|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
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
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
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 SOFT KNEE CLOSED T
|
Facility
|
OP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
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 SOFT KNEE CLOSED T
|
Facility
|
IP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
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 THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$411.39
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$250.91 |
| Max. Negotiated Rate |
$370.25 |
| Rate for Payer: Aetna Commercial |
$349.68
|
| Rate for Payer: BCBS Trust/PPO |
$317.92
|
| Rate for Payer: BCN Commercial |
$317.92
|
| Rate for Payer: Cash Price |
$329.11
|
| Rate for Payer: Cofinity Commercial |
$353.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.11
|
| Rate for Payer: Healthscope Commercial |
$370.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.68
|
| Rate for Payer: PHP Commercial |
$349.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.02
|
| Rate for Payer: UHC Core |
$343.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.54
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$411.39
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.71 |
| Max. Negotiated Rate |
$370.25 |
| Rate for Payer: Aetna Commercial |
$349.68
|
| Rate for Payer: Aetna Medicare |
$106.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.56
|
| Rate for Payer: BCBS Complete |
$164.56
|
| Rate for Payer: BCBS MAPPO |
$102.85
|
| Rate for Payer: BCBS Trust/PPO |
$319.86
|
| Rate for Payer: BCN Commercial |
$319.86
|
| Rate for Payer: BCN Medicare Advantage |
$102.85
|
| Rate for Payer: Cash Price |
$329.11
|
| Rate for Payer: Cofinity Commercial |
$353.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.85
|
| Rate for Payer: Healthscope Commercial |
$370.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.68
|
| Rate for Payer: PACE Senior Care Partners |
$97.71
|
| Rate for Payer: PACE SWMI |
$102.85
|
| Rate for Payer: PHP Commercial |
$349.68
|
| Rate for Payer: PHP Medicare Advantage |
$102.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.91
|
| Rate for Payer: Priority Health Medicare |
$102.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.91
|
| Rate for Payer: Railroad Medicare Medicare |
$102.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.02
|
| Rate for Payer: UHC Core |
$343.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.85
|
| Rate for Payer: UHC Medicare Advantage |
$105.93
|
| Rate for Payer: VA VA |
$102.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.54
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$528.36
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$475.52 |
| Rate for Payer: Aetna Commercial |
$449.11
|
| Rate for Payer: BCBS Trust/PPO |
$408.32
|
| Rate for Payer: BCN Commercial |
$408.32
|
| Rate for Payer: Cash Price |
$422.69
|
| Rate for Payer: Cofinity Commercial |
$454.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.69
|
| Rate for Payer: Healthscope Commercial |
$475.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.11
|
| Rate for Payer: PHP Commercial |
$449.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.96
|
| Rate for Payer: UHC Core |
$441.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.27
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$528.36
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$475.52 |
| Rate for Payer: Aetna Commercial |
$449.11
|
| Rate for Payer: Aetna Medicare |
$137.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.11
|
| Rate for Payer: BCBS Complete |
$211.34
|
| Rate for Payer: BCBS MAPPO |
$132.09
|
| Rate for Payer: BCBS Trust/PPO |
$410.80
|
| Rate for Payer: BCN Commercial |
$410.80
|
| Rate for Payer: BCN Medicare Advantage |
$132.09
|
| Rate for Payer: Cash Price |
$422.69
|
| Rate for Payer: Cofinity Commercial |
$454.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.09
|
| Rate for Payer: Healthscope Commercial |
$475.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.11
|
| Rate for Payer: PACE Senior Care Partners |
$125.49
|
| Rate for Payer: PACE SWMI |
$132.09
|
| Rate for Payer: PHP Commercial |
$449.11
|
| Rate for Payer: PHP Medicare Advantage |
$132.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.67
|
| Rate for Payer: Priority Health Medicare |
$132.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.25
|
| Rate for Payer: Railroad Medicare Medicare |
$132.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.96
|
| Rate for Payer: UHC Core |
$441.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.09
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: VA VA |
$132.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.27
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: BCBS Trust/PPO |
$52.49
|
| Rate for Payer: BCN Commercial |
$52.49
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.73
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.77
|
| Rate for Payer: UHC Core |
$56.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.94
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna Medicare |
$17.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.22
|
| Rate for Payer: BCBS Complete |
$27.17
|
| Rate for Payer: BCBS MAPPO |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$52.81
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: BCN Medicare Advantage |
$16.98
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.73
|
| Rate for Payer: PACE Senior Care Partners |
$16.13
|
| Rate for Payer: PACE SWMI |
$16.98
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: PHP Medicare Advantage |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.09
|
| Rate for Payer: Priority Health Medicare |
$16.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.77
|
| Rate for Payer: UHC Core |
$56.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.98
|
| Rate for Payer: UHC Medicare Advantage |
$17.49
|
| Rate for Payer: VA VA |
$16.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.94
