|
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 |
$781.07
|
| 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 |
$781.07
|
|
|
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 |
$781.07
|
| 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 |
$781.07
|
|
|
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 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 |
$322.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.80
|
| Rate for Payer: BCN Commercial |
$1,002.31
|
| Rate for Payer: BCN Medicare Advantage |
$322.29
|
| 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 |
$322.29
|
| 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 |
$322.29
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: PHP Medicare Advantage |
$322.29
|
| 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 |
$322.29
|
| 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 |
$322.29
|
| Rate for Payer: UHC Exchange |
$322.29
|
| Rate for Payer: UHC Medicare Advantage |
$322.29
|
| Rate for Payer: VA VA |
$322.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.86
|
|
|
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 |
$388.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.00
|
| Rate for Payer: BCN Commercial |
$1,207.72
|
| Rate for Payer: BCN Medicare Advantage |
$388.33
|
| 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 |
$388.33
|
| Rate for Payer: Healthscope Commercial |
$1,398.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,165.01
|
| 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 |
$388.33
|
| Rate for Payer: PHP Commercial |
$1,320.34
|
| Rate for Payer: PHP Medicare Advantage |
$388.33
|
| 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 |
$388.33
|
| 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 |
$388.33
|
| Rate for Payer: UHC Exchange |
$388.33
|
| Rate for Payer: UHC Medicare Advantage |
$388.33
|
| Rate for Payer: VA VA |
$388.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,165.01
|
|
|
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 |
$1,165.01
|
| 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 |
$1,165.01
|
|
|
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 |
$131.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.57
|
| 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
|
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 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 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 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 69
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,509.51 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna Commercial |
$5,897.05
|
| 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 |
$5,203.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.05
|
| Rate for Payer: Nomi Health Commercial |
$5,688.91
|
| Rate for Payer: PHP Commercial |
$5,897.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.51
|
| 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 |
$5,203.27
|
|
|
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 |
$5,897.05
|
| 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 |
$5,203.27
|
| 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 |
$5,897.05
|
| 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 |
$5,897.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,734.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.51
|
| 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 |
$5,203.27
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
OP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.42 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna Medicare |
$190.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.50
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS MAPPO |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$603.75
|
| Rate for Payer: BCN Commercial |
$571.00
|
| Rate for Payer: BCN Medicare Advantage |
$183.60
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: PACE Senior Care Partners |
$174.42
|
| Rate for Payer: PACE SWMI |
$183.60
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: PHP Medicare Advantage |
$183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health HMO/PPO |
$638.93
|
| Rate for Payer: Priority Health Medicare |
$185.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.05
|
| Rate for Payer: Railroad Medicare Medicare |
$183.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.27
|
| Rate for Payer: UHC Core |
$613.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.60
|
| Rate for Payer: UHC Exchange |
$183.60
|
| Rate for Payer: UHC Medicare Advantage |
$183.60
|
| Rate for Payer: VA VA |
$183.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.80
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: BCBS Trust/PPO |
$599.49
|
| Rate for Payer: BCN Commercial |
$567.54
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health HMO/PPO |
$638.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.27
|
| Rate for Payer: UHC Core |
$613.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.80
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
IP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.41 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: BCBS Trust/PPO |
$723.89
|
| Rate for Payer: BCN Commercial |
$685.31
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: Priority Health HMO/PPO |
$771.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.38
|
| Rate for Payer: UHC Core |
$740.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
OP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.61 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna Medicare |
$230.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.12
|
| Rate for Payer: BCBS Complete |
$354.72
|
| Rate for Payer: BCBS MAPPO |
$221.70
|
| Rate for Payer: BCBS Trust/PPO |
$729.03
|
| Rate for Payer: BCN Commercial |
$689.48
|
| Rate for Payer: BCN Medicare Advantage |
$221.70
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.70
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: PACE Senior Care Partners |
$210.61
|
| Rate for Payer: PACE SWMI |
$221.70
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: PHP Medicare Advantage |
$221.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: Priority Health HMO/PPO |
$771.51
|
| Rate for Payer: Priority Health Medicare |
$223.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.15
|
| Rate for Payer: Railroad Medicare Medicare |
$221.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.38
|
| Rate for Payer: UHC Core |
$740.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.70
|
| Rate for Payer: UHC Exchange |
$221.70
|
| Rate for Payer: UHC Medicare Advantage |
$221.70
|
| Rate for Payer: VA VA |
$221.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.55 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: BCBS Trust/PPO |
$611.03
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO |
$651.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.72
|
| Rate for Payer: UHC Core |
$625.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.78 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna Medicare |
$194.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.92
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS MAPPO |
$187.13
|
| Rate for Payer: BCBS Trust/PPO |
$615.37
|
| Rate for Payer: BCN Commercial |
$581.99
|
| Rate for Payer: BCN Medicare Advantage |
$187.13
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.13
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: PACE Senior Care Partners |
$177.78
|
| Rate for Payer: PACE SWMI |
$187.13
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: PHP Medicare Advantage |
$187.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO |
$651.23
|
| Rate for Payer: Priority Health Medicare |
$189.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.52
|
| Rate for Payer: Railroad Medicare Medicare |
$187.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.72
|
| Rate for Payer: UHC Core |
$625.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.13
|
| Rate for Payer: UHC Exchange |
$187.13
|
| Rate for Payer: UHC Medicare Advantage |
$187.13
|
| Rate for Payer: VA VA |
$187.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$457.19 |
| Max. Negotiated Rate |
$1,732.53 |
| Rate for Payer: Aetna Commercial |
$1,636.28
|
| Rate for Payer: Aetna Medicare |
$500.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.57
|
| Rate for Payer: BCBS Complete |
$770.01
|
| Rate for Payer: BCBS MAPPO |
$481.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.57
|
| Rate for Payer: BCN Commercial |
$1,496.71
|
| Rate for Payer: BCN Medicare Advantage |
$481.26
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,655.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.26
|
| Rate for Payer: Healthscope Commercial |
$1,732.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: Nomi Health Commercial |
$1,578.52
|
| Rate for Payer: PACE Senior Care Partners |
$457.19
|
| Rate for Payer: PACE SWMI |
$481.26
|
| Rate for Payer: PHP Commercial |
$1,636.28
|
| Rate for Payer: PHP Medicare Advantage |
$481.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,674.78
|
| Rate for Payer: Priority Health Medicare |
$486.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.77
|
| Rate for Payer: Railroad Medicare Medicare |
$481.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.03
|
| Rate for Payer: UHC Core |
$1,607.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.26
|
| Rate for Payer: UHC Exchange |
$481.26
|
| Rate for Payer: UHC Medicare Advantage |
$481.26
|
| Rate for Payer: VA VA |
$481.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.77
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,251.27 |
| Max. Negotiated Rate |
$1,732.53 |
| Rate for Payer: Aetna Commercial |
$1,636.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,571.40
|
| Rate for Payer: BCN Commercial |
$1,487.66
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,655.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Healthscope Commercial |
$1,732.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: Nomi Health Commercial |
$1,578.52
|
| Rate for Payer: PHP Commercial |
$1,636.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,674.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.03
|
| Rate for Payer: UHC Core |
$1,607.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.77
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: BCBS Trust/PPO |
$67.32
|
| Rate for Payer: BCN Commercial |
$63.73
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Nomi Health Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.61
|
| Rate for Payer: Priority Health HMO/PPO |
$71.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.57
|
| Rate for Payer: UHC Core |
$68.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.85
|
|
