|
HC GSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
OP
|
$576.50
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.92 |
| Max. Negotiated Rate |
$518.85 |
| Rate for Payer: Aetna Commercial |
$490.02
|
| Rate for Payer: Aetna Medicare |
$149.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.16
|
| Rate for Payer: BCBS Complete |
$230.60
|
| Rate for Payer: BCBS MAPPO |
$144.12
|
| Rate for Payer: BCBS Trust/PPO |
$473.94
|
| Rate for Payer: BCN Commercial |
$448.23
|
| Rate for Payer: BCN Medicare Advantage |
$144.12
|
| Rate for Payer: Cash Price |
$461.20
|
| Rate for Payer: Cofinity Commercial |
$495.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.12
|
| Rate for Payer: Healthscope Commercial |
$518.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.02
|
| Rate for Payer: Nomi Health Commercial |
$472.73
|
| Rate for Payer: PACE Senior Care Partners |
$136.92
|
| Rate for Payer: PACE SWMI |
$144.12
|
| Rate for Payer: PHP Commercial |
$490.02
|
| Rate for Payer: PHP Medicare Advantage |
$144.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.73
|
| Rate for Payer: Priority Health HMO/PPO |
$501.56
|
| Rate for Payer: Priority Health Medicare |
$145.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.25
|
| Rate for Payer: Railroad Medicare Medicare |
$144.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.32
|
| Rate for Payer: UHC Core |
$481.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.12
|
| Rate for Payer: UHC Exchange |
$144.12
|
| Rate for Payer: UHC Medicare Advantage |
$144.12
|
| Rate for Payer: VA VA |
$144.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.38
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
IP
|
$576.50
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.73 |
| Max. Negotiated Rate |
$518.85 |
| Rate for Payer: Aetna Commercial |
$490.02
|
| Rate for Payer: BCBS Trust/PPO |
$470.60
|
| Rate for Payer: BCN Commercial |
$445.52
|
| Rate for Payer: Cash Price |
$461.20
|
| Rate for Payer: Cofinity Commercial |
$495.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.20
|
| Rate for Payer: Healthscope Commercial |
$518.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.02
|
| Rate for Payer: Nomi Health Commercial |
$472.73
|
| Rate for Payer: PHP Commercial |
$490.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.73
|
| Rate for Payer: Priority Health HMO/PPO |
$501.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.32
|
| Rate for Payer: UHC Core |
$481.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.38
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
OP
|
$5,821.41
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.58 |
| Max. Negotiated Rate |
$5,239.27 |
| Rate for Payer: Aetna Commercial |
$4,948.20
|
| Rate for Payer: Aetna Medicare |
$1,513.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,819.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,819.19
|
| Rate for Payer: BCBS Complete |
$2,328.56
|
| Rate for Payer: BCBS MAPPO |
$1,455.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,785.78
|
| Rate for Payer: BCN Commercial |
$4,526.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,455.35
|
| Rate for Payer: Cash Price |
$4,657.13
|
| Rate for Payer: Cofinity Commercial |
$5,006.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,657.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,455.35
|
| Rate for Payer: Healthscope Commercial |
$5,239.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,366.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,528.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,673.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,948.20
|
| Rate for Payer: Nomi Health Commercial |
$4,773.56
|
| Rate for Payer: PACE Senior Care Partners |
$1,382.58
|
| Rate for Payer: PACE SWMI |
$1,455.35
|
| Rate for Payer: PHP Commercial |
$4,948.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,455.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,783.92
|
| Rate for Payer: Priority Health HMO/PPO |
$5,064.63
|
| Rate for Payer: Priority Health Medicare |
$1,469.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,900.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,455.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,122.84
|
| Rate for Payer: UHC Core |
$4,860.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,455.35
|
| Rate for Payer: UHC Exchange |
$1,455.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,455.35
|
| Rate for Payer: VA VA |
$1,455.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,366.06
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
IP
|
$5,821.41
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,783.92 |
| Max. Negotiated Rate |
$5,239.27 |
| Rate for Payer: Aetna Commercial |
