|
HC CAST SUP SHT GAUNTLET FBRGLS
|
Facility
|
IP
|
$57.22
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: BCBS Trust/PPO |
$46.71
|
| Rate for Payer: BCN Commercial |
$44.22
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health HMO/PPO |
$49.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.35
|
| Rate for Payer: UHC Core |
$47.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.92
|
|
|
HC CAST SUP SHT GAUNTLET FBRGLS
|
Facility
|
OP
|
$57.22
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.88
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS MAPPO |
$14.30
|
| Rate for Payer: BCBS Trust/PPO |
$47.04
|
| Rate for Payer: BCN Commercial |
$44.49
|
| Rate for Payer: BCN Medicare Advantage |
$14.30
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: PACE Senior Care Partners |
$13.59
|
| Rate for Payer: PACE SWMI |
$14.30
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health HMO/PPO |
$49.78
|
| Rate for Payer: Priority Health Medicare |
$14.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.34
|
| Rate for Payer: Railroad Medicare Medicare |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.35
|
| Rate for Payer: UHC Core |
$47.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.30
|
| Rate for Payer: UHC Exchange |
$14.30
|
| Rate for Payer: UHC Medicare Advantage |
$14.30
|
| Rate for Payer: VA VA |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.92
|
|
|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$31.21
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.80
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$31.21
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.48
|
| Rate for Payer: BCN Commercial |
$24.12
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
OP
|
$26.01
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
OP
|
$497.87
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$118.24 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Aetna Commercial |
$423.19
|
| Rate for Payer: Aetna Medicare |
$129.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.58
|
| Rate for Payer: BCBS Complete |
$197.55
|
| Rate for Payer: BCBS MAPPO |
$124.47
|
| Rate for Payer: BCBS Trust/PPO |
$409.30
|
| Rate for Payer: BCN Commercial |
$387.09
|
| Rate for Payer: BCN Medicare Advantage |
$124.47
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cofinity Commercial |
$428.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.47
|
| Rate for Payer: Healthscope Commercial |
$448.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.40
|
| Rate for Payer: Mclaren Medicaid |
$188.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.69
|
| Rate for Payer: Meridian Medicaid |
$197.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.19
|
| Rate for Payer: Nomi Health Commercial |
$408.25
|
| Rate for Payer: PACE Senior Care Partners |
$118.24
|
| Rate for Payer: PACE SWMI |
$124.47
|
| Rate for Payer: PHP Commercial |
$423.19
|
| Rate for Payer: PHP Medicare Advantage |
$124.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.62
|
| Rate for Payer: Priority Health HMO/PPO |
$433.15
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.57
|
| Rate for Payer: Railroad Medicare Medicare |
$124.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.13
|
| Rate for Payer: UHC Core |
$415.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.47
|
| Rate for Payer: UHC Exchange |
$124.47
|
| Rate for Payer: UHC Medicare Advantage |
$124.47
|
| Rate for Payer: UHCCP Medicaid |
$188.13
|
| Rate for Payer: VA VA |
$124.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.40
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
IP
|
$497.87
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$323.62 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Aetna Commercial |
$423.19
|
| Rate for Payer: BCBS Trust/PPO |
$406.41
|
| Rate for Payer: BCN Commercial |
$384.75
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cofinity Commercial |
$428.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.30
|
| Rate for Payer: Healthscope Commercial |
$448.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.19
|
| Rate for Payer: Nomi Health Commercial |
$408.25
|
| Rate for Payer: PHP Commercial |
$423.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.62
|
| Rate for Payer: Priority Health HMO/PPO |
$433.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.13
|
| Rate for Payer: UHC Core |
$415.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.40
|
|
|
HC CAST WEDGE
|
Facility
|
IP
|
$358.65
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$233.12 |
| Max. Negotiated Rate |
$322.78 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: BCBS Trust/PPO |
$292.77
|
| Rate for Payer: BCN Commercial |
$277.16
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cofinity Commercial |
