|
HC LC/CABG'S W INTERVENTION
|
Facility
|
IP
|
$10,797.39
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,585.33 |
| Max. Negotiated Rate |
$9,717.65 |
| Rate for Payer: Aetna Commercial |
$9,177.78
|
| Rate for Payer: BCBS Trust/PPO |
$8,344.22
|
| Rate for Payer: BCN Commercial |
$8,344.22
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cofinity Commercial |
$9,285.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,637.91
|
| Rate for Payer: Healthscope Commercial |
$9,717.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,098.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,177.78
|
| Rate for Payer: PHP Commercial |
$9,177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,558.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,393.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,585.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,501.70
|
| Rate for Payer: UHC Core |
$9,015.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,098.04
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$10,797.39
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,137.59 |
| Max. Negotiated Rate |
$9,717.65 |
| Rate for Payer: Aetna Commercial |
$9,177.78
|
| Rate for Payer: Aetna Medicare |
$2,807.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,374.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,374.18
|
| Rate for Payer: BCBS Complete |
$2,244.47
|
| Rate for Payer: BCBS MAPPO |
$2,699.35
|
| Rate for Payer: BCBS Trust/PPO |
$8,394.97
|
| Rate for Payer: BCN Commercial |
$8,394.97
|
| Rate for Payer: BCN Medicare Advantage |
$2,699.35
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cash Price |
$8,637.91
|
| Rate for Payer: Cofinity Commercial |
$9,285.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,637.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,699.35
|
| Rate for Payer: Healthscope Commercial |
$9,717.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,098.04
|
| Rate for Payer: Mclaren Medicaid |
$2,137.59
|
| Rate for Payer: Meridian Medicaid |
$2,244.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,834.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,104.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,177.78
|
| Rate for Payer: PACE Senior Care Partners |
$2,564.38
|
| Rate for Payer: PACE SWMI |
$2,699.35
|
| Rate for Payer: PHP Commercial |
$9,177.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,699.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,137.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,558.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,393.73
|
| Rate for Payer: Priority Health Medicare |
$2,699.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,585.33
|
| Rate for Payer: Railroad Medicare Medicare |
$2,699.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,501.70
|
| Rate for Payer: UHC Core |
$9,015.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,699.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,780.33
|
| Rate for Payer: VA VA |
$2,699.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,098.04
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna Medicare |
$15.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.31
|
| Rate for Payer: BCBS Complete |
$8.14
|
| Rate for Payer: BCBS MAPPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$45.56
|
| Rate for Payer: BCN Commercial |
$45.56
|
| Rate for Payer: BCN Medicare Advantage |
$14.65
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Mclaren Medicaid |
$7.75
|
| Rate for Payer: Meridian Medicaid |
$8.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: PACE Senior Care Partners |
$13.92
|
| Rate for Payer: PACE SWMI |
$14.65
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.98
|
| Rate for Payer: Priority Health Medicare |
$14.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.74
|
| Rate for Payer: Railroad Medicare Medicare |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.57
|
| Rate for Payer: UHC Core |
$48.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.65
|
| Rate for Payer: UHC Medicare Advantage |
$15.09
|
| Rate for Payer: VA VA |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: BCBS Trust/PPO |
$45.29
|
| Rate for Payer: BCN Commercial |
$45.29
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.81
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.57
|
| Rate for Payer: UHC Core |
$48.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
HC L&D MEDICAL EMERGENCY VISIT
|
Facility
|
IP
|
$860.74
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$524.97 |
| Max. Negotiated Rate |
$774.67 |
| Rate for Payer: Aetna Commercial |
$731.63
|
| Rate for Payer: BCBS Trust/PPO |
$665.18
|
| Rate for Payer: BCN Commercial |
$665.18
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cofinity Commercial |
$740.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.59
|
| Rate for Payer: Healthscope Commercial |
$774.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.63
|
| Rate for Payer: PHP Commercial |
$731.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$757.45
|
| Rate for Payer: UHC Core |
$718.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.56
|
|
|
HC L&D MEDICAL EMERGENCY VISIT
|
Facility
|
OP
|
$860.74
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.16 |
| Max. Negotiated Rate |
$774.67 |
| Rate for Payer: Aetna Commercial |
$731.63
|
| Rate for Payer: Aetna Medicare |
$223.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.98
|
| Rate for Payer: BCBS Complete |
$196.52
|
| Rate for Payer: BCBS MAPPO |
$215.18
|
| Rate for Payer: BCBS Trust/PPO |
$669.23
|
| Rate for Payer: BCN Commercial |
$669.23
|
| Rate for Payer: BCN Medicare Advantage |
$215.18
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cash Price |
$688.59
|
| Rate for Payer: Cofinity Commercial |
$740.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.18
