|
HC BACK SCREEN
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
IP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: BCBS Trust/PPO |
$55.79
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$56.04
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health HMO/PPO |
$59.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.14
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
OP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna Medicare |
$17.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.36
|
| Rate for Payer: BCBS Complete |
$27.34
|
| Rate for Payer: BCBS MAPPO |
$17.08
|
| Rate for Payer: BCBS Trust/PPO |
$56.18
|
| Rate for Payer: BCN Commercial |
$53.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.08
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.08
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$56.04
|
| Rate for Payer: PACE Senior Care Partners |
$16.23
|
| Rate for Payer: PACE SWMI |
$17.08
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: PHP Medicare Advantage |
$17.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health HMO/PPO |
$59.46
|
| Rate for Payer: Priority Health Medicare |
$17.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.79
|
| Rate for Payer: Railroad Medicare Medicare |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.14
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.08
|
| Rate for Payer: UHC Exchange |
$17.08
|
| Rate for Payer: UHC Medicare Advantage |
$17.08
|
| Rate for Payer: VA VA |
$17.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
OP
|
$8.87
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Aetna Commercial |
$7.54
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Commercial |
$6.90
|
| Rate for Payer: BCN Medicare Advantage |
$2.22
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$7.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.54
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: PACE Senior Care Partners |
$2.11
|
| Rate for Payer: PACE SWMI |
$2.22
|
| Rate for Payer: PHP Commercial |
$7.54
|
| Rate for Payer: PHP Medicare Advantage |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: Priority Health HMO/PPO |
$7.72
|
| Rate for Payer: Priority Health Medicare |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.81
|
| Rate for Payer: UHC Core |
$7.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.22
|
| Rate for Payer: UHC Exchange |
$2.22
|
| Rate for Payer: UHC Medicare Advantage |
$2.22
|
| Rate for Payer: VA VA |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.65
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
IP
|
$8.87
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Aetna Commercial |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.24
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.54
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: PHP Commercial |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: Priority Health HMO/PPO |
$7.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.81
|
| Rate for Payer: UHC Core |
$7.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.65
|
|
|
HC BAG WASTE
|
Facility
|
OP
|
$64.26
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.08
|
| Rate for Payer: BCBS Complete |
$25.70
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$52.83
|
| Rate for Payer: BCN Commercial |
$49.96
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: Nomi Health Commercial |
$52.69
|
| Rate for Payer: PACE Senior Care Partners |
$15.26
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: Priority Health HMO/PPO |
$55.91
|
| Rate for Payer: Priority Health Medicare |
$16.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.05
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.55
|
| Rate for Payer: UHC Core |
$53.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.06
|
| Rate for Payer: UHC Exchange |
$16.06
|
| Rate for Payer: UHC Medicare Advantage |
$16.06
|
| Rate for Payer: VA VA |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
|
|
HC BAG WASTE
|
Facility
|
IP
|
$64.26
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: BCBS Trust/PPO |
$52.46
|
| Rate for Payer: BCN Commercial |
$49.66
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: Nomi Health Commercial |
$52.69
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: Priority Health HMO/PPO |
$55.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.55
|
| Rate for Payer: UHC Core |
$53.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
IP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.92 |
| Max. Negotiated Rate |
$937.28 |
| Rate for Payer: Aetna Commercial |
$885.21
|
| Rate for Payer: BCBS Trust/PPO |
$850.11
|
| Rate for Payer: BCN Commercial |
$804.81
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Commercial |
$895.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Healthscope Commercial |
$937.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$781.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: Nomi Health Commercial |
$853.96
|
| Rate for Payer: PHP Commercial |
$885.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.92
|
| Rate for Payer: Priority Health HMO/PPO |
$906.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$697.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.45
|
| Rate for Payer: UHC Core |
$869.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$781.06
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
OP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$937.28 |
| Rate for Payer: Aetna Commercial |
$885.21
|
| Rate for Payer: Aetna Medicare |
$270.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.44
|
| Rate for Payer: BCBS Complete |
$416.57
|
| Rate for Payer: BCBS MAPPO |
