|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$77.49 |
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: BCBS Trust/PPO |
$66.54
|
| Rate for Payer: BCN Commercial |
$66.54
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$74.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.88
|
| Rate for Payer: Healthscope Commercial |
$77.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.77
|
| Rate for Payer: UHC Core |
$71.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.58
|
|
|
HC ELECTROPHYSIOLOGY CATHETET LEVEL 4
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,951.68 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,720.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,472.96
|
| Rate for Payer: BCN Commercial |
$2,472.96
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$2,752.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Healthscope Commercial |
$2,880.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,400.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: PHP Commercial |
$2,720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,784.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,951.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,816.00
|
| Rate for Payer: UHC Core |
$2,672.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,400.00
|
|
|
HC ELECTROPHYSIOLOGY CATHETET LEVEL 4
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,720.00
|
| Rate for Payer: Aetna Medicare |
$832.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,000.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,000.00
|
| Rate for Payer: BCBS Complete |
$1,280.00
|
| Rate for Payer: BCBS MAPPO |
$800.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,488.00
|
| Rate for Payer: BCN Commercial |
$2,488.00
|
| Rate for Payer: BCN Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$2,752.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.00
|
| Rate for Payer: Healthscope Commercial |
$2,880.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,400.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$840.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$920.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,720.00
|
| Rate for Payer: PACE Senior Care Partners |
$760.00
|
| Rate for Payer: PACE SWMI |
$800.00
|
| Rate for Payer: PHP Commercial |
$2,720.00
|
| Rate for Payer: PHP Medicare Advantage |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,240.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,784.00
|
| Rate for Payer: Priority Health Medicare |
$800.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,951.68
|
| Rate for Payer: Railroad Medicare Medicare |
$800.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,816.00
|
| Rate for Payer: UHC Core |
$2,672.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.00
|
| Rate for Payer: UHC Medicare Advantage |
$824.00
|
| Rate for Payer: VA VA |
$800.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,400.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 6
|
Facility
|
IP
|
$6,560.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,000.94 |
| Max. Negotiated Rate |
$5,904.00 |
| Rate for Payer: Aetna Commercial |
$5,576.00
|
| Rate for Payer: BCBS Trust/PPO |
$5,069.57
|
| Rate for Payer: BCN Commercial |
$5,069.57
|
| Rate for Payer: Cash Price |
$5,248.00
|
| Rate for Payer: Cofinity Commercial |
$5,641.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,248.00
|
| Rate for Payer: Healthscope Commercial |
$5,904.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,920.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,576.00
|
| Rate for Payer: PHP Commercial |
$5,576.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,592.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,707.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,000.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,772.80
|
| Rate for Payer: UHC Core |
$5,477.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,920.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS DIAG/ABLAT LEVEL 6
|
Facility
|
OP
|
$6,560.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,558.00 |
| Max. Negotiated Rate |
$5,904.00 |
| Rate for Payer: Aetna Commercial |
$5,576.00
|
| Rate for Payer: Aetna Medicare |
$1,705.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,050.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,050.00
|
| Rate for Payer: BCBS Complete |
$2,624.00
|
| Rate for Payer: BCBS MAPPO |
$1,640.00
|
| Rate for Payer: BCBS Trust/PPO |
$5,100.40
|
| Rate for Payer: BCN Commercial |
$5,100.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,640.00
|
| Rate for Payer: Cash Price |
$5,248.00
|
| Rate for Payer: Cofinity Commercial |
$5,641.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,248.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,640.00
|
| Rate for Payer: Healthscope Commercial |
$5,904.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,920.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,722.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,886.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,576.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,558.00
|
| Rate for Payer: PACE SWMI |
$1,640.00
|
| Rate for Payer: PHP Commercial |
$5,576.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,592.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,707.20
|
| Rate for Payer: Priority Health Medicare |
$1,640.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,000.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,640.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,772.80
|
| Rate for Payer: UHC Core |
$5,477.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,640.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.20
|
| Rate for Payer: VA VA |
$1,640.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,920.00
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 1
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: Aetna Medicare |
$175.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.94
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS MAPPO |
$168.75
|
| Rate for Payer: BCBS Trust/PPO |
$524.81
|
| Rate for Payer: BCN Commercial |
$524.81
|
| Rate for Payer: BCN Medicare Advantage |
$168.75
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.75
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: PACE Senior Care Partners |