|
| Rate for Payer: Healthscope Commercial |
$774.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.56
|
| Rate for Payer: Mclaren Medicaid |
$187.16
|
| Rate for Payer: Meridian Medicaid |
$196.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.63
|
| Rate for Payer: PACE Senior Care Partners |
$204.43
|
| Rate for Payer: PACE SWMI |
$215.18
|
| Rate for Payer: PHP Commercial |
$731.63
|
| Rate for Payer: PHP Medicare Advantage |
$215.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.84
|
| Rate for Payer: Priority Health Medicare |
$215.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.97
|
| Rate for Payer: Railroad Medicare Medicare |
$215.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$757.45
|
| Rate for Payer: UHC Core |
$718.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.18
|
| Rate for Payer: UHC Medicare Advantage |
$221.64
|
| Rate for Payer: VA VA |
$215.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.56
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,441.05
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$878.90 |
| Max. Negotiated Rate |
$1,296.94 |
| Rate for Payer: Aetna Commercial |
$1,224.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.64
|
| Rate for Payer: BCN Commercial |
$1,113.64
|
| Rate for Payer: Cash Price |
$1,152.84
|
| Rate for Payer: Cofinity Commercial |
$1,239.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.84
|
| Rate for Payer: Healthscope Commercial |
$1,296.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.89
|
| Rate for Payer: PHP Commercial |
$1,224.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,253.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,268.12
|
| Rate for Payer: UHC Core |
$1,203.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.79
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,441.05
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$342.25 |
| Max. Negotiated Rate |
$1,296.94 |
| Rate for Payer: Aetna Commercial |
$1,224.89
|
| Rate for Payer: Aetna Medicare |
$374.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$450.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$450.33
|
| Rate for Payer: BCBS Complete |
$576.42
|
| Rate for Payer: BCBS MAPPO |
$360.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,120.42
|
| Rate for Payer: BCN Commercial |
$1,120.42
|
| Rate for Payer: BCN Medicare Advantage |
$360.26
|
| Rate for Payer: Cash Price |
$1,152.84
|
| Rate for Payer: Cofinity Commercial |
$1,239.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.26
|
| Rate for Payer: Healthscope Commercial |
$1,296.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$378.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.89
|
| Rate for Payer: PACE Senior Care Partners |
$342.25
|
| Rate for Payer: PACE SWMI |
$360.26
|
| Rate for Payer: PHP Commercial |
$1,224.89
|
| Rate for Payer: PHP Medicare Advantage |
$360.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,253.71
|
| Rate for Payer: Priority Health Medicare |
$360.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.90
|
| Rate for Payer: Railroad Medicare Medicare |
$360.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,268.12
|
| Rate for Payer: UHC Core |
$1,203.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$360.26
|
| Rate for Payer: UHC Medicare Advantage |
$371.07
|
| Rate for Payer: VA VA |
$360.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.79
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,602.41
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$855.57 |
| Max. Negotiated Rate |
$3,242.17 |
| Rate for Payer: Aetna Commercial |
$3,062.05
|
| Rate for Payer: Aetna Medicare |
$936.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,125.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,125.75
|
| Rate for Payer: BCBS Complete |
$1,440.96
|
| Rate for Payer: BCBS MAPPO |
$900.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,800.87
|
| Rate for Payer: BCN Commercial |
$2,800.87
|
| Rate for Payer: BCN Medicare Advantage |
$900.60
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$3,098.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,881.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$900.60
|
| Rate for Payer: Healthscope Commercial |
$3,242.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,701.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$945.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,035.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: PACE Senior Care Partners |
$855.57
|
| Rate for Payer: PACE SWMI |
$900.60
|
| Rate for Payer: PHP Commercial |
$3,062.05
|
| Rate for Payer: PHP Medicare Advantage |
$900.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,134.10
|
| Rate for Payer: Priority Health Medicare |
$900.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,197.11
|
| Rate for Payer: Railroad Medicare Medicare |
$900.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,170.12
|
| Rate for Payer: UHC Core |
$3,008.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$900.60
|
| Rate for Payer: UHC Medicare Advantage |
$927.62
|
| Rate for Payer: VA VA |
$900.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,701.81
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,602.41
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,197.11 |
| Max. Negotiated Rate |
$3,242.17 |
| Rate for Payer: Aetna Commercial |
$3,062.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,783.94
|
| Rate for Payer: BCN Commercial |
$2,783.94
|
| Rate for Payer: Cash Price |
$2,881.93
|
| Rate for Payer: Cofinity Commercial |
$3,098.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,881.93
|
| Rate for Payer: Healthscope Commercial |
$3,242.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,701.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,062.05
|
| Rate for Payer: PHP Commercial |
