|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.88
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$13.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.98
|
| Rate for Payer: BCN Commercial |
$41.98
|
| Rate for Payer: BCN Medicare Advantage |
$13.50
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PACE Senior Care Partners |
$12.82
|
| Rate for Payer: PACE SWMI |
$13.50
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: PHP Medicare Advantage |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.98
|
| Rate for Payer: Priority Health Medicare |
$13.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.52
|
| Rate for Payer: UHC Core |
$45.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.50
|
| Rate for Payer: UHC Medicare Advantage |
$13.90
|
| Rate for Payer: VA VA |
$13.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.50
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: BCBS Trust/PPO |
$41.73
|
| Rate for Payer: BCN Commercial |
$41.73
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.52
|
| Rate for Payer: UHC Core |
$45.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.50
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,440.03
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$878.27 |
| Max. Negotiated Rate |
$1,296.03 |
| Rate for Payer: Aetna Commercial |
$1,224.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.86
|
| Rate for Payer: BCN Commercial |
$1,112.86
|
| Rate for Payer: Cash Price |
$1,152.02
|
| Rate for Payer: Cofinity Commercial |
$1,238.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.02
|
| Rate for Payer: Healthscope Commercial |
$1,296.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.03
|
| Rate for Payer: PHP Commercial |
$1,224.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,252.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.23
|
| Rate for Payer: UHC Core |
$1,202.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.02
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,440.03
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$342.01 |
| Max. Negotiated Rate |
$1,296.03 |
| Rate for Payer: Aetna Commercial |
$1,224.03
|
| Rate for Payer: Aetna Medicare |
$374.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$450.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$450.01
|
| Rate for Payer: BCBS Complete |
$576.01
|
| Rate for Payer: BCBS MAPPO |
$360.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,119.62
|
| Rate for Payer: BCN Commercial |
$1,119.62
|
| Rate for Payer: BCN Medicare Advantage |
$360.01
|
| Rate for Payer: Cash Price |
$1,152.02
|
| Rate for Payer: Cofinity Commercial |
$1,238.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.01
|
| Rate for Payer: Healthscope Commercial |
$1,296.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$378.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.03
|
| Rate for Payer: PACE Senior Care Partners |
$342.01
|
| Rate for Payer: PACE SWMI |
$360.01
|
| Rate for Payer: PHP Commercial |
$1,224.03
|
| Rate for Payer: PHP Medicare Advantage |
$360.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,252.83
|
| Rate for Payer: Priority Health Medicare |
$360.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.27
|
| Rate for Payer: Railroad Medicare Medicare |
$360.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.23
|
| Rate for Payer: UHC Core |
$1,202.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$360.01
|
| Rate for Payer: UHC Medicare Advantage |
$370.81
|
| Rate for Payer: VA VA |
$360.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.02
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,215.00
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$1,093.50 |
| Rate for Payer: Aetna Commercial |
$1,032.75
|
| Rate for Payer: Aetna Medicare |
$315.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.69
|
| Rate for Payer: BCBS Complete |
$486.00
|
| Rate for Payer: BCBS MAPPO |
$303.75
|
| Rate for Payer: BCBS Trust/PPO |
$944.66
|
| Rate for Payer: BCN Commercial |
$944.66
|
| Rate for Payer: BCN Medicare Advantage |
$303.75
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,044.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.75
|
| Rate for Payer: Healthscope Commercial |
$1,093.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$911.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$318.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: PACE Senior Care Partners |
$288.56
|
| Rate for Payer: PACE SWMI |
$303.75
|
| Rate for Payer: PHP Commercial |
$1,032.75
|
| Rate for Payer: PHP Medicare Advantage |
$303.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.05
|
| Rate for Payer: Priority Health Medicare |
$303.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$741.03
|
| Rate for Payer: Railroad Medicare Medicare |
$303.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,069.20
|
| Rate for Payer: UHC Core |
$1,014.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.75
|
| Rate for Payer: UHC Medicare Advantage |
$312.86
|
| Rate for Payer: VA VA |
$303.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$911.25
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,215.00
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$741.03 |
| Max. Negotiated Rate |
$1,093.50 |
