|
HC GUIDELINER CATHETER
|
Facility
|
IP
|
$1,718.55
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,048.14 |
| Max. Negotiated Rate |
$1,546.70 |
| Rate for Payer: Aetna Commercial |
$1,460.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.10
|
| Rate for Payer: BCN Commercial |
$1,328.10
|
| Rate for Payer: Cash Price |
$1,374.84
|
| Rate for Payer: Cofinity Commercial |
$1,477.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.84
|
| Rate for Payer: Healthscope Commercial |
$1,546.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,288.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,460.77
|
| Rate for Payer: PHP Commercial |
$1,460.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,202.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,495.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,048.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,512.32
|
| Rate for Payer: UHC Core |
$1,434.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,288.91
|
|
|
HC GUIDEWIRE
|
Facility
|
OP
|
$48.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$43.57 |
| Rate for Payer: Aetna Commercial |
$41.15
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.13
|
| Rate for Payer: BCBS Complete |
$19.36
|
| Rate for Payer: BCBS MAPPO |
$12.10
|
| Rate for Payer: BCBS Trust/PPO |
$37.64
|
| Rate for Payer: BCN Commercial |
$37.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.10
|
| Rate for Payer: Cash Price |
$38.73
|
| Rate for Payer: Cofinity Commercial |
$41.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$43.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.15
|
| Rate for Payer: PACE Senior Care Partners |
$11.50
|
| Rate for Payer: PACE SWMI |
$12.10
|
| Rate for Payer: PHP Commercial |
$41.15
|
| Rate for Payer: PHP Medicare Advantage |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.12
|
| Rate for Payer: Priority Health Medicare |
$12.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.53
|
| Rate for Payer: Railroad Medicare Medicare |
$12.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.60
|
| Rate for Payer: UHC Core |
$40.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.10
|
| Rate for Payer: UHC Medicare Advantage |
$12.47
|
| Rate for Payer: VA VA |
$12.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.31
|
|
|
HC GUIDEWIRE
|
Facility
|
IP
|
$48.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$43.57 |
| Rate for Payer: Aetna Commercial |
$41.15
|
| Rate for Payer: BCBS Trust/PPO |
$37.41
|
| Rate for Payer: BCN Commercial |
$37.41
|
| Rate for Payer: Cash Price |
$38.73
|
| Rate for Payer: Cofinity Commercial |
$41.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.73
|
| Rate for Payer: Healthscope Commercial |
$43.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.15
|
| Rate for Payer: PHP Commercial |
$41.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.60
|
| Rate for Payer: UHC Core |
$40.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.31
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
IP
|
$1,319.07
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$804.50 |
| Max. Negotiated Rate |
$1,187.16 |
| Rate for Payer: Aetna Commercial |
$1,121.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.38
|
| Rate for Payer: BCN Commercial |
$1,019.38
|
| Rate for Payer: Cash Price |
$1,055.26
|
| Rate for Payer: Cofinity Commercial |
$1,134.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.26
|
| Rate for Payer: Healthscope Commercial |
$1,187.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$989.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.21
|
| Rate for Payer: PHP Commercial |
$1,121.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$804.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,160.78
|
| Rate for Payer: UHC Core |
$1,101.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$989.30
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
OP
|
$1,319.07
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$313.28 |
| Max. Negotiated Rate |
$1,187.16 |
| Rate for Payer: Aetna Commercial |
$1,121.21
|
| Rate for Payer: Aetna Medicare |
$342.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$412.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$412.21
|
| Rate for Payer: BCBS Complete |
$527.63
|
| Rate for Payer: BCBS MAPPO |
$329.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.58
|
| Rate for Payer: BCN Commercial |
$1,025.58
|
| Rate for Payer: BCN Medicare Advantage |
$329.77
|
| Rate for Payer: Cash Price |
$1,055.26
|
| Rate for Payer: Cofinity Commercial |
$1,134.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.77
|
| Rate for Payer: Healthscope Commercial |
$1,187.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$989.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$346.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$379.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.21
|
| Rate for Payer: PACE Senior Care Partners |
$313.28
|
| Rate for Payer: PACE SWMI |
$329.77
|
| Rate for Payer: PHP Commercial |
$1,121.21
|
| Rate for Payer: PHP Medicare Advantage |
$329.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.59