$3,062.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,134.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,197.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,170.12
|
| Rate for Payer: UHC Core |
$3,008.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,701.81
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,881.83
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,757.63 |
| Max. Negotiated Rate |
$2,593.65 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,227.08
|
| Rate for Payer: BCN Commercial |
$2,227.08
|
| Rate for Payer: Cash Price |
$2,305.46
|
| Rate for Payer: Cofinity Commercial |
$2,478.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,305.46
|
| Rate for Payer: Healthscope Commercial |
$2,593.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,161.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,449.56
|
| Rate for Payer: PHP Commercial |
$2,449.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,507.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,757.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,536.01
|
| Rate for Payer: UHC Core |
$2,406.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,161.37
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,881.83
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$684.43 |
| Max. Negotiated Rate |
$2,593.65 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Aetna Medicare |
$749.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$900.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$900.57
|
| Rate for Payer: BCBS Complete |
$1,152.73
|
| Rate for Payer: BCBS MAPPO |
$720.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,240.62
|
| Rate for Payer: BCN Commercial |
$2,240.62
|
| Rate for Payer: BCN Medicare Advantage |
$720.46
|
| Rate for Payer: Cash Price |
$2,305.46
|
| Rate for Payer: Cofinity Commercial |
$2,478.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,305.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.46
|
| Rate for Payer: Healthscope Commercial |
$2,593.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,161.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$756.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$828.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,449.56
|
| Rate for Payer: PACE Senior Care Partners |
$684.43
|
| Rate for Payer: PACE SWMI |
$720.46
|
| Rate for Payer: PHP Commercial |
$2,449.56
|
| Rate for Payer: PHP Medicare Advantage |
$720.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,507.19
|
| Rate for Payer: Priority Health Medicare |
$720.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,757.63
|
| Rate for Payer: Railroad Medicare Medicare |
$720.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,536.01
|
| Rate for Payer: UHC Core |
$2,406.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$720.46
|
| Rate for Payer: UHC Medicare Advantage |
$742.07
|
| Rate for Payer: VA VA |
$720.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,161.37
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,952.95 |
| Max. Negotiated Rate |
$2,881.88 |
| Rate for Payer: Aetna Commercial |
$2,721.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,474.58
|
| Rate for Payer: BCN Commercial |
$2,474.58
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$2,753.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Healthscope Commercial |
$2,881.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,401.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PHP Commercial |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,785.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,952.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,817.84
|
| Rate for Payer: UHC Core |
$2,673.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,401.57
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$760.50 |
| Max. Negotiated Rate |
$2,881.88 |
| Rate for Payer: Aetna Commercial |
$2,721.78
|
| Rate for Payer: Aetna Medicare |
$832.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,000.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,000.65
|
| Rate for Payer: BCBS Complete |
$1,280.84
|
| Rate for Payer: BCBS MAPPO |
$800.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,489.62
|
| Rate for Payer: BCN Commercial |
$2,489.62
|
| Rate for Payer: BCN Medicare Advantage |
$800.52
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$2,753.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.52
|
| Rate for Payer: Healthscope Commercial |
$2,881.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,401.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$840.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$920.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PACE Senior Care Partners |
$760.50
|
| Rate for Payer: PACE SWMI |
$800.52
|
| Rate for Payer: PHP Commercial |
$2,721.78
|
| Rate for Payer: PHP Medicare Advantage |
$800.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,785.82
|
| Rate for Payer: Priority Health Medicare |
$800.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,952.95
|
| Rate for Payer: Railroad Medicare Medicare |
$800.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,817.84
|
| Rate for Payer: UHC Core |
$2,673.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.52
|
| Rate for Payer: UHC Medicare Advantage |
$824.54
|
| Rate for Payer: VA VA |
$800.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,401.57
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
IP
|
$1,188.59
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$724.92 |
| Max. Negotiated Rate |
$1,069.73 |
| Rate for Payer: Aetna Commercial |
$1,010.30
|
| Rate for Payer: BCBS Trust/PPO |
$918.54
|
| Rate for Payer: BCN Commercial |
$918.54
|
| Rate for Payer: Cash Price |
$950.87
|
| Rate for Payer: Cofinity Commercial |
$1,022.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.87