$160.31
|
| Rate for Payer: PACE SWMI |
$168.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: PHP Medicare Advantage |
$168.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.25
|
| Rate for Payer: Priority Health Medicare |
$168.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.68
|
| Rate for Payer: Railroad Medicare Medicare |
$168.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.00
|
| Rate for Payer: UHC Core |
$563.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.75
|
| Rate for Payer: UHC Medicare Advantage |
$173.81
|
| Rate for Payer: VA VA |
$168.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 1
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.68 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: BCBS Trust/PPO |
$521.64
|
| Rate for Payer: BCN Commercial |
$521.64
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.00
|
| Rate for Payer: UHC Core |
$563.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 2
|
Facility
|
OP
|
$1,208.70
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
27200325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.07 |
| Max. Negotiated Rate |
$1,087.83 |
| Rate for Payer: Aetna Commercial |
$1,027.40
|
| Rate for Payer: Aetna Medicare |
$314.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$377.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$377.72
|
| Rate for Payer: BCBS Complete |
$483.48
|
| Rate for Payer: BCBS MAPPO |
$302.18
|
| Rate for Payer: BCBS Trust/PPO |
$939.76
|
| Rate for Payer: BCN Commercial |
$939.76
|
| Rate for Payer: BCN Medicare Advantage |
$302.18
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,039.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.18
|
| Rate for Payer: Healthscope Commercial |
$1,087.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$317.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: PACE Senior Care Partners |
$287.07
|
| Rate for Payer: PACE SWMI |
$302.18
|
| Rate for Payer: PHP Commercial |
$1,027.40
|
| Rate for Payer: PHP Medicare Advantage |
$302.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,051.57
|
| Rate for Payer: Priority Health Medicare |
$302.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$737.19
|
| Rate for Payer: Railroad Medicare Medicare |
$302.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.66
|
| Rate for Payer: UHC Core |
$1,009.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.18
|
| Rate for Payer: UHC Medicare Advantage |
$311.24
|
| Rate for Payer: VA VA |
$302.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.52
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 2
|
Facility
|
IP
|
$1,208.70
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
27200325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$737.19 |
| Max. Negotiated Rate |
$1,087.83 |
| Rate for Payer: Aetna Commercial |
$1,027.40
|
| Rate for Payer: BCBS Trust/PPO |
$934.08
|
| Rate for Payer: BCN Commercial |
$934.08
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,039.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,087.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: PHP Commercial |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,051.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$737.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.66
|
| Rate for Payer: UHC Core |
$1,009.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.52
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 3
|
Facility
|
IP
|
$2,815.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,716.87 |
| Max. Negotiated Rate |
$2,533.50 |
| Rate for Payer: Aetna Commercial |
$2,392.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,175.43
|
| Rate for Payer: BCN Commercial |
$2,175.43
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Cofinity Commercial |
$2,420.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,252.00
|
| Rate for Payer: Healthscope Commercial |
$2,533.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,111.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,392.75
|
| Rate for Payer: PHP Commercial |
$2,392.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,970.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,449.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,716.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,477.20
|
| Rate for Payer: UHC Core |
$2,350.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,111.25
|
|
|
HC ELECTROPHYSIOLOGY CATHS LEVEL 3
|
Facility
|
OP
|
$2,815.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27200299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$668.56 |
| Max. Negotiated Rate |
$2,533.50 |
| Rate for Payer: Aetna Commercial |
$2,392.75
|
| Rate for Payer: Aetna Medicare |
$731.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.69
|
| Rate for Payer: BCBS Complete |
$1,126.00
|
| Rate for Payer: BCBS MAPPO |
$703.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,188.66
|
| Rate for Payer: BCN Commercial |
$2,188.66
|
| Rate for Payer: BCN Medicare Advantage |
$703.75
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Cofinity Commercial |
$2,420.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,252.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.75
|
| Rate for Payer: Healthscope Commercial |
$2,533.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,111.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$738.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$809.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,392.75
|
| Rate for Payer: PACE Senior Care Partners |
$668.56
|
| Rate for Payer: PACE SWMI |
$703.75
|
| Rate for Payer: PHP Commercial |
$2,392.75
|
| Rate for Payer: PHP Medicare Advantage |
$703.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,970.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,449.05
|
| Rate for Payer: Priority Health Medicare |
$703.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,716.87
|
| Rate for Payer: Railroad Medicare Medicare |
$703.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,477.20
|
| Rate for Payer: UHC Core |
$2,350.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$703.75
|
| Rate for Payer: UHC Medicare Advantage |
$724.86
|
| Rate for Payer: VA VA |
$703.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,111.25
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
IP
|
$261.70
