|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
OP
|
$584.55
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$526.10 |
| Rate for Payer: Aetna Commercial |
$496.87
|
| Rate for Payer: Aetna Medicare |
$151.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.67
|
| Rate for Payer: BCBS Complete |
$233.82
|
| Rate for Payer: BCBS MAPPO |
$146.14
|
| Rate for Payer: BCBS Trust/PPO |
$480.56
|
| Rate for Payer: BCN Commercial |
$454.49
|
| Rate for Payer: BCN Medicare Advantage |
$146.14
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$502.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.14
|
| Rate for Payer: Healthscope Commercial |
$526.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: Nomi Health Commercial |
$479.33
|
| Rate for Payer: PACE Senior Care Partners |
$138.83
|
| Rate for Payer: PACE SWMI |
$146.14
|
| Rate for Payer: PHP Commercial |
$496.87
|
| Rate for Payer: PHP Medicare Advantage |
$146.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: Priority Health HMO/PPO |
$508.56
|
| Rate for Payer: Priority Health Medicare |
$147.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.65
|
| Rate for Payer: Railroad Medicare Medicare |
$146.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.40
|
| Rate for Payer: UHC Core |
$488.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.14
|
| Rate for Payer: UHC Exchange |
$146.14
|
| Rate for Payer: UHC Medicare Advantage |
$146.14
|
| Rate for Payer: VA VA |
$146.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.41
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
IP
|
$584.55
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.96 |
| Max. Negotiated Rate |
$526.10 |
| Rate for Payer: Aetna Commercial |
$496.87
|
| Rate for Payer: BCBS Trust/PPO |
$477.17
|
| Rate for Payer: BCN Commercial |
$451.74
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$502.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Healthscope Commercial |
$526.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: Nomi Health Commercial |
$479.33
|
| Rate for Payer: PHP Commercial |
$496.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: Priority Health HMO/PPO |
$508.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.40
|
| Rate for Payer: UHC Core |
$488.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.41
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
IP
|
$1,169.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$759.90 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna Commercial |
$993.71
|
| Rate for Payer: BCBS Trust/PPO |
$954.31
|
| Rate for Payer: BCN Commercial |
$903.46
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,005.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Healthscope Commercial |
$1,052.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: Nomi Health Commercial |
$958.64
|
| Rate for Payer: PHP Commercial |
$993.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,017.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,028.78
|
| Rate for Payer: UHC Core |
$976.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.80
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
OP
|
$1,169.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$277.65 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna Commercial |
$993.71
|
| Rate for Payer: Aetna Medicare |
$303.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.33
|
| Rate for Payer: BCBS Complete |
$467.63
|
| Rate for Payer: BCBS MAPPO |
$292.27
|
| Rate for Payer: BCBS Trust/PPO |
$961.09
|
| Rate for Payer: BCN Commercial |
$908.95
|
| Rate for Payer: BCN Medicare Advantage |
$292.27
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,005.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.27
|
| Rate for Payer: Healthscope Commercial |
$1,052.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: Nomi Health Commercial |
$958.64
|
| Rate for Payer: PACE Senior Care Partners |
$277.65
|
| Rate for Payer: PACE SWMI |
$292.27
|
| Rate for Payer: PHP Commercial |
$993.71
|
| Rate for Payer: PHP Medicare Advantage |
$292.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,017.09
|
| Rate for Payer: Priority Health Medicare |
$295.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.28
|
| Rate for Payer: Railroad Medicare Medicare |
$292.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,028.78
|
| Rate for Payer: UHC Core |
$976.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.27
|
| Rate for Payer: UHC Exchange |
$292.27
|
| Rate for Payer: UHC Medicare Advantage |
$292.27
|
| Rate for Payer: VA VA |
$292.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.80
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.13 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$74.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.65
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: BCBS MAPPO |
$71.72
|
| Rate for Payer: BCBS Trust/PPO |
$235.84
|
| Rate for Payer: BCN Commercial |
$223.05
|
| Rate for Payer: BCN Medicare Advantage |
$71.72
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.72
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: PACE Senior Care Partners |
$68.13
|
| Rate for Payer: PACE SWMI |
$71.72
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: PHP Medicare Advantage |
$71.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health HMO/PPO |
$249.59
|
| Rate for Payer: Priority Health Medicare |
$72.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.21
|
| Rate for Payer: Railroad Medicare Medicare |
$71.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.45
|
| Rate for Payer: UHC Core |
$239.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.72
|
| Rate for Payer: UHC Exchange |
$71.72
|
| Rate for Payer: UHC Medicare Advantage |
$71.72
|
| Rate for Payer: VA VA |
$71.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$186.47 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.18
|
| Rate for Payer: BCN Commercial |
$221.70
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health HMO/PPO |
$249.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.45
|
| Rate for Payer: UHC Core |
$239.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
OP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.47 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna Medicare |