$260.36
|
| Rate for Payer: BCBS Trust/PPO |
$856.15
|
| Rate for Payer: BCN Commercial |
$809.70
|
| Rate for Payer: BCN Medicare Advantage |
$260.36
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Commercial |
$895.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.36
|
| Rate for Payer: Healthscope Commercial |
$937.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$781.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: Nomi Health Commercial |
$853.96
|
| Rate for Payer: PACE Senior Care Partners |
$247.34
|
| Rate for Payer: PACE SWMI |
$260.36
|
| Rate for Payer: PHP Commercial |
$885.21
|
| Rate for Payer: PHP Medicare Advantage |
$260.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.92
|
| Rate for Payer: Priority Health HMO/PPO |
$906.04
|
| Rate for Payer: Priority Health Medicare |
$262.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$697.75
|
| Rate for Payer: Railroad Medicare Medicare |
$260.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.45
|
| Rate for Payer: UHC Core |
$869.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.36
|
| Rate for Payer: UHC Exchange |
$260.36
|
| Rate for Payer: UHC Medicare Advantage |
$260.36
|
| Rate for Payer: VA VA |
$260.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$781.06
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
OP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.17 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna Medicare |
$335.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$402.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$402.86
|
| Rate for Payer: BCBS Complete |
$515.66
|
| Rate for Payer: BCBS MAPPO |
$322.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.80
|
| Rate for Payer: BCN Commercial |
$1,002.31
|
| Rate for Payer: BCN Medicare Advantage |
$322.28
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.28
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: Nomi Health Commercial |
$1,057.09
|
| Rate for Payer: PACE Senior Care Partners |
$306.17
|
| Rate for Payer: PACE SWMI |
$322.28
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: PHP Medicare Advantage |
$322.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,121.55
|
| Rate for Payer: Priority Health Medicare |
$325.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.72
|
| Rate for Payer: Railroad Medicare Medicare |
$322.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.44
|
| Rate for Payer: UHC Core |
$1,076.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.28
|
| Rate for Payer: UHC Exchange |
$322.28
|
| Rate for Payer: UHC Medicare Advantage |
$322.28
|
| Rate for Payer: VA VA |
$322.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.86
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
IP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.94 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,052.32
|
| Rate for Payer: BCN Commercial |
$996.25
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: Nomi Health Commercial |
$1,057.09
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,121.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.44
|
| Rate for Payer: UHC Core |
$1,076.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.86
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
IP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,009.67 |
| Max. Negotiated Rate |
$1,398.01 |
| Rate for Payer: Aetna Commercial |
$1,320.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,267.99
|
| Rate for Payer: BCN Commercial |
$1,200.42
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Commercial |
$1,335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,398.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: Nomi Health Commercial |
$1,273.74
|
| Rate for Payer: PHP Commercial |
$1,320.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,351.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,040.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,366.94
|
| Rate for Payer: UHC Core |
$1,297.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,165.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
OP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.92 |
| Max. Negotiated Rate |
$1,398.01 |
| Rate for Payer: Aetna Commercial |
$1,320.34
|
| Rate for Payer: Aetna Medicare |
$403.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$485.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$485.42
|
| Rate for Payer: BCBS Complete |
$621.34
|
| Rate for Payer: BCBS MAPPO |
$388.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.00
|
| Rate for Payer: BCN Commercial |
$1,207.72
|
| Rate for Payer: BCN Medicare Advantage |
$388.34
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Commercial |
$1,335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.34
|
| Rate for Payer: Healthscope Commercial |
$1,398.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,165.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$446.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: Nomi Health Commercial |
$1,273.74
|
| Rate for Payer: PACE Senior Care Partners |
$368.92
|
| Rate for Payer: PACE SWMI |
$388.34
|
| Rate for Payer: PHP Commercial |
$1,320.34
|
| Rate for Payer: PHP Medicare Advantage |
$388.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,351.41
|
| Rate for Payer: Priority Health Medicare |
$392.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,040.74
|
| Rate for Payer: Railroad Medicare Medicare |
$388.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,366.94
|
| Rate for Payer: UHC Core |
$1,297.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.34
|
| Rate for Payer: UHC Exchange |
$388.34
|
| Rate for Payer: UHC Medicare Advantage |
$388.34
|
| Rate for Payer: VA VA |
