer: BCN Commercial |
$270.48
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.00
|
| Rate for Payer: UHC Core |
$292.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC CATHETER NOS LVL 2
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.38
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS MAPPO |
$87.50
|
| Rate for Payer: BCBS Trust/PPO |
$272.12
|
| Rate for Payer: BCN Commercial |
$272.12
|
| Rate for Payer: BCN Medicare Advantage |
$87.50
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.50
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PACE Senior Care Partners |
$83.12
|
| Rate for Payer: PACE SWMI |
$87.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: PHP Medicare Advantage |
$87.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.50
|
| Rate for Payer: Priority Health Medicare |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.46
|
| Rate for Payer: Railroad Medicare Medicare |
$87.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.00
|
| Rate for Payer: UHC Core |
$292.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.50
|
| Rate for Payer: UHC Medicare Advantage |
$90.12
|
| Rate for Payer: VA VA |
$87.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
OP
|
$11,625.00
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,760.94 |
| Max. Negotiated Rate |
$10,462.50 |
| Rate for Payer: Aetna Commercial |
$9,881.25
|
| Rate for Payer: Aetna Medicare |
$3,022.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,632.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,632.81
|
| Rate for Payer: BCBS Complete |
$4,650.00
|
| Rate for Payer: BCBS MAPPO |
$2,906.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,038.44
|
| Rate for Payer: BCN Commercial |
$9,038.44
|
| Rate for Payer: BCN Medicare Advantage |
$2,906.25
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$9,997.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,906.25
|
| Rate for Payer: Healthscope Commercial |
$10,462.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,718.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,051.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,342.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: PACE Senior Care Partners |
$2,760.94
|
| Rate for Payer: PACE SWMI |
$2,906.25
|
| Rate for Payer: PHP Commercial |
$9,881.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,906.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,113.75
|
| Rate for Payer: Priority Health Medicare |
$2,906.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,090.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,906.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,230.00
|
| Rate for Payer: UHC Core |
$9,706.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,906.25
|
| Rate for Payer: UHC Medicare Advantage |
$2,993.44
|
| Rate for Payer: VA VA |
$2,906.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,718.75
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
IP
|
$11,625.00
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,090.09 |
| Max. Negotiated Rate |
$10,462.50 |
| Rate for Payer: Aetna Commercial |
$9,881.25
|
| Rate for Payer: BCBS Trust/PPO |
$8,983.80
|
| Rate for Payer: BCN Commercial |
$8,983.80
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$9,997.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$10,462.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: PHP Commercial |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,113.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,090.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,230.00
|
| Rate for Payer: UHC Core |
$9,706.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,718.75
|
|
|
HC CATHETER SINGLE
|
Facility
|
OP
|
$186.82
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.37 |
| Max. Negotiated Rate |
$168.14 |
| Rate for Payer: Aetna Commercial |
$158.80
|
| Rate for Payer: Aetna Medicare |
$48.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.38
|
| Rate for Payer: BCBS Complete |
$74.73
|
| Rate for Payer: BCBS MAPPO |
$46.70
|
| Rate for Payer: BCBS Trust/PPO |
$145.25
|
| Rate for Payer: BCN Commercial |
$145.25
|
| Rate for Payer: BCN Medicare Advantage |
$46.70
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.70
|
| Rate for Payer: Healthscope Commercial |
$168.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.80
|
| Rate for Payer: PACE Senior Care Partners |
$44.37
|
| Rate for Payer: PACE SWMI |
$46.70
|
| Rate for Payer: PHP Commercial |
$158.80
|
| Rate for Payer: PHP Medicare Advantage |
$46.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.53
|
| Rate for Payer: Priority Health Medicare |
$46.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.94
|
| Rate for Payer: Railroad Medicare Medicare |
$46.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.40
|
| Rate for Payer: UHC Core |
$155.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.70
|
| Rate for Payer: UHC Medicare Advantage |
$48.11
|
| Rate for Payer: VA VA |
$46.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
HC CATHETER SINGLE
|
Facility
|
IP
|
$186.82
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$168.14 |
| Rate for Payer: Aetna Commercial |
$158.80
|
| Rate for Payer: BCBS Trust/PPO |
$144.37
|
| Rate for Payer: BCN Commercial |
$144.37
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$168.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.80
|
| Rate for Payer: PHP Commercial |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.40
|
| Rate for Payer: UHC Core |
$155.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
OP
|
$1,606.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.54 |
| Max. Negotiated Rate |
$1,445.85 |
| Rate for Payer: Aetna Commercial |
$1,365.52
|
| Rate for Payer: Aetna Medicare |