$4,948.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,752.02
|
| Rate for Payer: BCN Commercial |
$4,498.79
|
| Rate for Payer: Cash Price |
$4,657.13
|
| Rate for Payer: Cofinity Commercial |
$5,006.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,657.13
|
| Rate for Payer: Healthscope Commercial |
$5,239.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,366.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,948.20
|
| Rate for Payer: Nomi Health Commercial |
$4,773.56
|
| Rate for Payer: PHP Commercial |
$4,948.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,783.92
|
| Rate for Payer: Priority Health HMO/PPO |
$5,064.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,900.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,122.84
|
| Rate for Payer: UHC Core |
$4,860.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,366.06
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
IP
|
$10,353.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,729.45 |
| Max. Negotiated Rate |
$9,317.70 |
| Rate for Payer: Aetna Commercial |
$8,800.05
|
| Rate for Payer: BCBS Trust/PPO |
$8,451.15
|
| Rate for Payer: BCN Commercial |
$8,000.80
|
| Rate for Payer: Cash Price |
$8,282.40
|
| Rate for Payer: Cofinity Commercial |
$8,903.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,282.40
|
| Rate for Payer: Healthscope Commercial |
$9,317.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,764.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,800.05
|
| Rate for Payer: Nomi Health Commercial |
$8,489.46
|
| Rate for Payer: PHP Commercial |
$8,800.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,729.45
|
| Rate for Payer: Priority Health HMO/PPO |
$9,007.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,936.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,110.64
|
| Rate for Payer: UHC Core |
$8,644.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,764.75
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
OP
|
$10,353.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,458.84 |
| Max. Negotiated Rate |
$9,317.70 |
| Rate for Payer: Aetna Commercial |
$8,800.05
|
| Rate for Payer: Aetna Medicare |
$2,691.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,235.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,235.31
|
| Rate for Payer: BCBS Complete |
$4,141.20
|
| Rate for Payer: BCBS MAPPO |
$2,588.25
|
| Rate for Payer: BCBS Trust/PPO |
$8,511.20
|
| Rate for Payer: BCN Commercial |
$8,049.46
|
| Rate for Payer: BCN Medicare Advantage |
$2,588.25
|
| Rate for Payer: Cash Price |
$8,282.40
|
| Rate for Payer: Cofinity Commercial |
$8,903.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,282.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,588.25
|
| Rate for Payer: Healthscope Commercial |
$9,317.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,764.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,717.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,976.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,800.05
|
| Rate for Payer: Nomi Health Commercial |
$8,489.46
|
| Rate for Payer: PACE Senior Care Partners |
$2,458.84
|
| Rate for Payer: PACE SWMI |
$2,588.25
|
| Rate for Payer: PHP Commercial |
$8,800.05
|
| Rate for Payer: PHP Medicare Advantage |
$2,588.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,729.45
|
| Rate for Payer: Priority Health HMO/PPO |
$9,007.11
|
| Rate for Payer: Priority Health Medicare |
$2,614.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,936.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,588.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,110.64
|
| Rate for Payer: UHC Core |
$8,644.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,588.25
|
| Rate for Payer: UHC Exchange |
$2,588.25
|
| Rate for Payer: UHC Medicare Advantage |
$2,588.25
|
| Rate for Payer: VA VA |
$2,588.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,764.75
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
OP
|
$13,252.86
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.55 |
| Max. Negotiated Rate |
$11,927.57 |
| Rate for Payer: Aetna Commercial |
$11,264.93
|
| Rate for Payer: Aetna Medicare |
$3,445.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,141.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,141.52
|
| Rate for Payer: BCBS Complete |
$5,301.14
|
| Rate for Payer: BCBS MAPPO |
$3,313.22
|
| Rate for Payer: BCBS Trust/PPO |
$10,895.18
|
| Rate for Payer: BCN Commercial |
$10,304.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,313.22
|
| Rate for Payer: Cash Price |
$10,602.29
|
| Rate for Payer: Cofinity Commercial |
$11,397.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,602.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,313.22
|
| Rate for Payer: Healthscope Commercial |