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,625.00
|
|
| Hospital Charge Code |
27800128
|
|
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 EMBOLIC GLUE LVL
|
Facility
|
OP
|
$11,625.00
|
|
| Hospital Charge Code |
27800128
|
|
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 EMBOLIC GLUE LVL 1
|
Facility
|
IP
|
$5,545.11
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,381.96 |
| Max. Negotiated Rate |
$4,990.60 |
| Rate for Payer: Aetna Commercial |
$4,713.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,285.26
|
| Rate for Payer: BCN Commercial |
$4,285.26
|
| Rate for Payer: Cash Price |
$4,436.09
|
| Rate for Payer: Cofinity Commercial |
$4,768.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.09
|
| Rate for Payer: Healthscope Commercial |
$4,990.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,158.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,713.34
|
| Rate for Payer: PHP Commercial |
$4,713.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,881.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,824.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,381.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,879.70
|
| Rate for Payer: UHC Core |
$4,630.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,158.83
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
OP
|
$5,545.11
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,316.96 |
| Max. Negotiated Rate |
$4,990.60 |
| Rate for Payer: Aetna Commercial |
$4,713.34
|
| Rate for Payer: Aetna Medicare |
$1,441.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,732.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,732.85
|
| Rate for Payer: BCBS Complete |
$2,218.04
|
| Rate for Payer: BCBS MAPPO |
$1,386.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,311.32
|
| Rate for Payer: BCN Commercial |
$4,311.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,386.28
|
| Rate for Payer: Cash Price |
$4,436.09
|
| Rate for Payer: Cofinity Commercial |
$4,768.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,436.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,386.28
|
| Rate for Payer: Healthscope Commercial |
$4,990.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,158.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,455.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,594.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,713.34
|
| Rate for Payer: PACE Senior Care Partners |
$1,316.96
|
| Rate for Payer: PACE SWMI |
$1,386.28
|
| Rate for Payer: PHP Commercial |
$4,713.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,386.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,881.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,824.25
|
| Rate for Payer: Priority Health Medicare |
$1,386.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,381.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,386.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,879.70
|
| Rate for Payer: UHC Core |
$4,630.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,386.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.87
|
| Rate for Payer: VA VA |
$1,386.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,158.83
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
IP
|
$1,836.46
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,120.06 |
| Max. Negotiated Rate |
$1,652.81 |
| Rate for Payer: Aetna Commercial |
$1,560.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,419.22
|
| Rate for Payer: BCN Commercial |
$1,419.22
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cofinity Commercial |
$1,579.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,469.17
|
| Rate for Payer: Healthscope Commercial |
$1,652.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,377.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,560.99
|
| Rate for Payer: PHP Commercial |
$1,560.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,597.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,120.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,616.08
|
| Rate for Payer: UHC Core |
$1,533.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,377.34
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
OP
|
$1,836.46
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,652.81 |
| Rate for Payer: Aetna Commercial |
$1,560.99
|
| Rate for Payer: Aetna Medicare |
$477.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$573.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$573.89
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$459.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,427.85
|
| Rate for Payer: BCN Commercial |
$1,427.85
|
| Rate for Payer: BCN Medicare Advantage |
$459.12
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cash Price |
$1,469.17
|
| Rate for Payer: Cofinity Commercial |
$1,579.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,469.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.12
|
| Rate for Payer: Healthscope Commercial |
$1,652.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,377.34
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$482.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$527.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,560.99
|
| Rate for Payer: PACE Senior Care Partners |
$436.16
|
| Rate for Payer: PACE SWMI |
$459.12
|
| Rate for Payer: PHP Commercial |
$1,560.99
|
| Rate for Payer: PHP Medicare Advantage |
$459.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,597.72
|
| Rate for Payer: Priority Health Medicare |
$459.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,120.06
|
| Rate for Payer: Railroad Medicare Medicare |
$459.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,616.08
|
| Rate for Payer: UHC Core |
$1,533.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.12
|
| Rate for Payer: UHC Medicare Advantage |
$472.89
|
| Rate for Payer: VA VA |
$459.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,377.34
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
OP
|
$779.90
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$701.91 |
| Rate for Payer: Aetna Commercial |
$662.92
|
| Rate for Payer: Aetna Medicare |