|
| Rate for Payer: Priority Health Medicare |
$329.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$804.50
|
| Rate for Payer: Railroad Medicare Medicare |
$329.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,160.78
|
| Rate for Payer: UHC Core |
$1,101.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.77
|
| Rate for Payer: UHC Medicare Advantage |
$339.66
|
| Rate for Payer: VA VA |
$329.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$989.30
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 1
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Medicare |
$20.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$19.50
|
| Rate for Payer: BCBS Trust/PPO |
$60.64
|
| Rate for Payer: BCN Commercial |
$60.64
|
| Rate for Payer: BCN Medicare Advantage |
$19.50
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.50
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PACE Senior Care Partners |
$18.52
|
| Rate for Payer: PACE SWMI |
$19.50
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Medicare Advantage |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.86
|
| Rate for Payer: Priority Health Medicare |
$19.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.57
|
| Rate for Payer: Railroad Medicare Medicare |
$19.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.64
|
| Rate for Payer: UHC Core |
$65.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.50
|
| Rate for Payer: UHC Medicare Advantage |
$20.08
|
| Rate for Payer: VA VA |
$19.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 1
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.57 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: BCBS Trust/PPO |
$60.28
|
| Rate for Payer: BCN Commercial |
$60.28
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.64
|
| Rate for Payer: UHC Core |
$65.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.31 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$118.24
|
| 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 Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
| 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 GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| 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 |
$118.96
|
| 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 Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| 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 |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
| 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 Medicare Advantage |
$39.40
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
OP
|
$318.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$286.34 |
| Rate for Payer: Aetna Commercial |
$270.43
|
| Rate for Payer: Aetna Medicare |
$82.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.42
|
| Rate for Payer: BCBS Complete |
$127.26
|
| Rate for Payer: BCBS MAPPO |
$79.54
|
| Rate for Payer: BCBS Trust/PPO |
$247.36
|
| Rate for Payer: BCN Commercial |
$247.36
|
| Rate for Payer: BCN Medicare Advantage |
$79.54
|
| Rate for Payer: Cash Price |
$254.52
|
| Rate for Payer: Cofinity Commercial |
$273.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.54
|
| Rate for Payer: Healthscope Commercial |
$286.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.43
|
| Rate for Payer: PACE Senior Care Partners |
$75.56
|
| Rate for Payer: PACE SWMI |
$79.54
|
| Rate for Payer: PHP Commercial |
$270.43
|
| Rate for Payer: PHP Medicare Advantage |
$79.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.79
|
| Rate for Payer: Priority Health Medicare |
$79.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.04
|
| Rate for Payer: Railroad Medicare Medicare |
$79.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.97
|
| Rate for Payer: UHC Core |
$265.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.54
|
| Rate for Payer: UHC Medicare Advantage |
$81.92
|
| Rate for Payer: VA VA |
$79.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.61
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
IP
|
$318.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$286.34 |
| Rate for Payer: Aetna Commercial |
$270.43
|
| Rate for Payer: BCBS Trust/PPO |
$245.87
|
| Rate for Payer: BCN Commercial |
$245.87
|
| Rate for Payer: Cash Price |
$254.52
|
| Rate for Payer: Cofinity Commercial |
$273.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.52
|
| Rate for Payer: Healthscope Commercial |
$286.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.43
|
| Rate for Payer: PHP Commercial |
$270.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.97
|
| Rate for Payer: UHC Core |
$265.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.61
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$407.70 |
| Rate for Payer: Aetna Commercial |
$385.05
|
| Rate for Payer: BCBS Trust/PPO |
$350.08
|
| Rate for Payer: BCN Commercial |
$350.08
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cofinity Commercial |
$389.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.40
|
| Rate for Payer: Healthscope Commercial |
$407.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.05
|
| Rate for Payer: PHP Commercial |
