|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
OP
|
$258.81
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.47 |
| Max. Negotiated Rate |
$369.18 |
| Rate for Payer: Aetna Commercial |
$219.99
|
| Rate for Payer: Aetna Medicare |
$67.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.88
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$64.70
|
| Rate for Payer: BCBS Trust/PPO |
$201.22
|
| Rate for Payer: BCN Commercial |
$201.22
|
| Rate for Payer: BCN Medicare Advantage |
$64.70
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$222.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.70
|
| Rate for Payer: Healthscope Commercial |
$232.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.11
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.99
|
| Rate for Payer: PACE Senior Care Partners |
$61.47
|
| Rate for Payer: PACE SWMI |
$64.70
|
| Rate for Payer: PHP Commercial |
$219.99
|
| Rate for Payer: PHP Medicare Advantage |
$64.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.16
|
| Rate for Payer: Priority Health Medicare |
$64.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.85
|
| Rate for Payer: Railroad Medicare Medicare |
$64.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.75
|
| Rate for Payer: UHC Core |
$216.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.70
|
| Rate for Payer: UHC Medicare Advantage |
$66.64
|
| Rate for Payer: VA VA |
$64.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.11
|
|
|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
IP
|
$258.81
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.85 |
| Max. Negotiated Rate |
$232.93 |
| Rate for Payer: Aetna Commercial |
$219.99
|
| Rate for Payer: BCBS Trust/PPO |
$200.01
|
| Rate for Payer: BCN Commercial |
$200.01
|
| Rate for Payer: Cash Price |
$207.05
|
| Rate for Payer: Cofinity Commercial |
$222.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.05
|
| Rate for Payer: Healthscope Commercial |
$232.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.99
|
| Rate for Payer: PHP Commercial |
$219.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.75
|
| Rate for Payer: UHC Core |
$216.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.11
|
|
|
HC MED SURG ROOM & BOARD
|
Facility
|
IP
|
$3,291.02
|
|
| Hospital Charge Code |
11000001
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,007.19 |
| Max. Negotiated Rate |
$2,961.92 |
| Rate for Payer: Aetna Commercial |
$2,797.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,543.30
|
| Rate for Payer: BCN Commercial |
$2,543.30
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cofinity Commercial |
$2,830.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,632.82
|
| Rate for Payer: Healthscope Commercial |
$2,961.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,468.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,797.37
|
| Rate for Payer: PHP Commercial |
$2,797.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,863.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,007.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,896.10
|
| Rate for Payer: UHC Core |
$2,748.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,468.26
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$37.09
|
| Rate for Payer: BCN Commercial |
$37.09
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.24
|
| Rate for Payer: UHC Core |
$40.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.00
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$37.32
|
| Rate for Payer: BCN Commercial |
$37.32
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.00
|
| Rate for Payer: Mclaren Medicaid |
$8.84
|
| Rate for Payer: Meridian Medicaid |
$9.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PACE Senior Care Partners |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.76
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.28
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.24
|
| Rate for Payer: UHC Core |
$40.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.00
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
OP
|
$29,376.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,976.80 |
| Max. Negotiated Rate |
$26,438.40 |
| Rate for Payer: Aetna Commercial |
$24,969.60
|
| Rate for Payer: Aetna Medicare |
$7,637.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,180.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,180.00
|
| Rate for Payer: BCBS Complete |
$11,750.40
|
| Rate for Payer: BCBS MAPPO |
$7,344.00
|
| Rate for Payer: BCBS Trust/PPO |
$22,839.84
|
| Rate for Payer: BCN Commercial |
$22,839.84
|
| Rate for Payer: BCN Medicare Advantage |
$7,344.00
|
| Rate for Payer: Cash Price |
$23,500.80
|
| Rate for Payer: Cofinity Commercial |
$25,263.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,500.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,344.00
|
| Rate for Payer: Healthscope Commercial |
$26,438.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,032.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,711.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,445.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,969.60
|
| Rate for Payer: PACE Senior Care Partners |
$6,976.80
|
| Rate for Payer: PACE SWMI |
$7,344.00
|
| Rate for Payer: PHP Commercial |
$24,969.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,344.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,563.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,557.12
|
| Rate for Payer: Priority Health Medicare |
$7,344.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,916.42
|
| Rate for Payer: Railroad Medicare Medicare |
$7,344.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,850.88
|
| Rate for Payer: UHC Core |
$24,528.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,344.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,564.32