$202.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.72
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$194.98
|
| Rate for Payer: BCBS Trust/PPO |
$606.37
|
| Rate for Payer: BCN Commercial |
$606.37
|
| Rate for Payer: BCN Medicare Advantage |
$194.98
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cofinity Commercial |
$670.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$623.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.98
|
| Rate for Payer: Healthscope Commercial |
$701.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$584.92
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$662.92
|
| Rate for Payer: PACE Senior Care Partners |
$185.23
|
| Rate for Payer: PACE SWMI |
$194.98
|
| Rate for Payer: PHP Commercial |
$662.92
|
| Rate for Payer: PHP Medicare Advantage |
$194.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.51
|
| Rate for Payer: Priority Health Medicare |
$194.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$475.66
|
| Rate for Payer: Railroad Medicare Medicare |
$194.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.31
|
| Rate for Payer: UHC Core |
$651.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.98
|
| Rate for Payer: UHC Medicare Advantage |
$200.82
|
| Rate for Payer: VA VA |
$194.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$584.92
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
IP
|
$779.90
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$475.66 |
| Max. Negotiated Rate |
$701.91 |
| Rate for Payer: Aetna Commercial |
$662.92
|
| Rate for Payer: BCBS Trust/PPO |
$602.71
|
| Rate for Payer: BCN Commercial |
$602.71
|
| Rate for Payer: Cash Price |
$623.92
|
| Rate for Payer: Cofinity Commercial |
$670.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$623.92
|
| Rate for Payer: Healthscope Commercial |
$701.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$584.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$662.92
|
| Rate for Payer: PHP Commercial |
$662.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$475.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.31
|
| Rate for Payer: UHC Core |
$651.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$584.92
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
IP
|
$16,128.73
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,836.91 |
| Max. Negotiated Rate |
$14,515.86 |
| Rate for Payer: Aetna Commercial |
$13,709.42
|
| Rate for Payer: BCBS Trust/PPO |
$12,464.28
|
| Rate for Payer: BCN Commercial |
$12,464.28
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cofinity Commercial |
$13,870.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,902.98
|
| Rate for Payer: Healthscope Commercial |
$14,515.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,096.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,709.42
|
| Rate for Payer: PHP Commercial |
$13,709.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,290.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,032.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,836.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,193.28
|
| Rate for Payer: UHC Core |
$13,467.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,096.55
|
|
|
HC EMBOLIZATION ARTERIAL OR VENOUS FOR HEMORRHAGE OR LYMPH EXTRAV
|
Facility
|
OP
|
$16,128.73
|
|
|
Service Code
|
CPT 37244
|
| Hospital Charge Code |
36100431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,830.57 |
| Max. Negotiated Rate |
$14,515.86 |
| Rate for Payer: Aetna Commercial |
$13,709.42
|
| Rate for Payer: Aetna Medicare |
$4,193.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,040.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,040.23
|
| Rate for Payer: BCBS Complete |
$7,577.51
|
| Rate for Payer: BCBS MAPPO |
$4,032.18
|
| Rate for Payer: BCBS Trust/PPO |
$12,540.09
|
| Rate for Payer: BCN Commercial |
$12,540.09
|
| Rate for Payer: BCN Medicare Advantage |
$4,032.18
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cash Price |
$12,902.98
|
| Rate for Payer: Cofinity Commercial |
$13,870.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,902.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,032.18
|
| Rate for Payer: Healthscope Commercial |
$14,515.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,096.55
|
| Rate for Payer: Mclaren Medicaid |
$7,216.67
|
| Rate for Payer: Meridian Medicaid |
$7,577.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,233.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,637.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,709.42
|
| Rate for Payer: PACE Senior Care Partners |
$3,830.57
|
| Rate for Payer: PACE SWMI |
$4,032.18
|
| Rate for Payer: PHP Commercial |
$13,709.42
|
| Rate for Payer: PHP Medicare Advantage |
$4,032.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,216.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,290.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,032.00
|
| Rate for Payer: Priority Health Medicare |
$4,032.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,836.91
|
| Rate for Payer: Railroad Medicare Medicare |
$4,032.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,193.28
|
| Rate for Payer: UHC Core |
$13,467.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,032.18
|
| Rate for Payer: UHC Medicare Advantage |
$4,153.15
|
| Rate for Payer: VA VA |
$4,032.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,096.55
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
OP
|
$18,025.83
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,281.13 |
| Max. Negotiated Rate |
$16,223.25 |
| Rate for Payer: Aetna Commercial |
$15,321.96
|
| Rate for Payer: Aetna Medicare |
$4,686.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,633.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,633.07
|
| Rate for Payer: BCBS Complete |
$12,078.04
|
| Rate for Payer: BCBS MAPPO |
$4,506.46
|
| Rate for Payer: BCBS Trust/PPO |
$14,015.08
|
| Rate for Payer: BCN Commercial |
$14,015.08
|
| Rate for Payer: BCN Medicare Advantage |
$4,506.46
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$15,502.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,420.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,506.46