$385.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.64
|
| Rate for Payer: UHC Core |
$378.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.75
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.59 |
| Max. Negotiated Rate |
$407.70 |
| Rate for Payer: Aetna Commercial |
$385.05
|
| Rate for Payer: Aetna Medicare |
$117.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.56
|
| Rate for Payer: BCBS Complete |
$181.20
|
| Rate for Payer: BCBS MAPPO |
$113.25
|
| Rate for Payer: BCBS Trust/PPO |
$352.21
|
| Rate for Payer: BCN Commercial |
$352.21
|
| Rate for Payer: BCN Medicare Advantage |
$113.25
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cofinity Commercial |
$389.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.25
|
| Rate for Payer: Healthscope Commercial |
$407.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.05
|
| Rate for Payer: PACE Senior Care Partners |
$107.59
|
| Rate for Payer: PACE SWMI |
$113.25
|
| Rate for Payer: PHP Commercial |
$385.05
|
| Rate for Payer: PHP Medicare Advantage |
$113.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.11
|
| Rate for Payer: Priority Health Medicare |
$113.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.28
|
| Rate for Payer: Railroad Medicare Medicare |
$113.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.64
|
| Rate for Payer: UHC Core |
$378.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.25
|
| Rate for Payer: UHC Medicare Advantage |
$116.65
|
| Rate for Payer: VA VA |
$113.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.75
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
OP
|
$658.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.39 |
| Max. Negotiated Rate |
$592.63 |
| Rate for Payer: Aetna Commercial |
$559.71
|
| Rate for Payer: Aetna Medicare |
$171.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.78
|
| Rate for Payer: BCBS Complete |
$263.39
|
| Rate for Payer: BCBS MAPPO |
$164.62
|
| Rate for Payer: BCBS Trust/PPO |
$511.97
|
| Rate for Payer: BCN Commercial |
$511.97
|
| Rate for Payer: BCN Medicare Advantage |
$164.62
|
| Rate for Payer: Cash Price |
$526.78
|
| Rate for Payer: Cofinity Commercial |
$566.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.62
|
| Rate for Payer: Healthscope Commercial |
$592.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.71
|
| Rate for Payer: PACE Senior Care Partners |
$156.39
|
| Rate for Payer: PACE SWMI |
$164.62
|
| Rate for Payer: PHP Commercial |
$559.71
|
| Rate for Payer: PHP Medicare Advantage |
$164.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.88
|
| Rate for Payer: Priority Health Medicare |
$164.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.61
|
| Rate for Payer: Railroad Medicare Medicare |
$164.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.46
|
| Rate for Payer: UHC Core |
$549.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.62
|
| Rate for Payer: UHC Medicare Advantage |
$169.56
|
| Rate for Payer: VA VA |
$164.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.86
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
IP
|
$658.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.61 |
| Max. Negotiated Rate |
$592.63 |
| Rate for Payer: Aetna Commercial |
$559.71
|
| Rate for Payer: BCBS Trust/PPO |
$508.87
|
| Rate for Payer: BCN Commercial |
$508.87
|
| Rate for Payer: Cash Price |
$526.78
|
| Rate for Payer: Cofinity Commercial |
$566.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.78
|
| Rate for Payer: Healthscope Commercial |
$592.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.71
|
| Rate for Payer: PHP Commercial |
$559.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.46
|
| Rate for Payer: UHC Core |
$549.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.86
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
OP
|
$43.03
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.45
|
| Rate for Payer: BCBS Complete |
$17.21
|
| Rate for Payer: BCBS MAPPO |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$33.46
|
| Rate for Payer: BCN Commercial |
$33.46
|
| Rate for Payer: BCN Medicare Advantage |
$10.76
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$38.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.58
|
| Rate for Payer: PACE Senior Care Partners |
$10.22
|
| Rate for Payer: PACE SWMI |
$10.76
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: PHP Medicare Advantage |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.44
|
| Rate for Payer: Priority Health Medicare |
$10.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.24
|
| Rate for Payer: Railroad Medicare Medicare |
$10.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.87
|
| Rate for Payer: UHC Core |
$35.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.76
|
| Rate for Payer: UHC Medicare Advantage |
$11.08
|
| Rate for Payer: VA VA |
$10.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.27
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
IP
|
$43.03
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$33.25
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.42
|
| Rate for Payer: Healthscope Commercial |