|
| Rate for Payer: VA VA |
$7,344.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,032.00
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
IP
|
$29,376.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$17,916.42 |
| Max. Negotiated Rate |
$26,438.40 |
| Rate for Payer: Aetna Commercial |
$24,969.60
|
| Rate for Payer: BCBS Trust/PPO |
$22,701.77
|
| Rate for Payer: BCN Commercial |
$22,701.77
|
| Rate for Payer: Cash Price |
$23,500.80
|
| Rate for Payer: Cofinity Commercial |
$25,263.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,500.80
|
| Rate for Payer: Healthscope Commercial |
$26,438.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,032.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,969.60
|
| Rate for Payer: PHP Commercial |
$24,969.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,563.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,557.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,916.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,850.88
|
| Rate for Payer: UHC Core |
$24,528.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,032.00
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
IP
|
$6,085.82
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,711.74 |
| Max. Negotiated Rate |
$5,477.24 |
| Rate for Payer: Aetna Commercial |
$5,172.95
|
| Rate for Payer: BCBS Trust/PPO |
$4,703.12
|
| Rate for Payer: BCN Commercial |
$4,703.12
|
| Rate for Payer: Cash Price |
$4,868.66
|
| Rate for Payer: Cofinity Commercial |
$5,233.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,868.66
|
| Rate for Payer: Healthscope Commercial |
$5,477.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,564.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,172.95
|
| Rate for Payer: PHP Commercial |
$5,172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,260.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,294.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,711.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,355.52
|
| Rate for Payer: UHC Core |
$5,081.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,564.36
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
OP
|
$6,085.82
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,445.38 |
| Max. Negotiated Rate |
$5,477.24 |
| Rate for Payer: Aetna Commercial |
$5,172.95
|
| Rate for Payer: Aetna Medicare |
$1,582.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,901.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,901.82
|
| Rate for Payer: BCBS Complete |
$2,434.33
|
| Rate for Payer: BCBS MAPPO |
$1,521.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,731.73
|
| Rate for Payer: BCN Commercial |
$4,731.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,521.46
|
| Rate for Payer: Cash Price |
$4,868.66
|
| Rate for Payer: Cofinity Commercial |
$5,233.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,868.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,521.46
|
| Rate for Payer: Healthscope Commercial |
$5,477.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,564.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,597.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,749.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,172.95
|
| Rate for Payer: PACE Senior Care Partners |
$1,445.38
|
| Rate for Payer: PACE SWMI |
$1,521.46
|
| Rate for Payer: PHP Commercial |
$5,172.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,521.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,260.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,294.66
|
| Rate for Payer: Priority Health Medicare |
$1,521.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,711.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,521.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,355.52
|
| Rate for Payer: UHC Core |
$5,081.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,521.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,567.10
|
| Rate for Payer: VA VA |
$1,521.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,564.36
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
OP
|
$8,670.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,059.12 |
| Max. Negotiated Rate |
$7,803.00 |
| Rate for Payer: Aetna Commercial |
$7,369.50
|
| Rate for Payer: Aetna Medicare |
$2,254.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,709.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,709.38
|
| Rate for Payer: BCBS Complete |
$3,468.00
|
| Rate for Payer: BCBS MAPPO |
$2,167.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,740.92
|
| Rate for Payer: BCN Commercial |
$6,740.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,167.50
|
| Rate for Payer: Cash Price |
$6,936.00
|
| Rate for Payer: Cofinity Commercial |
$7,456.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,936.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,167.50
|
| Rate for Payer: Healthscope Commercial |
$7,803.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,502.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,275.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,492.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,369.50
|
| Rate for Payer: PACE Senior Care Partners |
$2,059.12
|
| Rate for Payer: PACE SWMI |
$2,167.50
|
| Rate for Payer: PHP Commercial |
$7,369.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,167.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,069.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,542.90
|
| Rate for Payer: Priority Health Medicare |
$2,167.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,287.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2,167.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,629.60
|
| Rate for Payer: UHC Core |
$7,239.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,167.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,232.52