$308.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.92
|
| Rate for Payer: Healthscope Commercial |
$322.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.85
|
| Rate for Payer: Nomi Health Commercial |
$294.09
|
| Rate for Payer: PHP Commercial |
$304.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.12
|
| Rate for Payer: Priority Health HMO/PPO |
$312.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.61
|
| Rate for Payer: UHC Core |
$299.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.99
|
|
|
HC CAST WEDGE
|
Facility
|
OP
|
$358.65
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$322.78 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna Medicare |
$93.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.08
|
| Rate for Payer: BCBS Complete |
$197.55
|
| Rate for Payer: BCBS MAPPO |
$89.66
|
| Rate for Payer: BCBS Trust/PPO |
$294.85
|
| Rate for Payer: BCN Commercial |
$278.85
|
| Rate for Payer: BCN Medicare Advantage |
$89.66
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cofinity Commercial |
$308.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.66
|
| Rate for Payer: Healthscope Commercial |
$322.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.99
|
| Rate for Payer: Mclaren Medicaid |
$188.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.15
|
| Rate for Payer: Meridian Medicaid |
$197.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.85
|
| Rate for Payer: Nomi Health Commercial |
$294.09
|
| Rate for Payer: PACE Senior Care Partners |
$85.18
|
| Rate for Payer: PACE SWMI |
$89.66
|
| Rate for Payer: PHP Commercial |
$304.85
|
| Rate for Payer: PHP Medicare Advantage |
$89.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.12
|
| Rate for Payer: Priority Health HMO/PPO |
$312.03
|
| Rate for Payer: Priority Health Medicare |
$90.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.30
|
| Rate for Payer: Railroad Medicare Medicare |
$89.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.61
|
| Rate for Payer: UHC Core |
$299.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.66
|
| Rate for Payer: UHC Exchange |
$89.66
|
| Rate for Payer: UHC Medicare Advantage |
$89.66
|
| Rate for Payer: UHCCP Medicaid |
$188.13
|
| Rate for Payer: VA VA |
$89.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.99
|
|
|
HC CAST WINDOW
|
Facility
|
OP
|
$193.91
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$174.52 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: Aetna Medicare |
$50.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.60
|
| Rate for Payer: BCBS Complete |
$117.37
|
| Rate for Payer: BCBS MAPPO |
$48.48
|
| Rate for Payer: BCBS Trust/PPO |
$159.41
|
| Rate for Payer: BCN Commercial |
$150.77
|
| Rate for Payer: BCN Medicare Advantage |
$48.48
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.48
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.43
|
| Rate for Payer: Mclaren Medicaid |
$111.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.90
|
| Rate for Payer: Meridian Medicaid |
$117.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.82
|
| Rate for Payer: Nomi Health Commercial |
$159.01
|
| Rate for Payer: PACE Senior Care Partners |
$46.05
|
| Rate for Payer: PACE SWMI |
$48.48
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: PHP Medicare Advantage |
$48.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.04
|
| Rate for Payer: Priority Health HMO/PPO |
$168.70
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.92
|
| Rate for Payer: Railroad Medicare Medicare |
$48.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.64
|
| Rate for Payer: UHC Core |
$161.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.48
|
| Rate for Payer: UHC Exchange |
$48.48
|
| Rate for Payer: UHC Medicare Advantage |
$48.48
|
| Rate for Payer: UHCCP Medicaid |
$111.78
|
| Rate for Payer: VA VA |
$48.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.43
|
|
|
HC CAST WINDOW
|
Facility
|
IP
|
$193.91
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$126.04 |
| Max. Negotiated Rate |
$174.52 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: BCBS Trust/PPO |
$158.29
|
| Rate for Payer: BCN Commercial |
$149.85
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.82
|
| Rate for Payer: Nomi Health Commercial |
$159.01
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.04
|
| Rate for Payer: Priority Health HMO/PPO |
$168.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.64
|
| Rate for Payer: UHC Core |
$161.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.43
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
OP
|
$60.34
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna Medicare |
$15.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.86
|
| Rate for Payer: BCBS Complete |
$19.17