$11,927.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,939.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,478.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,810.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,264.93
|
| Rate for Payer: Nomi Health Commercial |
$10,867.35
|
| Rate for Payer: PACE Senior Care Partners |
$3,147.55
|
| Rate for Payer: PACE SWMI |
$3,313.22
|
| Rate for Payer: PHP Commercial |
$11,264.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,313.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,614.36
|
| Rate for Payer: Priority Health HMO/PPO |
$11,529.99
|
| Rate for Payer: Priority Health Medicare |
$3,346.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,879.42
|
| Rate for Payer: Railroad Medicare Medicare |
$3,313.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,662.52
|
| Rate for Payer: UHC Core |
$11,066.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,313.22
|
| Rate for Payer: UHC Exchange |
$3,313.22
|
| Rate for Payer: UHC Medicare Advantage |
$3,313.22
|
| Rate for Payer: VA VA |
$3,313.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,939.65
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
IP
|
$13,252.86
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,614.36 |
| Max. Negotiated Rate |
$11,927.57 |
| Rate for Payer: Aetna Commercial |
$11,264.93
|
| Rate for Payer: BCBS Trust/PPO |
$10,818.31
|
| Rate for Payer: BCN Commercial |
$10,241.81
|
| Rate for Payer: Cash Price |
$10,602.29
|
| Rate for Payer: Cofinity Commercial |
$11,397.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,602.29
|
| Rate for Payer: Healthscope Commercial |
$11,927.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,939.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,264.93
|
| Rate for Payer: Nomi Health Commercial |
$10,867.35
|
| Rate for Payer: PHP Commercial |
$11,264.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,614.36
|
| Rate for Payer: Priority Health HMO/PPO |
$11,529.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,879.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,662.52
|
| Rate for Payer: UHC Core |
$11,066.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,939.65
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
IP
|
$534.58
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.48 |
| Max. Negotiated Rate |
$481.12 |
| Rate for Payer: Aetna Commercial |
$454.39
|
| Rate for Payer: BCBS Trust/PPO |
$436.38
|
| Rate for Payer: BCN Commercial |
$413.12
|
| Rate for Payer: Cash Price |
$427.66
|
| Rate for Payer: Cofinity Commercial |
$459.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.66
|
| Rate for Payer: Healthscope Commercial |
$481.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.39
|
| Rate for Payer: Nomi Health Commercial |
$438.36
|
| Rate for Payer: PHP Commercial |
$454.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.48
|
| Rate for Payer: Priority Health HMO/PPO |
$465.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Core |
$446.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.94
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
OP
|
$534.58
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.96 |
| Max. Negotiated Rate |
$481.12 |
| Rate for Payer: Aetna Commercial |
$454.39
|
| Rate for Payer: Aetna Medicare |
$138.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.06
|
| Rate for Payer: BCBS Complete |
$213.83
|
| Rate for Payer: BCBS MAPPO |
$133.65
|
| Rate for Payer: BCBS Trust/PPO |
$439.48
|
| Rate for Payer: BCN Commercial |
$415.64
|
| Rate for Payer: BCN Medicare Advantage |
$133.65
|
| Rate for Payer: Cash Price |
$427.66
|
| Rate for Payer: Cofinity Commercial |
$459.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.65
|
| Rate for Payer: Healthscope Commercial |
$481.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.39
|
| Rate for Payer: Nomi Health Commercial |
$438.36
|
| Rate for Payer: PACE Senior Care Partners |
$126.96
|
| Rate for Payer: PACE SWMI |
$133.65
|
| Rate for Payer: PHP Commercial |
$454.39
|
| Rate for Payer: PHP Medicare Advantage |
$133.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.48
|
| Rate for Payer: Priority Health HMO/PPO |
$465.08
|
| Rate for Payer: Priority Health Medicare |
$134.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.17
|
| Rate for Payer: Railroad Medicare Medicare |
$133.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Core |
$446.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.65
|
| Rate for Payer: UHC Exchange |
$133.65
|
| Rate for Payer: UHC Medicare Advantage |
$133.65
|
| Rate for Payer: VA VA |
$133.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.94
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
IP
|
$1,752.92