|
| Rate for Payer: Healthscope Commercial |
$16,223.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,519.37
|
| Rate for Payer: Mclaren Medicaid |
$11,502.90
|
| Rate for Payer: Meridian Medicaid |
$12,078.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,731.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,182.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: PACE Senior Care Partners |
$4,281.13
|
| Rate for Payer: PACE SWMI |
$4,506.46
|
| Rate for Payer: PHP Commercial |
$15,321.96
|
| Rate for Payer: PHP Medicare Advantage |
$4,506.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,502.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,682.47
|
| Rate for Payer: Priority Health Medicare |
$4,506.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,993.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,506.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,862.73
|
| Rate for Payer: UHC Core |
$15,051.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,506.46
|
| Rate for Payer: UHC Medicare Advantage |
$4,641.65
|
| Rate for Payer: VA VA |
$4,506.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,519.37
|
|
|
HC EMBOLIZATION ARTERIAL OTHER THAN HEMORRHAGE
|
Facility
|
IP
|
$18,025.83
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
36100429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,993.95 |
| Max. Negotiated Rate |
$16,223.25 |
| Rate for Payer: Aetna Commercial |
$15,321.96
|
| Rate for Payer: BCBS Trust/PPO |
$13,930.36
|
| Rate for Payer: BCN Commercial |
$13,930.36
|
| Rate for Payer: Cash Price |
$14,420.66
|
| Rate for Payer: Cofinity Commercial |
$15,502.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,420.66
|
| Rate for Payer: Healthscope Commercial |
$16,223.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,519.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,321.96
|
| Rate for Payer: PHP Commercial |
$15,321.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,618.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,682.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,993.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,862.73
|
| Rate for Payer: UHC Core |
$15,051.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,519.37
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
OP
|
$7,479.11
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,776.29 |
| Max. Negotiated Rate |
$6,731.20 |
| Rate for Payer: Aetna Commercial |
$6,357.24
|
| Rate for Payer: Aetna Medicare |
$1,944.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.22
|
| Rate for Payer: BCBS Complete |
$2,991.64
|
| Rate for Payer: BCBS MAPPO |
$1,869.78
|
| Rate for Payer: BCBS Trust/PPO |
$5,815.01
|
| Rate for Payer: BCN Commercial |
$5,815.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,869.78
|
| Rate for Payer: Cash Price |
$5,983.29
|
| Rate for Payer: Cofinity Commercial |
$6,432.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,983.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,869.78
|
| Rate for Payer: Healthscope Commercial |
$6,731.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,609.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,963.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,357.24
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.29
|
| Rate for Payer: PACE SWMI |
$1,869.78
|
| Rate for Payer: PHP Commercial |
$6,357.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,869.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,235.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,506.83
|
| Rate for Payer: Priority Health Medicare |
$1,869.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,561.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,869.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,581.62
|
| Rate for Payer: UHC Core |
$6,245.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,869.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,925.87
|
| Rate for Payer: VA VA |
$1,869.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,609.33
|
|
|
HC EMBOLIZATION CNS
|
Facility
|
IP
|
$7,479.11
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
36100271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,561.51 |
| Max. Negotiated Rate |
$6,731.20 |
| Rate for Payer: Aetna Commercial |
$6,357.24
|
| Rate for Payer: BCBS Trust/PPO |
$5,779.86
|
| Rate for Payer: BCN Commercial |
$5,779.86
|
| Rate for Payer: Cash Price |
$5,983.29
|
| Rate for Payer: Cofinity Commercial |
$6,432.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,983.29
|
| Rate for Payer: Healthscope Commercial |
$6,731.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,609.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,357.24
|
| Rate for Payer: PHP Commercial |
$6,357.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,235.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,506.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,561.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,581.62
|
| Rate for Payer: UHC Core |
$6,245.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,609.33
|
|
|
HC EMBOLIZATION COILS LEVEL 8
|
Facility
|
IP
|
$1,837.50
|
|
| Hospital Charge Code |
27800104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.69 |
| Max. Negotiated Rate |
$1,653.75 |
| Rate for Payer: Aetna Commercial |
$1,561.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.02
|
| Rate for Payer: BCN Commercial |
$1,420.02
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cofinity Commercial |
$1,580.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,470.00
|
| Rate for Payer: Healthscope Commercial |
$1,653.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,378.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,561.88
|
| Rate for Payer: PHP Commercial |
$1,561.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,598.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,120.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,617.00
|
| Rate for Payer: UHC Core |
$1,534.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,378.12
|
|