|
| Rate for Payer: Healthscope Commercial |
$1,069.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.30
|
| Rate for Payer: PHP Commercial |
$1,010.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,045.96
|
| Rate for Payer: UHC Core |
$992.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.44
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
OP
|
$1,188.59
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$282.29 |
| Max. Negotiated Rate |
$1,069.73 |
| Rate for Payer: Aetna Commercial |
$1,010.30
|
| Rate for Payer: Aetna Medicare |
$309.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.43
|
| Rate for Payer: BCBS Complete |
$475.44
|
| Rate for Payer: BCBS MAPPO |
$297.15
|
| Rate for Payer: BCBS Trust/PPO |
$924.13
|
| Rate for Payer: BCN Commercial |
$924.13
|
| Rate for Payer: BCN Medicare Advantage |
$297.15
|
| Rate for Payer: Cash Price |
$950.87
|
| Rate for Payer: Cofinity Commercial |
$1,022.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.15
|
| Rate for Payer: Healthscope Commercial |
$1,069.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.30
|
| Rate for Payer: PACE Senior Care Partners |
$282.29
|
| Rate for Payer: PACE SWMI |
$297.15
|
| Rate for Payer: PHP Commercial |
$1,010.30
|
| Rate for Payer: PHP Medicare Advantage |
$297.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.07
|
| Rate for Payer: Priority Health Medicare |
$297.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.92
|
| Rate for Payer: Railroad Medicare Medicare |
$297.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,045.96
|
| Rate for Payer: UHC Core |
$992.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.15
|
| Rate for Payer: UHC Medicare Advantage |
$306.06
|
| Rate for Payer: VA VA |
$297.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.44
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
IP
|
$1,427.13
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$870.41 |
| Max. Negotiated Rate |
$1,284.42 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.89
|
| Rate for Payer: BCN Commercial |
$1,102.89
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cofinity Commercial |
$1,227.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,141.70
|
| Rate for Payer: Healthscope Commercial |
$1,284.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,213.06
|
| Rate for Payer: PHP Commercial |
$1,213.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,241.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$870.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,255.87
|
| Rate for Payer: UHC Core |
$1,191.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.35
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
OP
|
$1,427.13
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$338.94 |
| Max. Negotiated Rate |
$1,284.42 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Medicare |
$371.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$445.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$445.98
|
| Rate for Payer: BCBS Complete |
$570.85
|
| Rate for Payer: BCBS MAPPO |
$356.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.59
|
| Rate for Payer: BCN Commercial |
$1,109.59
|
| Rate for Payer: BCN Medicare Advantage |
$356.78
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cofinity Commercial |
$1,227.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,141.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.78
|
| Rate for Payer: Healthscope Commercial |
$1,284.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$374.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,213.06
|
| Rate for Payer: PACE Senior Care Partners |
$338.94
|
| Rate for Payer: PACE SWMI |
$356.78
|
| Rate for Payer: PHP Commercial |
$1,213.06
|
| Rate for Payer: PHP Medicare Advantage |
$356.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,241.60
|
| Rate for Payer: Priority Health Medicare |
$356.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$870.41
|
| Rate for Payer: Railroad Medicare Medicare |
$356.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,255.87
|
| Rate for Payer: UHC Core |
$1,191.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$356.78
|
| Rate for Payer: UHC Medicare Advantage |
$367.49
|
| Rate for Payer: VA VA |
$356.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.35
|
|
|
HC LEAD
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.00
|
| Rate for Payer: BCN Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.72
|
| Rate for Payer: UHC Core |
$36.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.00
|
|
|
HC LEAD
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.75
|
| Rate for Payer: BCBS Complete |
$9.38
|
| Rate for Payer: BCBS MAPPO |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$34.21
|
| Rate for Payer: BCN Commercial |
$34.21
|
| Rate for Payer: BCN Medicare Advantage |
$11.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.00
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Meridian Medicaid |
$9.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: PACE Senior Care Partners |
$10.45
|
| Rate for Payer: PACE SWMI |
$11.00
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: PHP Medicare Advantage |
$11.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.28
|
| Rate for Payer: Priority Health Medicare |
$11.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.72
|
| Rate for Payer: UHC Core |
$36.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.00
|
| Rate for Payer: UHC Medicare Advantage |
$11.33
|
| Rate for Payer: VA VA |
$11.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.00
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
IP
|
$14,450.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,813.06 |
| Max. Negotiated Rate |
$13,005.00 |
| Rate for Payer: Aetna Commercial |
$12,282.50
|
| Rate for Payer: BCBS Trust/PPO |