$417.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$502.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$502.03
|
| Rate for Payer: BCBS Complete |
$642.60
|
| Rate for Payer: BCBS MAPPO |
$401.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.05
|
| Rate for Payer: BCN Commercial |
$1,249.05
|
| Rate for Payer: BCN Medicare Advantage |
$401.62
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,381.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$1,445.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,204.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$421.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$461.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.52
|
| Rate for Payer: PACE Senior Care Partners |
$381.54
|
| Rate for Payer: PACE SWMI |
$401.62
|
| Rate for Payer: PHP Commercial |
$1,365.52
|
| Rate for Payer: PHP Medicare Advantage |
$401.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,397.66
|
| Rate for Payer: Priority Health Medicare |
$401.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$979.80
|
| Rate for Payer: Railroad Medicare Medicare |
$401.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,413.72
|
| Rate for Payer: UHC Core |
$1,341.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$401.62
|
| Rate for Payer: UHC Medicare Advantage |
$413.67
|
| Rate for Payer: VA VA |
$401.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,204.88
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
IP
|
$1,606.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$979.80 |
| Max. Negotiated Rate |
$1,445.85 |
| Rate for Payer: Aetna Commercial |
$1,365.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,241.50
|
| Rate for Payer: BCN Commercial |
$1,241.50
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,381.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,445.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,204.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.52
|
| Rate for Payer: PHP Commercial |
$1,365.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,397.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$979.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,413.72
|
| Rate for Payer: UHC Core |
$1,341.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,204.88
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
IP
|
$7,545.17
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,601.80 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Aetna Commercial |
$6,413.39
|
| Rate for Payer: BCBS Trust/PPO |
$5,830.91
|
| Rate for Payer: BCN Commercial |
$5,830.91
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$6,488.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,036.14
|
| Rate for Payer: Healthscope Commercial |
$6,790.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,658.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: PHP Commercial |
$6,413.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,564.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,601.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,639.75
|
| Rate for Payer: UHC Core |
$6,300.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,658.88
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
OP
|
$7,545.17
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.98 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Aetna Commercial |
$6,413.39
|
| Rate for Payer: Aetna Medicare |
$1,961.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,357.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,357.87
|
| Rate for Payer: BCBS Complete |
$3,018.07
|
| Rate for Payer: BCBS MAPPO |
$1,886.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,866.37
|
| Rate for Payer: BCN Commercial |
$5,866.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,886.29
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$6,488.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,036.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,886.29
|
| Rate for Payer: Healthscope Commercial |
$6,790.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,658.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,980.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,169.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: PACE Senior Care Partners |
$1,791.98
|
| Rate for Payer: PACE SWMI |
$1,886.29
|
| Rate for Payer: PHP Commercial |
$6,413.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,886.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,564.30
|
| Rate for Payer: Priority Health Medicare |
$1,886.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,601.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,886.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,639.75
|
| Rate for Payer: UHC Core |
$6,300.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,886.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,942.88
|
| Rate for Payer: VA VA |
$1,886.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,658.88
|
|
|
HC CATHETER, TRANSLUMIN NON-LASER
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,463.76 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$2,040.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,854.72
|
| Rate for Payer: BCN Commercial |
$1,854.72
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,064.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,920.00
|
| Rate for Payer: Healthscope Commercial |
$2,160.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,800.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,040.00
|
| Rate for Payer: PHP Commercial |
$2,040.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,088.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,463.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,112.00
|
| Rate for Payer: UHC Core |
$2,004.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,800.00