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$49.61
|
| Rate for Payer: BCN Commercial |
$46.91
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Mclaren Medicaid |
$18.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.84
|
| Rate for Payer: Meridian Medicaid |
$19.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: Nomi Health Commercial |
$49.48
|
| Rate for Payer: PACE Senior Care Partners |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.22
|
| Rate for Payer: Priority Health HMO/PPO |
$52.50
|
| Rate for Payer: Priority Health Medicare |
$15.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.43
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.10
|
| Rate for Payer: UHC Core |
$50.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$15.08
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$18.26
|
| Rate for Payer: VA VA |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
IP
|
$60.34
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: BCBS Trust/PPO |
$49.26
|
| Rate for Payer: BCN Commercial |
$46.63
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: Nomi Health Commercial |
$49.48
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.22
|
| Rate for Payer: Priority Health HMO/PPO |
$52.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.10
|
| Rate for Payer: UHC Core |
$50.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
OP
|
$57.84
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| Rate for Payer: Aetna Medicare |
$15.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.08
|
| Rate for Payer: BCBS Complete |
$20.73
|
| Rate for Payer: BCBS MAPPO |
$14.46
|
| Rate for Payer: BCBS Trust/PPO |
$47.55
|
| Rate for Payer: BCN Commercial |
$44.97
|
| Rate for Payer: BCN Medicare Advantage |
$14.46
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$49.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$52.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.38
|
| Rate for Payer: Mclaren Medicaid |
$19.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.18
|
| Rate for Payer: Meridian Medicaid |
$20.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.16
|
| Rate for Payer: Nomi Health Commercial |
$47.43
|
| Rate for Payer: PACE Senior Care Partners |
$13.74
|
| Rate for Payer: PACE SWMI |
$14.46
|
| Rate for Payer: PHP Commercial |
$49.16
|
| Rate for Payer: PHP Medicare Advantage |
$14.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health HMO/PPO |
$50.32
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.75
|
| Rate for Payer: Railroad Medicare Medicare |
$14.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.90
|
| Rate for Payer: UHC Core |
$48.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.46
|
| Rate for Payer: UHC Exchange |
$14.46
|
| Rate for Payer: UHC Medicare Advantage |
$14.46
|
| Rate for Payer: UHCCP Medicaid |
$19.74
|
| Rate for Payer: VA VA |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.38
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
IP
|
$57.84
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| Rate for Payer: BCBS Trust/PPO |
$47.21
|
| Rate for Payer: BCN Commercial |
$44.70
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$49.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.27
|
| Rate for Payer: Healthscope Commercial |
$52.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.16
|
| Rate for Payer: Nomi Health Commercial |
$47.43
|
| Rate for Payer: PHP Commercial |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health HMO/PPO |
$50.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.90
|
| Rate for Payer: UHC Core |
$48.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.38
|
|
|
HC CATFISH IGE
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.76
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.87
|
| Rate for Payer: BCN Commercial |
$56.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO |
$63.36
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.80
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.09
|
| Rate for Payer: UHC Core |
$60.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.21
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC CATFISH IGE
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: BCBS Trust/PPO |
$59.45
|
| Rate for Payer: BCN Commercial |
$56.28
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO |
$63.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.09
|
| Rate for Payer: UHC Core |
$60.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
OP
|
$5,705.55
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,355.07 |
| Max. Negotiated Rate |
$5,135.00 |
| Rate for Payer: Aetna Commercial |
$4,849.72
|
| Rate for Payer: Aetna Medicare |
$1,483.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,782.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,782.98