$38.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.58
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.87
|
| Rate for Payer: UHC Core |
$35.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.27
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
IP
|
$1,789.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,091.12 |
| Max. Negotiated Rate |
$1,610.11 |
| Rate for Payer: Aetna Commercial |
$1,520.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,382.55
|
| Rate for Payer: BCN Commercial |
$1,382.55
|
| Rate for Payer: Cash Price |
$1,431.21
|
| Rate for Payer: Cofinity Commercial |
$1,538.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.21
|
| Rate for Payer: Healthscope Commercial |
$1,610.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,520.66
|
| Rate for Payer: PHP Commercial |
$1,520.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,252.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,556.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,574.33
|
| Rate for Payer: UHC Core |
$1,493.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,341.76
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
OP
|
$1,789.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.89 |
| Max. Negotiated Rate |
$1,610.11 |
| Rate for Payer: Aetna Commercial |
$1,520.66
|
| Rate for Payer: Aetna Medicare |
$465.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$559.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$559.07
|
| Rate for Payer: BCBS Complete |
$715.60
|
| Rate for Payer: BCBS MAPPO |
$447.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,390.96
|
| Rate for Payer: BCN Commercial |
$1,390.96
|
| Rate for Payer: BCN Medicare Advantage |
$447.25
|
| Rate for Payer: Cash Price |
$1,431.21
|
| Rate for Payer: Cofinity Commercial |
$1,538.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.25
|
| Rate for Payer: Healthscope Commercial |
$1,610.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,341.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$469.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,520.66
|
| Rate for Payer: PACE Senior Care Partners |
$424.89
|
| Rate for Payer: PACE SWMI |
$447.25
|
| Rate for Payer: PHP Commercial |
$1,520.66
|
| Rate for Payer: PHP Medicare Advantage |
$447.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,252.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,556.44
|
| Rate for Payer: Priority Health Medicare |
$447.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.12
|
| Rate for Payer: Railroad Medicare Medicare |
$447.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,574.33
|
| Rate for Payer: UHC Core |
$1,493.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.25
|
| Rate for Payer: UHC Medicare Advantage |
$460.67
|
| Rate for Payer: VA VA |
$447.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,341.76
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
OP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.86 |
| Max. Negotiated Rate |
$1,780.53 |
| Rate for Payer: Aetna Commercial |
$1,681.61
|
| Rate for Payer: Aetna Medicare |
$514.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$618.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$618.24
|
| Rate for Payer: BCBS Complete |
$791.35
|
| Rate for Payer: BCBS MAPPO |
$494.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,538.18
|
| Rate for Payer: BCN Commercial |
$1,538.18
|
| Rate for Payer: BCN Medicare Advantage |
$494.59
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cofinity Commercial |
$1,701.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$494.59
|
| Rate for Payer: Healthscope Commercial |
$1,780.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$519.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,681.61
|
| Rate for Payer: PACE Senior Care Partners |
$469.86
|
| Rate for Payer: PACE SWMI |
$494.59
|
| Rate for Payer: PHP Commercial |
$1,681.61
|
| Rate for Payer: PHP Medicare Advantage |
$494.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,384.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,721.18
|
| Rate for Payer: Priority Health Medicare |
$494.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,206.61
|
| Rate for Payer: Railroad Medicare Medicare |
$494.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.97
|
| Rate for Payer: UHC Core |
$1,651.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$494.59
|
| Rate for Payer: UHC Medicare Advantage |
$509.43
|
| Rate for Payer: VA VA |
$494.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.78
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
IP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,206.61 |
| Max. Negotiated Rate |
$1,780.53 |
| Rate for Payer: Aetna Commercial |
$1,681.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,528.88
|
| Rate for Payer: BCN Commercial |
$1,528.88
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cofinity Commercial |
$1,701.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.70
|
| Rate for Payer: Healthscope Commercial |
$1,780.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,681.61
|
| Rate for Payer: PHP Commercial |