$11,166.96
|
| Rate for Payer: BCN Commercial |
$11,166.96
|
| Rate for Payer: Cash Price |
$11,560.00
|
| Rate for Payer: Cofinity Commercial |
$12,427.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,560.00
|
| Rate for Payer: Healthscope Commercial |
$13,005.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,837.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,282.50
|
| Rate for Payer: PHP Commercial |
$12,282.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,115.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,571.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,813.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,716.00
|
| Rate for Payer: UHC Core |
$12,065.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,837.50
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
OP
|
$14,450.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.88 |
| Max. Negotiated Rate |
$13,005.00 |
| Rate for Payer: Aetna Commercial |
$12,282.50
|
| Rate for Payer: Aetna Medicare |
$3,757.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,515.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,515.62
|
| Rate for Payer: BCBS Complete |
$5,780.00
|
| Rate for Payer: BCBS MAPPO |
$3,612.50
|
| Rate for Payer: BCBS Trust/PPO |
$11,234.88
|
| Rate for Payer: BCN Commercial |
$11,234.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,612.50
|
| Rate for Payer: Cash Price |
$11,560.00
|
| Rate for Payer: Cofinity Commercial |
$12,427.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,612.50
|
| Rate for Payer: Healthscope Commercial |
$13,005.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,837.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,793.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,154.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,282.50
|
| Rate for Payer: PACE Senior Care Partners |
$3,431.88
|
| Rate for Payer: PACE SWMI |
$3,612.50
|
| Rate for Payer: PHP Commercial |
$12,282.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,612.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,115.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,571.50
|
| Rate for Payer: Priority Health Medicare |
$3,612.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,813.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,612.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,716.00
|
| Rate for Payer: UHC Core |
$12,065.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,720.88
|
| Rate for Payer: VA VA |
$3,612.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,837.50
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.20 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna Commercial |
$1,734.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,576.51
|
| Rate for Payer: BCN Commercial |
$1,576.51
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Commercial |
$1,836.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,530.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.00
|
| Rate for Payer: PHP Commercial |
$1,734.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,774.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,244.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,795.20
|
| Rate for Payer: UHC Core |
$1,703.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,530.00
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.50 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna Commercial |
$1,734.00
|
| Rate for Payer: Aetna Medicare |
$530.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$637.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$637.50
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: BCBS MAPPO |
$510.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.10
|
| Rate for Payer: BCN Commercial |
$1,586.10
|
| Rate for Payer: BCN Medicare Advantage |
$510.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.00
|
| Rate for Payer: Healthscope Commercial |
$1,836.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,530.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$535.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$586.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.00
|
| Rate for Payer: PACE Senior Care Partners |
$484.50
|
| Rate for Payer: PACE SWMI |
$510.00
|
| Rate for Payer: PHP Commercial |
$1,734.00
|
| Rate for Payer: PHP Medicare Advantage |
$510.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,774.80
|
| Rate for Payer: Priority Health Medicare |
$510.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,244.20
|
| Rate for Payer: Railroad Medicare Medicare |
$510.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,795.20
|
| Rate for Payer: UHC Core |
$1,703.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.00
|
| Rate for Payer: UHC Medicare Advantage |
$525.30
|
| Rate for Payer: VA VA |
$510.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,530.00
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
IP
|
$7,656.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,669.39 |
| Max. Negotiated Rate |
$6,890.40 |
| Rate for Payer: Aetna Commercial |
$6,507.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,916.56
|
| Rate for Payer: BCN Commercial |
$5,916.56
|
| Rate for Payer: Cash Price |
$6,124.80
|
| Rate for Payer: Cofinity Commercial |
$6,584.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,124.80
|
| Rate for Payer: Healthscope Commercial |
$6,890.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,742.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,507.60
|
| Rate for Payer: PHP Commercial |
$6,507.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,660.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,669.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,737.28
|
| Rate for Payer: UHC Core |
$6,392.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,742.00
|
|