$66.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.56
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS MAPPO |
$63.65
|
| Rate for Payer: BCBS Trust/PPO |
$209.30
|
| Rate for Payer: BCN Commercial |
$197.94
|
| Rate for Payer: BCN Medicare Advantage |
$63.65
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: PACE Senior Care Partners |
$60.47
|
| Rate for Payer: PACE SWMI |
$63.65
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: PHP Medicare Advantage |
$63.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health HMO/PPO |
$221.49
|
| Rate for Payer: Priority Health Medicare |
$64.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.58
|
| Rate for Payer: Railroad Medicare Medicare |
$63.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.04
|
| Rate for Payer: UHC Core |
$212.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.65
|
| Rate for Payer: UHC Exchange |
$63.65
|
| Rate for Payer: UHC Medicare Advantage |
$63.65
|
| Rate for Payer: VA VA |
$63.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: BCBS Trust/PPO |
$207.82
|
| Rate for Payer: BCN Commercial |
$196.75
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health HMO/PPO |
$221.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.04
|
| Rate for Payer: UHC Core |
$212.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
OP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.47 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna Medicare |
$66.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.56
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS MAPPO |
$63.65
|
| Rate for Payer: BCBS Trust/PPO |
$209.30
|
| Rate for Payer: BCN Commercial |
$197.94
|
| Rate for Payer: BCN Medicare Advantage |
$63.65
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: PACE Senior Care Partners |
$60.47
|
| Rate for Payer: PACE SWMI |
$63.65
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: PHP Medicare Advantage |
$63.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health HMO/PPO |
$221.49
|
| Rate for Payer: Priority Health Medicare |
$64.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.58
|
| Rate for Payer: Railroad Medicare Medicare |
$63.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.04
|
| Rate for Payer: UHC Core |
$212.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.65
|
| Rate for Payer: UHC Exchange |
$63.65
|
| Rate for Payer: UHC Medicare Advantage |
$63.65
|
| Rate for Payer: VA VA |
$63.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: BCBS Trust/PPO |
$207.82
|
| Rate for Payer: BCN Commercial |
$196.75
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: Nomi Health Commercial |
$208.76
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health HMO/PPO |
$221.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.04
|
| Rate for Payer: UHC Core |
$212.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$186.47 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.18
|
| Rate for Payer: BCN Commercial |
$221.70
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health HMO/PPO |
$249.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.45
|
| Rate for Payer: UHC Core |
$239.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.13 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$74.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.65
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: BCBS MAPPO |
$71.72
|
| Rate for Payer: BCBS Trust/PPO |
$235.84
|
| Rate for Payer: BCN Commercial |
$223.05
|
| Rate for Payer: BCN Medicare Advantage |
$71.72
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.72
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: Nomi Health Commercial |
$235.24
|
| Rate for Payer: PACE Senior Care Partners |
$68.13
|
| Rate for Payer: PACE SWMI |
$71.72
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: PHP Medicare Advantage |
$71.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health HMO/PPO |
$249.59
|
| Rate for Payer: Priority Health Medicare |
$72.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.21
|
| Rate for Payer: Railroad Medicare Medicare |
$71.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.45
|
| Rate for Payer: UHC Core |
$239.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.72
|
| Rate for Payer: UHC Exchange |
$71.72
|
| Rate for Payer: UHC Medicare Advantage |
$71.72
|
| Rate for Payer: VA VA |
$71.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: BCBS Trust/PPO |
$342.54
|
| Rate for Payer: BCN Commercial |
$324.28
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: Nomi Health Commercial |
$344.09
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health HMO/PPO |
$365.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.27
|
| Rate for Payer: UHC Core |
$350.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.71
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.66 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: Aetna Medicare |
$109.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.13
|
| Rate for Payer: BCBS Complete |
$167.85
|
| Rate for Payer: BCBS MAPPO |
$104.91
|
| Rate for Payer: BCBS Trust/PPO |
$344.97
|
| Rate for Payer: BCN Commercial |
$326.25
|
| Rate for Payer: BCN Medicare Advantage |
$104.91
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.91
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: Nomi Health Commercial |
$344.09
|
| Rate for Payer: PACE Senior Care Partners |
$99.66
|
| Rate for Payer: PACE SWMI |
$104.91
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: PHP Medicare Advantage |
$104.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health HMO/PPO |
$365.07
|
| Rate for Payer: Priority Health Medicare |
$105.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.15
|
| Rate for Payer: Railroad Medicare Medicare |
$104.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.27
|
| Rate for Payer: UHC Core |
$350.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.91
|
| Rate for Payer: UHC Exchange |
$104.91
|
| Rate for Payer: UHC Medicare Advantage |
$104.91
|
| Rate for Payer: VA VA |
$104.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.71
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$350.30 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: BCBS Trust/PPO |