|
|
|
HC CATHETER, TRANSLUMIN NON-LASER
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$2,040.00
|
| Rate for Payer: Aetna Medicare |
$624.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$750.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$750.00
|
| Rate for Payer: BCBS Complete |
$960.00
|
| Rate for Payer: BCBS MAPPO |
$600.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,866.00
|
| Rate for Payer: BCN Commercial |
$1,866.00
|
| Rate for Payer: BCN Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,064.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,920.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.00
|
| Rate for Payer: Healthscope Commercial |
$2,160.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,800.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$630.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$690.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,040.00
|
| Rate for Payer: PACE Senior Care Partners |
$570.00
|
| Rate for Payer: PACE SWMI |
$600.00
|
| Rate for Payer: PHP Commercial |
$2,040.00
|
| Rate for Payer: PHP Medicare Advantage |
$600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,088.00
|
| Rate for Payer: Priority Health Medicare |
$600.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,463.76
|
| Rate for Payer: Railroad Medicare Medicare |
$600.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,112.00
|
| Rate for Payer: UHC Core |
$2,004.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.00
|
| Rate for Payer: UHC Medicare Advantage |
$618.00
|
| Rate for Payer: VA VA |
$600.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,800.00
|
|
|
HC CATHETER TRANSLUM INTRAVAS LITHOTRIPSY CORONARY
|
Facility
|
IP
|
$9,520.00
|
|
|
Service Code
|
CPT C1761
|
| Hospital Charge Code |
27200350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,806.25 |
| Max. Negotiated Rate |
$8,568.00 |
| Rate for Payer: Aetna Commercial |
$8,092.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,357.06
|
| Rate for Payer: BCN Commercial |
$7,357.06
|
| Rate for Payer: Cash Price |
$7,616.00
|
| Rate for Payer: Cofinity Commercial |
$8,187.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,616.00
|
| Rate for Payer: Healthscope Commercial |
$8,568.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,140.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,092.00
|
| Rate for Payer: PHP Commercial |
$8,092.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,664.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,282.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,806.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,377.60
|
| Rate for Payer: UHC Core |
$7,949.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,140.00
|
|
|
HC CATHETER TRANSLUM INTRAVAS LITHOTRIPSY CORONARY
|
Facility
|
OP
|
$9,520.00
|
|
|
Service Code
|
CPT C1761
|
| Hospital Charge Code |
27200350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,261.00 |
| Max. Negotiated Rate |
$8,568.00 |
| Rate for Payer: Aetna Commercial |
$8,092.00
|
| Rate for Payer: Aetna Medicare |
$2,475.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,975.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,975.00
|
| Rate for Payer: BCBS Complete |
$3,808.00
|
| Rate for Payer: BCBS MAPPO |
$2,380.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,401.80
|
| Rate for Payer: BCN Commercial |
$7,401.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,380.00
|
| Rate for Payer: Cash Price |
$7,616.00
|
| Rate for Payer: Cofinity Commercial |
$8,187.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,616.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,380.00
|
| Rate for Payer: Healthscope Commercial |
$8,568.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,140.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,499.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,737.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,092.00
|
| Rate for Payer: PACE Senior Care Partners |
$2,261.00
|
| Rate for Payer: PACE SWMI |
$2,380.00
|
| Rate for Payer: PHP Commercial |
$8,092.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,380.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,664.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,282.40
|
| Rate for Payer: Priority Health Medicare |
$2,380.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,806.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2,380.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,377.60
|
| Rate for Payer: UHC Core |
$7,949.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,380.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,451.40
|
| Rate for Payer: VA VA |
$2,380.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,140.00
|
|
|
HC CATH LAB STANDBY
|
Facility
|
OP
|
$489.91
|
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$440.92 |
| Rate for Payer: Aetna Commercial |
$416.42
|
| Rate for Payer: Aetna Medicare |
$127.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.10
|
| Rate for Payer: BCBS Complete |
$195.96
|
| Rate for Payer: BCBS MAPPO |
$122.48
|
| Rate for Payer: BCBS Trust/PPO |
$380.91
|
| Rate for Payer: BCN Commercial |
$380.91
|
| Rate for Payer: BCN Medicare Advantage |
$122.48
|
| Rate for Payer: Cash Price |
$391.93
|
| Rate for Payer: Cofinity Commercial |
$421.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.48
|
| Rate for Payer: Healthscope Commercial |
$440.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.42
|
| Rate for Payer: PACE Senior Care Partners |
$116.35
|
| Rate for Payer: PACE SWMI |
$122.48
|
| Rate for Payer: PHP Commercial |
$416.42
|
| Rate for Payer: PHP Medicare Advantage |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.22
|
| Rate for Payer: Priority Health Medicare |