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,139.40 |
| Max. Negotiated Rate |
$1,577.63 |
| Rate for Payer: Aetna Commercial |
$1,489.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,430.91
|
| Rate for Payer: BCN Commercial |
$1,354.66
|
| Rate for Payer: Cash Price |
$1,402.34
|
| Rate for Payer: Cofinity Commercial |
$1,507.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,402.34
|
| Rate for Payer: Healthscope Commercial |
$1,577.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,314.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.98
|
| Rate for Payer: Nomi Health Commercial |
$1,437.39
|
| Rate for Payer: PHP Commercial |
$1,489.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,139.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,525.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,174.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,542.57
|
| Rate for Payer: UHC Core |
$1,463.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,314.69
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
OP
|
$1,752.92
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.32 |
| Max. Negotiated Rate |
$1,577.63 |
| Rate for Payer: Aetna Commercial |
$1,489.98
|
| Rate for Payer: Aetna Medicare |
$455.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$547.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$547.79
|
| Rate for Payer: BCBS Complete |
$701.17
|
| Rate for Payer: BCBS MAPPO |
$438.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.08
|
| Rate for Payer: BCN Commercial |
$1,362.90
|
| Rate for Payer: BCN Medicare Advantage |
$438.23
|
| Rate for Payer: Cash Price |
$1,402.34
|
| Rate for Payer: Cofinity Commercial |
$1,507.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,402.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.23
|
| Rate for Payer: Healthscope Commercial |
$1,577.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,314.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$460.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$503.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.98
|
| Rate for Payer: Nomi Health Commercial |
$1,437.39
|
| Rate for Payer: PACE Senior Care Partners |
$416.32
|
| Rate for Payer: PACE SWMI |
$438.23
|
| Rate for Payer: PHP Commercial |
$1,489.98
|
| Rate for Payer: PHP Medicare Advantage |
$438.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,139.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,525.04
|
| Rate for Payer: Priority Health Medicare |
$442.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,174.46
|
| Rate for Payer: Railroad Medicare Medicare |
$438.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,542.57
|
| Rate for Payer: UHC Core |
$1,463.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$438.23
|
| Rate for Payer: UHC Exchange |
$438.23
|
| Rate for Payer: UHC Medicare Advantage |
$438.23
|
| Rate for Payer: VA VA |
$438.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,314.69
|
|
|
HC GUIDEWIRE
|
Facility
|
IP
|
$49.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$44.44 |
| Rate for Payer: Aetna Commercial |
$41.97
|
| Rate for Payer: BCBS Trust/PPO |
$40.31
|
| Rate for Payer: BCN Commercial |
$38.16
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cofinity Commercial |
$42.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.50
|
| Rate for Payer: Healthscope Commercial |
$44.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.97
|
| Rate for Payer: Nomi Health Commercial |
$40.49
|
| Rate for Payer: PHP Commercial |
$41.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.10
|
| Rate for Payer: Priority Health HMO/PPO |
$42.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.45
|
| Rate for Payer: UHC Core |
$41.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.03
|
|
|
HC GUIDEWIRE
|
Facility
|
OP
|
$49.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$44.44 |
| Rate for Payer: Aetna Commercial |
$41.97
|
| Rate for Payer: Aetna Medicare |
$12.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.43
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$12.35
|
| Rate for Payer: BCBS Trust/PPO |
$40.60
|
| Rate for Payer: BCN Commercial |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.35
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cofinity Commercial |
$42.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.35
|
| Rate for Payer: Healthscope Commercial |
$44.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.97
|
| Rate for Payer: Nomi Health Commercial |
$40.49
|
| Rate for Payer: PACE Senior Care Partners |
$11.73
|
| Rate for Payer: PACE SWMI |
$12.35
|
| Rate for Payer: PHP Commercial |
$41.97
|
| Rate for Payer: PHP Medicare Advantage |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.10
|
| Rate for Payer: Priority Health HMO/PPO |