|
| Rate for Payer: BCBS Complete |
$2,282.22
|
| Rate for Payer: BCBS MAPPO |
$1,426.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,690.53
|
| Rate for Payer: BCN Commercial |
$4,436.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,426.39
|
| Rate for Payer: Cash Price |
$4,564.44
|
| Rate for Payer: Cofinity Commercial |
$4,906.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,564.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,426.39
|
| Rate for Payer: Healthscope Commercial |
$5,135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,279.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,497.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,640.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,849.72
|
| Rate for Payer: Nomi Health Commercial |
$4,678.55
|
| Rate for Payer: PACE Senior Care Partners |
$1,355.07
|
| Rate for Payer: PACE SWMI |
$1,426.39
|
| Rate for Payer: PHP Commercial |
$4,849.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,426.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,708.61
|
| Rate for Payer: Priority Health HMO/PPO |
$4,963.83
|
| Rate for Payer: Priority Health Medicare |
$1,440.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,822.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,426.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,020.88
|
| Rate for Payer: UHC Core |
$4,764.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,426.39
|
| Rate for Payer: UHC Exchange |
$1,426.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,426.39
|
| Rate for Payer: VA VA |
$1,426.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,279.16
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
IP
|
$5,705.55
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,708.61 |
| Max. Negotiated Rate |
$5,135.00 |
| Rate for Payer: Aetna Commercial |
$4,849.72
|
| Rate for Payer: BCBS Trust/PPO |
$4,657.44
|
| Rate for Payer: BCN Commercial |
$4,409.25
|
| Rate for Payer: Cash Price |
$4,564.44
|
| Rate for Payer: Cofinity Commercial |
$4,906.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,564.44
|
| Rate for Payer: Healthscope Commercial |
$5,135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,279.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,849.72
|
| Rate for Payer: Nomi Health Commercial |
$4,678.55
|
| Rate for Payer: PHP Commercial |
$4,849.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,708.61
|
| Rate for Payer: Priority Health HMO/PPO |
$4,963.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,822.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,020.88
|
| Rate for Payer: UHC Core |
$4,764.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,279.16
|
|
|
HC CATHETER BALLOON DILATATION NON VASCULAR
|
Facility
|
OP
|
$3,501.78
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.67 |
| Max. Negotiated Rate |
$3,151.60 |
| Rate for Payer: Aetna Commercial |
$2,976.51
|
| Rate for Payer: Aetna Medicare |
$910.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,094.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,094.31
|
| Rate for Payer: BCBS Complete |
$1,400.71
|
| Rate for Payer: BCBS MAPPO |
$875.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,878.81
|
| Rate for Payer: BCN Commercial |
$2,722.63
|
| Rate for Payer: BCN Medicare Advantage |
$875.44
|
| Rate for Payer: Cash Price |
$2,801.42
|
| Rate for Payer: Cofinity Commercial |
$3,011.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,801.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.44
|
| Rate for Payer: Healthscope Commercial |
$3,151.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,626.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$919.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,006.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,976.51
|
| Rate for Payer: Nomi Health Commercial |
$2,871.46
|
| Rate for Payer: PACE Senior Care Partners |
$831.67
|
| Rate for Payer: PACE SWMI |
$875.44
|
| Rate for Payer: PHP Commercial |
$2,976.51
|
| Rate for Payer: PHP Medicare Advantage |
$875.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,046.55
|
| Rate for Payer: Priority Health Medicare |
$884.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,346.19
|
| Rate for Payer: Railroad Medicare Medicare |
$875.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,081.57
|
| Rate for Payer: UHC Core |
$2,923.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$875.44
|
| Rate for Payer: UHC Exchange |
$875.44
|
| Rate for Payer: UHC Medicare Advantage |
$875.44
|
| Rate for Payer: VA VA |
$875.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,626.34
|
|
|
HC CATHETER BALLOON DILATATION NON VASCULAR
|
Facility
|
IP
|
$3,501.78
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,276.16 |