$439.93
|
| Rate for Payer: BCN Commercial |
$416.49
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$404.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: Nomi Health Commercial |
$441.92
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health HMO/PPO |
$468.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$361.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$474.26
|
| Rate for Payer: UHC Core |
$450.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$404.20
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: Aetna Medicare |
$140.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.42
|
| Rate for Payer: BCBS Complete |
$215.57
|
| Rate for Payer: BCBS MAPPO |
$134.73
|
| Rate for Payer: BCBS Trust/PPO |
$443.05
|
| Rate for Payer: BCN Commercial |
$419.02
|
| Rate for Payer: BCN Medicare Advantage |
$134.73
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.73
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$404.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: Nomi Health Commercial |
$441.92
|
| Rate for Payer: PACE Senior Care Partners |
$128.00
|
| Rate for Payer: PACE SWMI |
$134.73
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: PHP Medicare Advantage |
$134.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health HMO/PPO |
$468.87
|
| Rate for Payer: Priority Health Medicare |
$136.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$361.08
|
| Rate for Payer: Railroad Medicare Medicare |
$134.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$474.26
|
| Rate for Payer: UHC Core |
$450.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.73
|
| Rate for Payer: UHC Exchange |
$134.73
|
| Rate for Payer: UHC Medicare Advantage |
$134.73
|
| Rate for Payer: VA VA |
$134.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$404.20
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Aetna Medicare |
$18.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.65
|
| Rate for Payer: BCBS Complete |
$27.71
|
| Rate for Payer: BCBS MAPPO |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$56.96
|
| Rate for Payer: BCN Commercial |
$53.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.32
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: PACE Senior Care Partners |
$16.45
|
| Rate for Payer: PACE SWMI |
$17.32
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health HMO/PPO |
$60.27
|
| Rate for Payer: Priority Health Medicare |
$17.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.42
|
| Rate for Payer: Railroad Medicare Medicare |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.97
|
| Rate for Payer: UHC Core |
$57.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.32
|
| Rate for Payer: UHC Exchange |
$17.32
|
| Rate for Payer: UHC Medicare Advantage |
$17.32
|
| Rate for Payer: VA VA |
$17.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.96
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: BCBS Trust/PPO |
$56.55
|
| Rate for Payer: BCN Commercial |
$53.54
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health HMO/PPO |
$60.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.97
|
| Rate for Payer: UHC Core |
$57.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.96
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
OP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.16 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: Aetna Medicare |
$3,082.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,705.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,705.47
|
| Rate for Payer: BCBS Complete |
$4,743.00
|
| Rate for Payer: BCBS MAPPO |
$2,964.38
|
| Rate for Payer: BCBS Trust/PPO |
$9,748.05
|
| Rate for Payer: BCN Commercial |
$9,219.21
|
| Rate for Payer: BCN Medicare Advantage |
$2,964.38
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,964.38
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,893.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,112.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,409.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: Nomi Health Commercial |
$9,723.15
|
| Rate for Payer: PACE Senior Care Partners |
$2,816.16
|
| Rate for Payer: PACE SWMI |
$2,964.38
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: PHP Medicare Advantage |
$2,964.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health HMO/PPO |
$10,316.02
|
| Rate for Payer: Priority Health Medicare |
$2,994.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,944.52
|
| Rate for Payer: Railroad Medicare Medicare |
$2,964.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,434.60
|
| Rate for Payer: UHC Core |
$9,901.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,964.38
|
| Rate for Payer: UHC Exchange |
$2,964.38
|
| Rate for Payer: UHC Medicare Advantage |
$2,964.38
|
| Rate for Payer: VA VA |
$2,964.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,893.12
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,707.38 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: BCBS Trust/PPO |
$9,679.28
|
| Rate for Payer: BCN Commercial |
$9,163.48
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,893.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: Nomi Health Commercial |
$9,723.15
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health HMO/PPO |
$10,316.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,944.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,434.60
|
| Rate for Payer: UHC Core |
$9,901.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,893.12
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
IP
|
$5,656.01
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,676.41 |
| Max. Negotiated Rate |
$5,090.41 |
| Rate for Payer: Aetna Commercial |
$4,807.61
|
| Rate for Payer: BCBS Trust/PPO |
$4,617.00
|
| Rate for Payer: BCN Commercial |
$4,370.96
|
| Rate for Payer: Cash Price |
$4,524.81
|
| Rate for Payer: Cofinity Commercial |
$4,864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,524.81
|
| Rate for Payer: Healthscope Commercial |
$5,090.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,242.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,807.61
|
| Rate for Payer: Nomi Health Commercial |
$4,637.93
|
| Rate for Payer: PHP Commercial |