$42.96
|
| Rate for Payer: Priority Health Medicare |
$12.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.45
|
| Rate for Payer: UHC Core |
$41.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.35
|
| Rate for Payer: UHC Exchange |
$12.35
|
| Rate for Payer: UHC Medicare Advantage |
$12.35
|
| Rate for Payer: VA VA |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.03
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
OP
|
$1,345.45
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$319.54 |
| Max. Negotiated Rate |
$1,210.90 |
| Rate for Payer: Aetna Commercial |
$1,143.63
|
| Rate for Payer: Aetna Medicare |
$349.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$420.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$420.45
|
| Rate for Payer: BCBS Complete |
$538.18
|
| Rate for Payer: BCBS MAPPO |
$336.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,106.09
|
| Rate for Payer: BCN Commercial |
$1,046.09
|
| Rate for Payer: BCN Medicare Advantage |
$336.36
|
| Rate for Payer: Cash Price |
$1,076.36
|
| Rate for Payer: Cofinity Commercial |
$1,157.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.36
|
| Rate for Payer: Healthscope Commercial |
$1,210.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,009.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$353.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.63
|
| Rate for Payer: Nomi Health Commercial |
$1,103.27
|
| Rate for Payer: PACE Senior Care Partners |
$319.54
|
| Rate for Payer: PACE SWMI |
$336.36
|
| Rate for Payer: PHP Commercial |
$1,143.63
|
| Rate for Payer: PHP Medicare Advantage |
$336.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.54
|
| Rate for Payer: Priority Health HMO/PPO |
$1,170.54
|
| Rate for Payer: Priority Health Medicare |
$339.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.45
|
| Rate for Payer: Railroad Medicare Medicare |
$336.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,184.00
|
| Rate for Payer: UHC Core |
$1,123.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.36
|
| Rate for Payer: UHC Exchange |
$336.36
|
| Rate for Payer: UHC Medicare Advantage |
$336.36
|
| Rate for Payer: VA VA |
$336.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,009.09
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
IP
|
$1,345.45
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$874.54 |
| Max. Negotiated Rate |
$1,210.90 |
| Rate for Payer: Aetna Commercial |
$1,143.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.29
|
| Rate for Payer: BCN Commercial |
$1,039.76
|
| Rate for Payer: Cash Price |
$1,076.36
|
| Rate for Payer: Cofinity Commercial |
$1,157.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.36
|
| Rate for Payer: Healthscope Commercial |
$1,210.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,009.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.63
|
| Rate for Payer: Nomi Health Commercial |
$1,103.27
|
| Rate for Payer: PHP Commercial |
$1,143.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.54
|
| Rate for Payer: Priority Health HMO/PPO |
$1,170.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,184.00
|
| Rate for Payer: UHC Core |
$1,123.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,009.09
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 1
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.86
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS MAPPO |
$19.89
|
| Rate for Payer: BCBS Trust/PPO |
$65.41
|
| Rate for Payer: BCN Commercial |
$61.86
|
| Rate for Payer: BCN Medicare Advantage |
$19.89
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.89
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.89
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: PHP Medicare Advantage |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO |
$69.22
|
| Rate for Payer: Priority Health Medicare |
$20.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.31
|
| Rate for Payer: Railroad Medicare Medicare |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.01
|
| Rate for Payer: UHC Core |
$66.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.89
|
| Rate for Payer: UHC Exchange |
$19.89
|
| Rate for Payer: UHC Medicare Advantage |
$19.89
|
| Rate for Payer: VA VA |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 1
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: BCBS Trust/PPO |
$64.94
|
| Rate for Payer: BCN Commercial |
$61.48
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO |
$69.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.01
|
| Rate for Payer: UHC Core |
$66.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 14
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$958.75 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Aetna Commercial |