| Max. Negotiated Rate |
$3,151.60 |
| Rate for Payer: Aetna Commercial |
$2,976.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,858.50
|
| Rate for Payer: BCN Commercial |
$2,706.18
|
| Rate for Payer: Cash Price |
$2,801.42
|
| Rate for Payer: Cofinity Commercial |
$3,011.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,801.42
|
| Rate for Payer: Healthscope Commercial |
$3,151.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,626.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,976.51
|
| Rate for Payer: Nomi Health Commercial |
$2,871.46
|
| Rate for Payer: PHP Commercial |
$2,976.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,046.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,346.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,081.57
|
| Rate for Payer: UHC Core |
$2,923.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,626.34
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
IP
|
$148.17
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$133.35 |
| Rate for Payer: Aetna Commercial |
$125.94
|
| Rate for Payer: BCBS Trust/PPO |
$120.95
|
| Rate for Payer: BCN Commercial |
$114.51
|
| Rate for Payer: Cash Price |
$118.54
|
| Rate for Payer: Cofinity Commercial |
$127.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.54
|
| Rate for Payer: Healthscope Commercial |
$133.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.94
|
| Rate for Payer: Nomi Health Commercial |
$121.50
|
| Rate for Payer: PHP Commercial |
$125.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.31
|
| Rate for Payer: Priority Health HMO/PPO |
$128.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.39
|
| Rate for Payer: UHC Core |
$123.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.13
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
OP
|
$148.17
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.19 |
| Max. Negotiated Rate |
$133.35 |
| Rate for Payer: Aetna Commercial |
$125.94
|
| Rate for Payer: Aetna Medicare |
$38.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.30
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS MAPPO |
$37.04
|
| Rate for Payer: BCBS Trust/PPO |
$121.81
|
| Rate for Payer: BCN Commercial |
$115.20
|
| Rate for Payer: BCN Medicare Advantage |
$37.04
|
| Rate for Payer: Cash Price |
$118.54
|
| Rate for Payer: Cofinity Commercial |
$127.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.04
|
| Rate for Payer: Healthscope Commercial |
$133.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.94
|
| Rate for Payer: Nomi Health Commercial |
$121.50
|
| Rate for Payer: PACE Senior Care Partners |
$35.19
|
| Rate for Payer: PACE SWMI |
$37.04
|
| Rate for Payer: PHP Commercial |
$125.94
|
| Rate for Payer: PHP Medicare Advantage |
$37.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.31
|
| Rate for Payer: Priority Health HMO/PPO |
$128.91
|
| Rate for Payer: Priority Health Medicare |
$37.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.39
|
| Rate for Payer: UHC Core |
$123.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.04
|
| Rate for Payer: UHC Exchange |
$37.04
|
| Rate for Payer: UHC Medicare Advantage |
$37.04
|
| Rate for Payer: VA VA |
$37.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.13
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 7
|
Facility
|
OP
|
$792.81
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.29 |
| Max. Negotiated Rate |
$713.53 |
| Rate for Payer: Aetna Commercial |
$673.89
|
| Rate for Payer: Aetna Medicare |
$206.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.75
|
| Rate for Payer: BCBS Complete |
$317.12
|
| Rate for Payer: BCBS MAPPO |
$198.20
|
| Rate for Payer: BCBS Trust/PPO |
$651.77
|
| Rate for Payer: BCN Commercial |
$616.41
|
| Rate for Payer: BCN Medicare Advantage |
$198.20
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.20
|
| Rate for Payer: Healthscope Commercial |
$713.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.89
|
| Rate for Payer: Nomi Health Commercial |
$650.10
|
| Rate for Payer: PACE Senior Care Partners |
$188.29
|
| Rate for Payer: PACE SWMI |
$198.20
|
| Rate for Payer: PHP Commercial |
$673.89
|
| Rate for Payer: PHP Medicare Advantage |
$198.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.33
|
| Rate for Payer: Priority Health HMO/PPO |
$689.74
|
| Rate for Payer: Priority Health Medicare |
$200.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.18
|
| Rate for Payer: Railroad Medicare Medicare |
$198.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.67
|
| Rate for Payer: UHC Core |
$662.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.20
|
| Rate for Payer: UHC Exchange |
$198.20
|
| Rate for Payer: UHC Medicare Advantage |
$198.20
|
| Rate for Payer: VA VA |
$198.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.61
|
|