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$159.61 |
| Max. Negotiated Rate |
$235.53 |
| Rate for Payer: Aetna Commercial |
$222.44
|
| Rate for Payer: BCBS Trust/PPO |
$202.24
|
| Rate for Payer: BCN Commercial |
$202.24
|
| Rate for Payer: Cash Price |
$209.36
|
| Rate for Payer: Cofinity Commercial |
$225.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.36
|
| Rate for Payer: Healthscope Commercial |
$235.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.44
|
| Rate for Payer: PHP Commercial |
$222.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.30
|
| Rate for Payer: UHC Core |
$218.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.28
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
OP
|
$261.70
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$235.53 |
| Rate for Payer: Aetna Commercial |
$222.44
|
| Rate for Payer: Aetna Medicare |
$68.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.78
|
| Rate for Payer: BCBS Complete |
$104.68
|
| Rate for Payer: BCBS MAPPO |
$65.42
|
| Rate for Payer: BCBS Trust/PPO |
$203.47
|
| Rate for Payer: BCN Commercial |
$203.47
|
| Rate for Payer: BCN Medicare Advantage |
$65.42
|
| Rate for Payer: Cash Price |
$209.36
|
| Rate for Payer: Cofinity Commercial |
$225.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$235.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.44
|
| Rate for Payer: PACE Senior Care Partners |
$62.15
|
| Rate for Payer: PACE SWMI |
$65.42
|
| Rate for Payer: PHP Commercial |
$222.44
|
| Rate for Payer: PHP Medicare Advantage |
$65.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.68
|
| Rate for Payer: Priority Health Medicare |
$65.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.61
|
| Rate for Payer: Railroad Medicare Medicare |
$65.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.30
|
| Rate for Payer: UHC Core |
$218.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.42
|
| Rate for Payer: UHC Medicare Advantage |
$67.39
|
| Rate for Payer: VA VA |
$65.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.28
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
OP
|
$26,484.59
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,899.07 |
| Max. Negotiated Rate |
$23,836.13 |
| Rate for Payer: Aetna Commercial |
$22,511.90
|
| Rate for Payer: Aetna Medicare |
$6,885.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,276.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,276.43
|
| Rate for Payer: BCBS Complete |
$5,144.02
|
| Rate for Payer: BCBS MAPPO |
$6,621.15
|
| Rate for Payer: BCBS Trust/PPO |
$20,591.77
|
| Rate for Payer: BCN Commercial |
$20,591.77
|
| Rate for Payer: BCN Medicare Advantage |
$6,621.15
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cofinity Commercial |
$22,776.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,187.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,621.15
|
| Rate for Payer: Healthscope Commercial |
$23,836.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,863.44
|
| Rate for Payer: Mclaren Medicaid |
$4,899.07
|
| Rate for Payer: Meridian Medicaid |
$5,144.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,952.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,614.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,511.90
|
| Rate for Payer: PACE Senior Care Partners |
$6,290.09
|
| Rate for Payer: PACE SWMI |
$6,621.15
|
| Rate for Payer: PHP Commercial |
$22,511.90
|
| Rate for Payer: PHP Medicare Advantage |
$6,621.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,899.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,539.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,041.59
|
| Rate for Payer: Priority Health Medicare |
$6,621.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16,152.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6,621.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,306.44
|
| Rate for Payer: UHC Core |
$22,114.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,621.15
|
| Rate for Payer: UHC Medicare Advantage |
$6,819.78
|
| Rate for Payer: VA VA |
$6,621.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,863.44
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
IP
|
$26,484.59
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,152.95 |
| Max. Negotiated Rate |
$23,836.13 |
| Rate for Payer: Aetna Commercial |
$22,511.90
|
| Rate for Payer: BCBS Trust/PPO |
$20,467.29
|
| Rate for Payer: BCN Commercial |
$20,467.29
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cofinity Commercial |
$22,776.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,187.67
|
| Rate for Payer: Healthscope Commercial |
$23,836.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,863.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,511.90
|
| Rate for Payer: PHP Commercial |
$22,511.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,539.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,041.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16,152.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,306.44
|
| Rate for Payer: UHC Core |
$22,114.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,863.44
|
|
|
HC ELM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
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 ELM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
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 ELVAREX CHAP STYLE ONE LEG
|
Facility
|
IP
|
$573.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$349.53 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: BCBS Trust/PPO |
$442.88
|
| Rate for Payer: BCN Commercial |
$442.88
|
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Cofinity Commercial |
$492.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.47
|
| Rate for Payer: Healthscope Commercial |
$515.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.13
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$349.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.32
|
| Rate for Payer: UHC Core |
$478.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
OP
|
$573.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.11 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: Aetna Medicare |
$149.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.09
|
| Rate for Payer: BCBS Complete |
$229.24
|
| Rate for Payer: BCBS MAPPO |
$143.27
|
| Rate for Payer: BCBS Trust/PPO |
$445.58
|
| Rate for Payer: BCN Commercial |
$445.58
|