$1,253.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,204.04
|
| Rate for Payer: BCN Commercial |
$1,139.88
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,268.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.00
|
| Rate for Payer: Healthscope Commercial |
$1,327.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.75
|
| Rate for Payer: Nomi Health Commercial |
$1,209.50
|
| Rate for Payer: PHP Commercial |
$1,253.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,283.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$988.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.00
|
| Rate for Payer: UHC Core |
$1,231.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.25
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 14
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.31 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Aetna Commercial |
$1,253.75
|
| Rate for Payer: Aetna Medicare |
$383.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$460.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$460.94
|
| Rate for Payer: BCBS Complete |
$590.00
|
| Rate for Payer: BCBS MAPPO |
$368.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.60
|
| Rate for Payer: BCN Commercial |
$1,146.81
|
| Rate for Payer: BCN Medicare Advantage |
$368.75
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,268.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.75
|
| Rate for Payer: Healthscope Commercial |
$1,327.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.75
|
| Rate for Payer: Nomi Health Commercial |
$1,209.50
|
| Rate for Payer: PACE Senior Care Partners |
$350.31
|
| Rate for Payer: PACE SWMI |
$368.75
|
| Rate for Payer: PHP Commercial |
$1,253.75
|
| Rate for Payer: PHP Medicare Advantage |
$368.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,283.25
|
| Rate for Payer: Priority Health Medicare |
$372.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$988.25
|
| Rate for Payer: Railroad Medicare Medicare |
$368.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.00
|
| Rate for Payer: UHC Core |
$1,231.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$368.75
|
| Rate for Payer: UHC Exchange |
$368.75
|
| Rate for Payer: UHC Medicare Advantage |
$368.75
|
| Rate for Payer: VA VA |
$368.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.25
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.77
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: BCBS MAPPO |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.30
|
| Rate for Payer: BCN Commercial |
$121.34
|
| Rate for Payer: BCN Medicare Advantage |
$39.02
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PACE Senior Care Partners |
$37.06
|
| Rate for Payer: PACE SWMI |
$39.02
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Medicare |
$39.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.56
|
| Rate for Payer: Railroad Medicare Medicare |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.02
|
| Rate for Payer: UHC Exchange |
$39.02
|
| Rate for Payer: UHC Medicare Advantage |
$39.02
|
| Rate for Payer: VA VA |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: BCBS Trust/PPO |
$127.39
|
| Rate for Payer: BCN Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
OP
|
$324.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$292.06 |
| Rate for Payer: Aetna Commercial |
$275.83
|
| Rate for Payer: Aetna Medicare |
$84.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.41
|
| Rate for Payer: BCBS Complete |
$129.80
|
| Rate for Payer: BCBS MAPPO |
$81.13
|
| Rate for Payer: BCBS Trust/PPO |
$266.78
|
| Rate for Payer: BCN Commercial |
$252.31
|
| Rate for Payer: BCN Medicare Advantage |
$81.13
|
| Rate for Payer: Cash Price |
$259.61
|
| Rate for Payer: Cofinity Commercial |
$279.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.13
|
| Rate for Payer: Healthscope Commercial |
$292.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.83
|
| Rate for Payer: Nomi Health Commercial |
$266.10
|
| Rate for Payer: PACE Senior Care Partners |
$77.07
|
| Rate for Payer: PACE SWMI |
$81.13
|
| Rate for Payer: PHP Commercial |
$275.83
|
| Rate for Payer: PHP Medicare Advantage |
$81.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.93
|
| Rate for Payer: Priority Health HMO/PPO |
$282.32
|
| Rate for Payer: Priority Health Medicare |
$81.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.42
|
| Rate for Payer: Railroad Medicare Medicare |
$81.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.57
|
| Rate for Payer: UHC Core |
$270.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.13
|
| Rate for Payer: UHC Exchange |
$81.13
|
| Rate for Payer: UHC Medicare Advantage |
$81.13
|
| Rate for Payer: VA VA |
$81.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.38
|
|