$388.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,165.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.40 |
| Max. Negotiated Rate |
$2,203.20 |
| Rate for Payer: Aetna Commercial |
$2,080.80
|
| Rate for Payer: Aetna Medicare |
$636.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$765.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$765.00
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$612.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,012.50
|
| Rate for Payer: BCN Commercial |
$1,903.32
|
| Rate for Payer: BCN Medicare Advantage |
$612.00
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$2,105.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$612.00
|
| Rate for Payer: Healthscope Commercial |
$2,203.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,836.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$642.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$703.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: Nomi Health Commercial |
$2,007.36
|
| Rate for Payer: PACE Senior Care Partners |
$581.40
|
| Rate for Payer: PACE SWMI |
$612.00
|
| Rate for Payer: PHP Commercial |
$2,080.80
|
| Rate for Payer: PHP Medicare Advantage |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2,129.76
|
| Rate for Payer: Priority Health Medicare |
$618.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,640.16
|
| Rate for Payer: Railroad Medicare Medicare |
$612.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,154.24
|
| Rate for Payer: UHC Core |
$2,044.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$612.00
|
| Rate for Payer: UHC Exchange |
$612.00
|
| Rate for Payer: UHC Medicare Advantage |
$612.00
|
| Rate for Payer: VA VA |
$612.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,836.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,591.20 |
| Max. Negotiated Rate |
$2,203.20 |
| Rate for Payer: Aetna Commercial |
$2,080.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,998.30
|
| Rate for Payer: BCN Commercial |
$1,891.81
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$2,105.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Healthscope Commercial |
$2,203.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,836.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: Nomi Health Commercial |
$2,007.36
|
| Rate for Payer: PHP Commercial |
$2,080.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2,129.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,640.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,154.24
|
| Rate for Payer: UHC Core |
$2,044.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,836.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna Medicare |
$109.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.58
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: BCBS MAPPO |
$105.26
|
| Rate for Payer: BCBS Trust/PPO |
$346.14
|
| Rate for Payer: BCN Commercial |
$327.36
|
| Rate for Payer: BCN Medicare Advantage |
$105.26
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.26
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: PACE Senior Care Partners |
$100.00
|
| Rate for Payer: PACE SWMI |
$105.26
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: PHP Medicare Advantage |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health HMO/PPO |
$366.30
|
| Rate for Payer: Priority Health Medicare |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.10
|
| Rate for Payer: Railroad Medicare Medicare |
$105.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.52
|
| Rate for Payer: UHC Core |
$351.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.26
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UHC Medicare Advantage |
$105.26
|
| Rate for Payer: VA VA |
$105.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: BCBS Trust/PPO |
$343.69
|
| Rate for Payer: BCN Commercial |
$325.38
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health HMO/PPO |
$366.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.52
|
| Rate for Payer: UHC Core |
$351.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
OP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$529.30 |
| Rate for Payer: Aetna Commercial |
$499.89
|
| Rate for Payer: Aetna Medicare |
$152.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.78
|
| Rate for Payer: BCBS Complete |
$235.24
|
| Rate for Payer: BCBS MAPPO |
$147.03
|
| Rate for Payer: BCBS Trust/PPO |
$483.49
|
| Rate for Payer: BCN Commercial |
$457.26
|
| Rate for Payer: BCN Medicare Advantage |
$147.03
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Commercial |
$505.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.03
|
| Rate for Payer: Healthscope Commercial |
$529.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: Nomi Health Commercial |
$482.25
|
| Rate for Payer: PACE Senior Care Partners |
$139.68
|
| Rate for Payer: PACE SWMI |
$147.03
|
| Rate for Payer: PHP Commercial |
$499.89
|
| Rate for Payer: PHP Medicare Advantage |
$147.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.27
|
| Rate for Payer: Priority Health HMO/PPO |
$511.66
|
| Rate for Payer: Priority Health Medicare |
$148.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$394.03
|
| Rate for Payer: Railroad Medicare Medicare |
$147.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.54
|
| Rate for Payer: UHC Core |
$491.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.03
|
| Rate for Payer: UHC Exchange |
$147.03
|
| Rate for Payer: UHC Medicare Advantage |
$147.03
|
| Rate for Payer: VA VA |
$147.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.08
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
IP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.27 |