| Rate for Payer: BCN Medicare Advantage |
$143.27
|
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Cofinity Commercial |
$492.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.27
|
| Rate for Payer: Healthscope Commercial |
$515.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$150.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.13
|
| Rate for Payer: PACE Senior Care Partners |
$136.11
|
| Rate for Payer: PACE SWMI |
$143.27
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: PHP Medicare Advantage |
$143.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.59
|
| Rate for Payer: Priority Health Medicare |
$143.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$349.53
|
| Rate for Payer: Railroad Medicare Medicare |
$143.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.32
|
| Rate for Payer: UHC Core |
$478.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.27
|
| Rate for Payer: UHC Medicare Advantage |
$147.57
|
| Rate for Payer: VA VA |
$143.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
IP
|
$1,146.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$699.04 |
| Max. Negotiated Rate |
$1,031.54 |
| Rate for Payer: Aetna Commercial |
$974.23
|
| Rate for Payer: BCBS Trust/PPO |
$885.74
|
| Rate for Payer: BCN Commercial |
$885.74
|
| Rate for Payer: Cash Price |
$916.92
|
| Rate for Payer: Cofinity Commercial |
$985.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.92
|
| Rate for Payer: Healthscope Commercial |
$1,031.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$974.23
|
| Rate for Payer: PHP Commercial |
$974.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$997.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$699.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,008.61
|
| Rate for Payer: UHC Core |
$957.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.61
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
OP
|
$1,146.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$272.21 |
| Max. Negotiated Rate |
$1,031.54 |
| Rate for Payer: Aetna Commercial |
$974.23
|
| Rate for Payer: Aetna Medicare |
$298.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$358.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$358.17
|
| Rate for Payer: BCBS Complete |
$458.46
|
| Rate for Payer: BCBS MAPPO |
$286.54
|
| Rate for Payer: BCBS Trust/PPO |
$891.13
|
| Rate for Payer: BCN Commercial |
$891.13
|
| Rate for Payer: BCN Medicare Advantage |
$286.54
|
| Rate for Payer: Cash Price |
$916.92
|
| Rate for Payer: Cofinity Commercial |
$985.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.54
|
| Rate for Payer: Healthscope Commercial |
$1,031.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$300.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$974.23
|
| Rate for Payer: PACE Senior Care Partners |
$272.21
|
| Rate for Payer: PACE SWMI |
$286.54
|
| Rate for Payer: PHP Commercial |
$974.23
|
| Rate for Payer: PHP Medicare Advantage |
$286.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$997.15
|
| Rate for Payer: Priority Health Medicare |
$286.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$699.04
|
| Rate for Payer: Railroad Medicare Medicare |
$286.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,008.61
|
| Rate for Payer: UHC Core |
$957.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.54
|
| Rate for Payer: UHC Medicare Advantage |
$295.13
|
| Rate for Payer: VA VA |
$286.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.61
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
OP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$253.12 |
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: Aetna Medicare |
$73.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.89
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$70.31
|
| Rate for Payer: BCBS Trust/PPO |
$218.67
|
| Rate for Payer: BCN Commercial |
$218.67
|
| Rate for Payer: BCN Medicare Advantage |
$70.31
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.31
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: PACE Senior Care Partners |
$66.80
|
| Rate for Payer: PACE SWMI |
$70.31
|
| Rate for Payer: PHP Commercial |
$239.06
|
| Rate for Payer: PHP Medicare Advantage |
$70.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.69
|
| Rate for Payer: Priority Health Medicare |
$70.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.53
|
| Rate for Payer: Railroad Medicare Medicare |
$70.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.50
|
| Rate for Payer: UHC Core |
$234.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.31
|
| Rate for Payer: UHC Medicare Advantage |
$72.42
|
| Rate for Payer: VA VA |
$70.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
IP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$253.12 |
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: BCBS Trust/PPO |
$217.35
|
| Rate for Payer: BCN Commercial |
$217.35
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: PHP Commercial |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.50
|
| Rate for Payer: UHC Core |
$234.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$152.23 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: BCBS Trust/PPO |
$192.89
|
| Rate for Payer: BCN Commercial |
$192.89
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.65
|
| Rate for Payer: UHC Core |
$208.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna Medicare |
$64.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.00
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: BCBS MAPPO |
$62.40
|
| Rate for Payer: BCBS Trust/PPO |
$194.06
|
| Rate for Payer: BCN Commercial |
$194.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.40
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PACE Senior Care Partners |
$59.28
|
| Rate for Payer: PACE SWMI |
$62.40
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: PHP Medicare Advantage |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.15
|
| Rate for Payer: Priority Health Medicare |
$62.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.23
|
| Rate for Payer: Railroad Medicare Medicare |
$62.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.65
|
| Rate for Payer: UHC Core |
$208.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.40
|
| Rate for Payer: UHC Medicare Advantage |
$64.27
|
| Rate for Payer: VA VA |
$62.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