|
| Rate for Payer: VA VA |
$2,167.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,502.50
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
IP
|
$8,670.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,287.83 |
| Max. Negotiated Rate |
$7,803.00 |
| Rate for Payer: Aetna Commercial |
$7,369.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,700.18
|
| Rate for Payer: BCN Commercial |
$6,700.18
|
| Rate for Payer: Cash Price |
$6,936.00
|
| Rate for Payer: Cofinity Commercial |
$7,456.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,936.00
|
| Rate for Payer: Healthscope Commercial |
$7,803.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,502.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,369.50
|
| Rate for Payer: PHP Commercial |
$7,369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,069.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,542.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,287.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,629.60
|
| Rate for Payer: UHC Core |
$7,239.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,502.50
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
OP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,128.92 |
| Max. Negotiated Rate |
$23,225.40 |
| Rate for Payer: Aetna Commercial |
$21,935.10
|
| Rate for Payer: Aetna Medicare |
$6,709.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,064.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,064.38
|
| Rate for Payer: BCBS Complete |
$10,322.40
|
| Rate for Payer: BCBS MAPPO |
$6,451.50
|
| Rate for Payer: BCBS Trust/PPO |
$20,064.16
|
| Rate for Payer: BCN Commercial |
$20,064.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,451.50
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$22,193.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,451.50
|
| Rate for Payer: Healthscope Commercial |
$23,225.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,774.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,419.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: PACE Senior Care Partners |
$6,128.92
|
| Rate for Payer: PACE SWMI |
$6,451.50
|
| Rate for Payer: PHP Commercial |
$21,935.10
|
| Rate for Payer: PHP Medicare Advantage |
$6,451.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,451.22
|
| Rate for Payer: Priority Health Medicare |
$6,451.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,739.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6,451.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,709.28
|
| Rate for Payer: UHC Core |
$21,548.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,451.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,645.04
|
| Rate for Payer: VA VA |
$6,451.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
IP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,739.08 |
| Max. Negotiated Rate |
$23,225.40 |
| Rate for Payer: Aetna Commercial |
$21,935.10
|
| Rate for Payer: BCBS Trust/PPO |
$19,942.88
|
| Rate for Payer: BCN Commercial |
$19,942.88
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$22,193.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Healthscope Commercial |
$23,225.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: PHP Commercial |
$21,935.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,451.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,739.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,709.28
|
| Rate for Payer: UHC Core |
$21,548.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
OP
|
$23,358.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,547.52 |
| Max. Negotiated Rate |
$21,022.20 |
| Rate for Payer: Aetna Commercial |
$19,854.30
|
| Rate for Payer: Aetna Medicare |
$6,073.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,299.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,299.38
|
| Rate for Payer: BCBS Complete |
$9,343.20
|
| Rate for Payer: BCBS MAPPO |
$5,839.50
|
| Rate for Payer: BCBS Trust/PPO |
$18,160.84
|
| Rate for Payer: BCN Commercial |
$18,160.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,839.50
|
| Rate for Payer: Cash Price |
$18,686.40
|
| Rate for Payer: Cofinity Commercial |
$20,087.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,686.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,839.50
|
| Rate for Payer: Healthscope Commercial |
$21,022.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,518.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,131.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,715.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,854.30
|
| Rate for Payer: PACE Senior Care Partners |
$5,547.52
|
| Rate for Payer: PACE SWMI |
$5,839.50
|
| Rate for Payer: PHP Commercial |
$19,854.30
|
| Rate for Payer: PHP Medicare Advantage |
$5,839.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,350.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,321.46
|
| Rate for Payer: Priority Health Medicare |
$5,839.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,246.04
|
| Rate for Payer: Railroad Medicare Medicare |
$5,839.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,555.04
|
| Rate for Payer: UHC Core |
$19,503.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,839.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,014.68
|
| Rate for Payer: VA VA |
$5,839.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,518.50
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
IP
|
$23,358.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,246.04 |
| Max. Negotiated Rate |
$21,022.20 |
| Rate for Payer: Aetna Commercial |
$19,854.30
|
| Rate for Payer: BCBS Trust/PPO |
$18,051.06
|
| Rate for Payer: BCN Commercial |
$18,051.06
|
| Rate for Payer: Cash Price |
$18,686.40
|
| Rate for Payer: Cofinity Commercial |