$122.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.80
|
| Rate for Payer: Railroad Medicare Medicare |
$122.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.12
|
| Rate for Payer: UHC Core |
$409.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.48
|
| Rate for Payer: UHC Medicare Advantage |
$126.15
|
| Rate for Payer: VA VA |
$122.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.43
|
|
|
HC CATH LAB STANDBY
|
Facility
|
IP
|
$489.91
|
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$298.80 |
| Max. Negotiated Rate |
$440.92 |
| Rate for Payer: Aetna Commercial |
$416.42
|
| Rate for Payer: BCBS Trust/PPO |
$378.60
|
| Rate for Payer: BCN Commercial |
$378.60
|
| Rate for Payer: Cash Price |
$391.93
|
| Rate for Payer: Cofinity Commercial |
$421.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.93
|
| Rate for Payer: Healthscope Commercial |
$440.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.42
|
| Rate for Payer: PHP Commercial |
$416.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.12
|
| Rate for Payer: UHC Core |
$409.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.43
|
|
|
HC CATH PULM ART VENT 14FR
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.88
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.62
|
| Rate for Payer: BCN Commercial |
$116.62
|
| Rate for Payer: BCN Medicare Advantage |
$37.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Senior Care Partners |
$35.62
|
| Rate for Payer: PACE SWMI |
$37.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$37.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Medicare |
$37.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: Railroad Medicare Medicare |
$37.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.50
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: VA VA |
$37.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC CATH PULM ART VENT 14FR
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC CATHTER NOS LVL 7
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$612.00
|
| Rate for Payer: Aetna Medicare |
$187.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.00
|
| Rate for Payer: BCBS Complete |
$288.00
|
| Rate for Payer: BCBS MAPPO |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$559.80
|
| Rate for Payer: BCN Commercial |
$559.80
|
| Rate for Payer: BCN Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$619.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$648.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$189.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: PACE Senior Care Partners |
$171.00
|
| Rate for Payer: PACE SWMI |
$180.00
|
| Rate for Payer: PHP Commercial |
$612.00
|
| Rate for Payer: PHP Medicare Advantage |
$180.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.40
|
| Rate for Payer: Priority Health Medicare |
$180.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.13
|
| Rate for Payer: Railroad Medicare Medicare |
$180.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.60
|
| Rate for Payer: UHC Core |
$601.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.00
|
| Rate for Payer: UHC Medicare Advantage |
$185.40
|
| Rate for Payer: VA VA |
$180.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.00
|
|
|
HC CATHTER NOS LVL 7
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.13 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$612.00
|
| Rate for Payer: BCBS Trust/PPO |
$556.42
|
| Rate for Payer: BCN Commercial |
$556.42
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$619.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Healthscope Commercial |
$648.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: PHP Commercial |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.60
|
| Rate for Payer: UHC Core |
$601.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.00
|
|
|
HC CAT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200031
|
|
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 CAT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200031
|
|
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 CBC INCLUDES DIFF & PLATELETS
|
Facility
|
OP
|
$29.85
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
30500007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.33
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS MAPPO |
$7.46
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCN Commercial |
$23.21
|
| Rate for Payer: BCN Medicare Advantage |
$7.46
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$26.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.39
|
| Rate for Payer: Mclaren Medicaid |
$5.73
|
| Rate for Payer: Meridian Medicaid |
$6.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: PACE Senior Care Partners |
$7.09
|
| Rate for Payer: PACE SWMI |
$7.46
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: PHP Medicare Advantage |
$7.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.97
|
| Rate for Payer: Priority Health Medicare |
$7.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.21
|
| Rate for Payer: Railroad Medicare Medicare |
$7.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.27
|
| Rate for Payer: UHC Core |
$24.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.46
|
| Rate for Payer: UHC Medicare Advantage |
$7.69
|
| Rate for Payer: VA VA |
$7.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.39
|
|
|
HC CBC INCLUDES DIFF & PLATELETS
|
Facility
|
IP
|
$29.85
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
30500007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: BCBS Trust/PPO |
$23.07
|
| Rate for Payer: BCN Commercial |
$23.07
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$26.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.27
|
| Rate for Payer: UHC Core |
$24.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.39
|
|