$1,681.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,384.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,721.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,206.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.97
|
| Rate for Payer: UHC Core |
$1,651.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.78
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
OP
|
$280.38
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.59 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna Commercial |
$238.32
|
| Rate for Payer: Aetna Medicare |
$72.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.62
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$70.10
|
| Rate for Payer: BCBS Trust/PPO |
$218.00
|
| Rate for Payer: BCN Commercial |
$218.00
|
| Rate for Payer: BCN Medicare Advantage |
$70.10
|
| Rate for Payer: Cash Price |
$224.30
|
| Rate for Payer: Cofinity Commercial |
$241.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.10
|
| Rate for Payer: Healthscope Commercial |
$252.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.32
|
| Rate for Payer: PACE Senior Care Partners |
$66.59
|
| Rate for Payer: PACE SWMI |
$70.10
|
| Rate for Payer: PHP Commercial |
$238.32
|
| Rate for Payer: PHP Medicare Advantage |
$70.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.93
|
| Rate for Payer: Priority Health Medicare |
$70.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.00
|
| Rate for Payer: Railroad Medicare Medicare |
$70.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.73
|
| Rate for Payer: UHC Core |
$234.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.10
|
| Rate for Payer: UHC Medicare Advantage |
$72.20
|
| Rate for Payer: VA VA |
$70.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.28
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
IP
|
$280.38
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna Commercial |
$238.32
|
| Rate for Payer: BCBS Trust/PPO |
$216.68
|
| Rate for Payer: BCN Commercial |
$216.68
|
| Rate for Payer: Cash Price |
$224.30
|
| Rate for Payer: Cofinity Commercial |
$241.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.30
|
| Rate for Payer: Healthscope Commercial |
$252.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.32
|
| Rate for Payer: PHP Commercial |
$238.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.73
|
| Rate for Payer: UHC Core |
$234.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.28
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
IP
|
$2,429.14
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,481.53 |
| Max. Negotiated Rate |
$2,186.23 |
| Rate for Payer: Aetna Commercial |
$2,064.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.24
|
| Rate for Payer: BCN Commercial |
$1,877.24
|
| Rate for Payer: Cash Price |
$1,943.31
|
| Rate for Payer: Cofinity Commercial |
$2,089.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,943.31
|
| Rate for Payer: Healthscope Commercial |
$2,186.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,821.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,064.77
|
| Rate for Payer: PHP Commercial |
$2,064.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,700.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,113.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,481.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,137.64
|
| Rate for Payer: UHC Core |
$2,028.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,821.86
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
OP
|
$2,429.14
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.92 |
| Max. Negotiated Rate |
$2,186.23 |
| Rate for Payer: Aetna Commercial |
$2,064.77
|
| Rate for Payer: Aetna Medicare |
$631.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.11
|
| Rate for Payer: BCBS Complete |
$971.66
|
| Rate for Payer: BCBS MAPPO |
$607.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.66
|
| Rate for Payer: BCN Commercial |
$1,888.66
|
| Rate for Payer: BCN Medicare Advantage |
$607.28
|
| Rate for Payer: Cash Price |
$1,943.31
|
| Rate for Payer: Cofinity Commercial |
$2,089.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,943.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.28
|
| Rate for Payer: Healthscope Commercial |
$2,186.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,821.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,064.77
|
| Rate for Payer: PACE Senior Care Partners |
$576.92
|
| Rate for Payer: PACE SWMI |
$607.28
|
| Rate for Payer: PHP Commercial |
$2,064.77
|
| Rate for Payer: PHP Medicare Advantage |
$607.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,700.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,113.35
|
| Rate for Payer: Priority Health Medicare |
$607.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,481.53
|
| Rate for Payer: Railroad Medicare Medicare |
$607.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,137.64
|
| Rate for Payer: UHC Core |
$2,028.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.28
|
| Rate for Payer: UHC Medicare Advantage |
$625.50
|
| Rate for Payer: VA VA |
$607.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,821.86
|
|