$4,807.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,676.41
|
| Rate for Payer: Priority Health HMO/PPO |
$4,920.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,789.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,977.29
|
| Rate for Payer: UHC Core |
$4,722.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,242.01
|
|
|
HC EMBOLIC GLUE LVL 1
|
Facility
|
OP
|
$5,656.01
|
|
| Hospital Charge Code |
27800050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.30 |
| Max. Negotiated Rate |
$5,090.41 |
| Rate for Payer: Aetna Commercial |
$4,807.61
|
| Rate for Payer: Aetna Medicare |
$1,470.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,767.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,767.50
|
| Rate for Payer: BCBS Complete |
$2,262.40
|
| Rate for Payer: BCBS MAPPO |
$1,414.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,649.81
|
| Rate for Payer: BCN Commercial |
$4,397.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,414.00
|
| Rate for Payer: Cash Price |
$4,524.81
|
| Rate for Payer: Cofinity Commercial |
$4,864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,524.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,414.00
|
| Rate for Payer: Healthscope Commercial |
$5,090.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,242.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,484.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,626.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,807.61
|
| Rate for Payer: Nomi Health Commercial |
$4,637.93
|
| Rate for Payer: PACE Senior Care Partners |
$1,343.30
|
| Rate for Payer: PACE SWMI |
$1,414.00
|
| Rate for Payer: PHP Commercial |
$4,807.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,414.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,676.41
|
| Rate for Payer: Priority Health HMO/PPO |
$4,920.73
|
| Rate for Payer: Priority Health Medicare |
$1,428.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,789.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,414.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,977.29
|
| Rate for Payer: UHC Core |
$4,722.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,414.00
|
| Rate for Payer: UHC Exchange |
$1,414.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,414.00
|
| Rate for Payer: VA VA |
$1,414.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,242.01
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
IP
|
$2,046.45
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,330.19 |
| Max. Negotiated Rate |
$1,841.81 |
| Rate for Payer: Aetna Commercial |
$1,739.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.52
|
| Rate for Payer: BCN Commercial |
$1,581.50
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cofinity Commercial |
$1,759.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,637.16
|
| Rate for Payer: Healthscope Commercial |
$1,841.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,534.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,739.48
|
| Rate for Payer: Nomi Health Commercial |
$1,678.09
|
| Rate for Payer: PHP Commercial |
$1,739.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,780.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,371.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,800.88
|
| Rate for Payer: UHC Core |
$1,708.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,534.84
|
|
|
HC EMBOLI DETECTION WITH BUBBLE STUDY
|
Facility
|
OP
|
$2,046.45
|
|
|
Service Code
|
CPT 93893
|
| Hospital Charge Code |
92100035
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$1,841.81 |
| Rate for Payer: Aetna Commercial |
$1,739.48
|
| Rate for Payer: Aetna Medicare |
$532.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$639.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$639.52
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$511.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,682.39
|
| Rate for Payer: BCN Commercial |
$1,591.11
|
| Rate for Payer: BCN Medicare Advantage |
$511.61
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cash Price |
$1,637.16
|
| Rate for Payer: Cofinity Commercial |
$1,759.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,637.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$511.61
|
| Rate for Payer: Healthscope Commercial |
$1,841.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,534.84
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.19
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,739.48
|
| Rate for Payer: Nomi Health Commercial |
$1,678.09
|
| Rate for Payer: PACE Senior Care Partners |
$486.03
|
| Rate for Payer: PACE SWMI |
$511.61
|
| Rate for Payer: PHP Commercial |
$1,739.48
|
| Rate for Payer: PHP Medicare Advantage |
$511.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,780.41
|
| Rate for Payer: Priority Health Medicare |
$516.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,371.12
|
| Rate for Payer: Railroad Medicare Medicare |
$511.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,800.88
|
| Rate for Payer: UHC Core |
$1,708.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$511.61
|
| Rate for Payer: UHC Exchange |
$511.61
|
| Rate for Payer: UHC Medicare Advantage |
$511.61
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$511.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,534.84
|
|
|
HC EMBOLI DETECTION WITH OUT BUBBLE STUDY
|
Facility
|
IP
|
$795.50
|
|
|
Service Code
|
CPT 93892
|
| Hospital Charge Code |
92100034
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$517.08 |
| Max. Negotiated Rate |
$715.95 |
| Rate for Payer: Aetna Commercial |
$676.17
|
| Rate for Payer: BCBS Trust/PPO |
$649.37
|
| Rate for Payer: BCN Commercial |
$614.76
|
| Rate for Payer: Cash Price |
$636.40
|
| Rate for Payer: Cofinity Commercial |
$684.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.40
|
| Rate for Payer: Healthscope Commercial |
$715.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.17
|
| Rate for Payer: Nomi Health Commercial |
$652.31
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.08
|
| Rate for Payer: Priority Health HMO/PPO |
$692.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.04
|
| Rate for Payer: UHC Core |
$664.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.62
|
|