$20,087.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,686.40
|
| Rate for Payer: Healthscope Commercial |
$21,022.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,518.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19,854.30
|
| Rate for Payer: PHP Commercial |
$19,854.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,350.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,321.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,246.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,555.04
|
| Rate for Payer: UHC Core |
$19,503.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,518.50
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
OP
|
$12,956.99
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,077.29 |
| Max. Negotiated Rate |
$11,661.29 |
| Rate for Payer: Aetna Commercial |
$11,013.44
|
| Rate for Payer: Aetna Medicare |
$3,368.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,049.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,049.06
|
| Rate for Payer: BCBS Complete |
$5,182.80
|
| Rate for Payer: BCBS MAPPO |
$3,239.25
|
| Rate for Payer: BCBS Trust/PPO |
$10,074.06
|
| Rate for Payer: BCN Commercial |
$10,074.06
|
| Rate for Payer: BCN Medicare Advantage |
$3,239.25
|
| Rate for Payer: Cash Price |
$10,365.59
|
| Rate for Payer: Cofinity Commercial |
$11,143.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,365.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,239.25
|
| Rate for Payer: Healthscope Commercial |
$11,661.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,717.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,401.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,725.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,013.44
|
| Rate for Payer: PACE Senior Care Partners |
$3,077.29
|
| Rate for Payer: PACE SWMI |
$3,239.25
|
| Rate for Payer: PHP Commercial |
$11,013.44
|
| Rate for Payer: PHP Medicare Advantage |
$3,239.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,069.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,272.58
|
| Rate for Payer: Priority Health Medicare |
$3,239.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,902.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,239.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,402.15
|
| Rate for Payer: UHC Core |
$10,819.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,239.25
|
| Rate for Payer: UHC Medicare Advantage |
$3,336.42
|
| Rate for Payer: VA VA |
$3,239.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,717.74
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
IP
|
$12,956.99
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,902.47 |
| Max. Negotiated Rate |
$11,661.29 |
| Rate for Payer: Aetna Commercial |
$11,013.44
|
| Rate for Payer: BCBS Trust/PPO |
$10,013.16
|
| Rate for Payer: BCN Commercial |
$10,013.16
|
| Rate for Payer: Cash Price |
$10,365.59
|
| Rate for Payer: Cofinity Commercial |
$11,143.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,365.59
|
| Rate for Payer: Healthscope Commercial |
$11,661.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,717.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,013.44
|
| Rate for Payer: PHP Commercial |
$11,013.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,069.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,272.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,902.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,402.15
|
| Rate for Payer: UHC Core |
$10,819.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,717.74
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
OP
|
$15,291.65
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,631.77 |
| Max. Negotiated Rate |
$13,762.48 |
| Rate for Payer: Aetna Commercial |
$12,997.90
|
| Rate for Payer: Aetna Medicare |
$3,975.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,778.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,778.64
|
| Rate for Payer: BCBS Complete |
$6,116.66
|
| Rate for Payer: BCBS MAPPO |
$3,822.91
|
| Rate for Payer: BCBS Trust/PPO |
$11,889.26
|
| Rate for Payer: BCN Commercial |
$11,889.26
|
| Rate for Payer: BCN Medicare Advantage |
$3,822.91
|
| Rate for Payer: Cash Price |
$12,233.32
|
| Rate for Payer: Cofinity Commercial |
$13,150.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,233.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,822.91
|
| Rate for Payer: Healthscope Commercial |
$13,762.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,468.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,014.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,396.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,997.90
|
| Rate for Payer: PACE Senior Care Partners |
$3,631.77
|
| Rate for Payer: PACE SWMI |
$3,822.91
|
| Rate for Payer: PHP Commercial |
$12,997.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,822.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,704.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,303.74
|
| Rate for Payer: Priority Health Medicare |
$3,822.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,326.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3,822.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,456.65
|
| Rate for Payer: UHC Core |
$12,768.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,822.91
|
| Rate for Payer: UHC Medicare Advantage |
$3,937.60
|
| Rate for Payer: VA VA |
$3,822.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,468.74
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
IP
|
$15,291.65
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,326.38 |
| Max. Negotiated Rate |
$13,762.48 |
| Rate for Payer: Aetna Commercial |
$12,997.90
|
| Rate for Payer: BCBS Trust/PPO |
$11,817.39
|
| Rate for Payer: BCN Commercial |
$11,817.39
|
| Rate for Payer: Cash Price |
$12,233.32