| Max. Negotiated Rate |
$529.30 |
| Rate for Payer: Aetna Commercial |
$499.89
|
| Rate for Payer: BCBS Trust/PPO |
$480.07
|
| Rate for Payer: BCN Commercial |
$454.49
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Commercial |
$505.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Healthscope Commercial |
$529.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: Nomi Health Commercial |
$482.25
|
| Rate for Payer: PHP Commercial |
$499.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.27
|
| Rate for Payer: Priority Health HMO/PPO |
$511.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$394.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.54
|
| Rate for Payer: UHC Core |
$491.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.08
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
IP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.51 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Aetna Commercial |
$587.83
|
| Rate for Payer: BCBS Trust/PPO |
$564.52
|
| Rate for Payer: BCN Commercial |
$534.44
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Commercial |
$594.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Healthscope Commercial |
$622.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: Nomi Health Commercial |
$567.08
|
| Rate for Payer: PHP Commercial |
$587.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.51
|
| Rate for Payer: Priority Health HMO/PPO |
$601.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.57
|
| Rate for Payer: UHC Core |
$577.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.67
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
OP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.25 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Aetna Commercial |
$587.83
|
| Rate for Payer: Aetna Medicare |
$179.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.11
|
| Rate for Payer: BCBS Complete |
$276.62
|
| Rate for Payer: BCBS MAPPO |
$172.89
|
| Rate for Payer: BCBS Trust/PPO |
$568.53
|
| Rate for Payer: BCN Commercial |
$537.69
|
| Rate for Payer: BCN Medicare Advantage |
$172.89
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Commercial |
$594.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.89
|
| Rate for Payer: Healthscope Commercial |
$622.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: Nomi Health Commercial |
$567.08
|
| Rate for Payer: PACE Senior Care Partners |
$164.25
|
| Rate for Payer: PACE SWMI |
$172.89
|
| Rate for Payer: PHP Commercial |
$587.83
|
| Rate for Payer: PHP Medicare Advantage |
$172.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.51
|
| Rate for Payer: Priority Health HMO/PPO |
$601.66
|
| Rate for Payer: Priority Health Medicare |
$174.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.35
|
| Rate for Payer: Railroad Medicare Medicare |
$172.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.57
|
| Rate for Payer: UHC Core |
$577.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.89
|
| Rate for Payer: UHC Exchange |
$172.89
|
| Rate for Payer: UHC Medicare Advantage |
$172.89
|
| Rate for Payer: VA VA |
$172.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.67
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
OP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,647.70 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna Commercial |
$5,897.04
|
| Rate for Payer: Aetna Medicare |
$1,803.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,168.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,168.03
|
| Rate for Payer: BCBS Complete |
$2,775.08
|
| Rate for Payer: BCBS MAPPO |
$1,734.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,703.48
|
| Rate for Payer: BCN Commercial |
$5,394.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,734.42
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,734.42
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,203.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,821.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,994.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.04
|
| Rate for Payer: Nomi Health Commercial |
$5,688.91
|
| Rate for Payer: PACE Senior Care Partners |
$1,647.70
|
| Rate for Payer: PACE SWMI |
$1,734.42
|
| Rate for Payer: PHP Commercial |
$5,897.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,734.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.50
|
| Rate for Payer: Priority Health HMO/PPO |
$6,035.80
|
| Rate for Payer: Priority Health Medicare |
$1,751.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,648.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,734.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,105.18
|
| Rate for Payer: UHC Core |
$5,792.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,734.42
|
| Rate for Payer: UHC Exchange |
$1,734.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,734.42
|
| Rate for Payer: VA VA |
$1,734.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,203.28
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,509.50 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna Commercial |
$5,897.04
|
| Rate for Payer: BCBS Trust/PPO |
$5,663.24
|
| Rate for Payer: BCN Commercial |
$5,361.45
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,203.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.04
|
| Rate for Payer: Nomi Health Commercial |
$5,688.91
|
| Rate for Payer: PHP Commercial |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.50
|
| Rate for Payer: Priority Health HMO/PPO |
$6,035.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,648.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,105.18
|
| Rate for Payer: UHC Core |
$5,792.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,203.28
|
|