|
| Rate for Payer: Cofinity Commercial |
$13,150.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,233.32
|
| Rate for Payer: Healthscope Commercial |
$13,762.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,468.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,997.90
|
| Rate for Payer: PHP Commercial |
$12,997.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,704.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,303.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,326.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,456.65
|
| Rate for Payer: UHC Core |
$12,768.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,468.74
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: BCBS Trust/PPO |
$141.89
|
| Rate for Payer: BCN Commercial |
$141.89
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.06
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.57
|
| Rate for Payer: UHC Core |
$153.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.38
|
| Rate for Payer: BCBS Complete |
$73.44
|
| Rate for Payer: BCBS MAPPO |
$45.90
|
| Rate for Payer: BCBS Trust/PPO |
$142.75
|
| Rate for Payer: BCN Commercial |
$142.75
|
| Rate for Payer: BCN Medicare Advantage |
$45.90
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.06
|
| Rate for Payer: PACE Senior Care Partners |
$43.60
|
| Rate for Payer: PACE SWMI |
$45.90
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: PHP Medicare Advantage |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.73
|
| Rate for Payer: Priority Health Medicare |
$45.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.98
|
| Rate for Payer: Railroad Medicare Medicare |
$45.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.57
|
| Rate for Payer: UHC Core |
$153.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.90
|
| Rate for Payer: UHC Medicare Advantage |
$47.28
|
| Rate for Payer: VA VA |
$45.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$516.58
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.69 |
| Max. Negotiated Rate |
$464.92 |
| Rate for Payer: Aetna Commercial |
$439.09
|
| Rate for Payer: Aetna Medicare |
$134.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.43
|
| Rate for Payer: BCBS Complete |
$206.63
|
| Rate for Payer: BCBS MAPPO |
$129.14
|
| Rate for Payer: BCBS Trust/PPO |
$401.64
|
| Rate for Payer: BCN Commercial |
$401.64
|
| Rate for Payer: BCN Medicare Advantage |
$129.14
|
| Rate for Payer: Cash Price |
$413.26
|
| Rate for Payer: Cofinity Commercial |
$444.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.14
|
| Rate for Payer: Healthscope Commercial |
$464.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.09
|
| Rate for Payer: PACE Senior Care Partners |
$122.69
|
| Rate for Payer: PACE SWMI |
$129.14
|
| Rate for Payer: PHP Commercial |
$439.09
|
| Rate for Payer: PHP Medicare Advantage |
$129.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$449.42
|
| Rate for Payer: Priority Health Medicare |
$129.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$315.06
|
| Rate for Payer: Railroad Medicare Medicare |
$129.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.59
|
| Rate for Payer: UHC Core |
$431.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.14
|
| Rate for Payer: UHC Medicare Advantage |
$133.02
|
| Rate for Payer: VA VA |
$129.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.44
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$516.58
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$315.06 |
| Max. Negotiated Rate |
$464.92 |
| Rate for Payer: Aetna Commercial |
$439.09
|
| Rate for Payer: BCBS Trust/PPO |
$399.21
|
| Rate for Payer: BCN Commercial |
$399.21
|
| Rate for Payer: Cash Price |
$413.26
|
| Rate for Payer: Cofinity Commercial |
$444.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.26
|
| Rate for Payer: Healthscope Commercial |
$464.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.09
|
| Rate for Payer: PHP Commercial |
$439.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$449.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$315.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.59
|
| Rate for Payer: UHC Core |
$431.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.44
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
OP
|
$236.64
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna Medicare |
$61.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.95
|
| Rate for Payer: BCBS Complete |
$94.66
|
| Rate for Payer: BCBS MAPPO |
$59.16
|
| Rate for Payer: BCBS Trust/PPO |
$183.99
|
| Rate for Payer: BCN Commercial |
$183.99
|
| Rate for Payer: BCN Medicare Advantage |
$59.16
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.16
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.14
|
| Rate for Payer: PACE Senior Care Partners |
$56.20
|
| Rate for Payer: PACE SWMI |
$59.16
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: PHP Medicare Advantage |
$59.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.88
|
| Rate for Payer: Priority Health Medicare |
$59.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.33
|
| Rate for Payer: Railroad Medicare Medicare |
$59.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.24
|
| Rate for Payer: UHC Core |
$197.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.16
|
| Rate for Payer: UHC Medicare Advantage |
$60.93
|
| Rate for Payer: VA VA |
$59.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
IP
|
$236.64
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.33 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: BCBS Trust/PPO |
$182.88
|
| Rate for Payer: BCN Commercial |
$182.88
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.14
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.24
|
| Rate for Payer: UHC Core |
$197.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