| Rate for Payer: Aetna Commercial |
$1,032.75
|
| Rate for Payer: BCBS Trust/PPO |
$938.95
|
| Rate for Payer: BCN Commercial |
$938.95
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,044.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.00
|
| Rate for Payer: Healthscope Commercial |
$1,093.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$911.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: PHP Commercial |
$1,032.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$741.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,069.20
|
| Rate for Payer: UHC Core |
$1,014.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$911.25
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$750.18 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Aetna Commercial |
$1,045.50
|
| Rate for Payer: BCBS Trust/PPO |
$950.54
|
| Rate for Payer: BCN Commercial |
$950.54
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cofinity Commercial |
$1,057.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$984.00
|
| Rate for Payer: Healthscope Commercial |
$1,107.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$922.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,045.50
|
| Rate for Payer: PHP Commercial |
$1,045.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,070.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$750.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,082.40
|
| Rate for Payer: UHC Core |
$1,027.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$922.50
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.12 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Aetna Commercial |
$1,045.50
|
| Rate for Payer: Aetna Medicare |
$319.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$384.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$384.38
|
| Rate for Payer: BCBS Complete |
$492.00
|
| Rate for Payer: BCBS MAPPO |
$307.50
|
| Rate for Payer: BCBS Trust/PPO |
$956.32
|
| Rate for Payer: BCN Commercial |
$956.32
|
| Rate for Payer: BCN Medicare Advantage |
$307.50
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cofinity Commercial |
$1,057.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$984.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.50
|
| Rate for Payer: Healthscope Commercial |
$1,107.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$922.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$322.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,045.50
|
| Rate for Payer: PACE Senior Care Partners |
$292.12
|
| Rate for Payer: PACE SWMI |
$307.50
|
| Rate for Payer: PHP Commercial |
$1,045.50
|
| Rate for Payer: PHP Medicare Advantage |
$307.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,070.10
|
| Rate for Payer: Priority Health Medicare |
$307.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$750.18
|
| Rate for Payer: Railroad Medicare Medicare |
$307.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,082.40
|
| Rate for Payer: UHC Core |
$1,027.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$307.50
|
| Rate for Payer: UHC Medicare Advantage |
$316.72
|
| Rate for Payer: VA VA |
$307.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$922.50
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,787.50
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$899.53 |
| Max. Negotiated Rate |
$3,408.75 |
| Rate for Payer: Aetna Commercial |
$3,219.38
|
| Rate for Payer: Aetna Medicare |
$984.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,183.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,183.59
|
| Rate for Payer: BCBS Complete |
$1,515.00
|
| Rate for Payer: BCBS MAPPO |
$946.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,944.78
|
| Rate for Payer: BCN Commercial |
$2,944.78
|
| Rate for Payer: BCN Medicare Advantage |
$946.88
|
| Rate for Payer: Cash Price |
$3,030.00
|
| Rate for Payer: Cofinity Commercial |
$3,257.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,030.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.88
|
| Rate for Payer: Healthscope Commercial |
$3,408.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,840.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$994.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,088.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,219.38
|
| Rate for Payer: PACE Senior Care Partners |
$899.53
|
| Rate for Payer: PACE SWMI |
$946.88
|
| Rate for Payer: PHP Commercial |
$3,219.38
|
| Rate for Payer: PHP Medicare Advantage |
$946.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,295.12
|
| Rate for Payer: Priority Health Medicare |
$946.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,310.00
|
| Rate for Payer: Railroad Medicare Medicare |
$946.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,333.00
|
| Rate for Payer: UHC Core |
$3,162.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$946.88
|
| Rate for Payer: UHC Medicare Advantage |
$975.28
|
| Rate for Payer: VA VA |
$946.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,840.62
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,787.50
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,310.00 |
| Max. Negotiated Rate |
$3,408.75 |
| Rate for Payer: Aetna Commercial |
$3,219.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,926.98
|
| Rate for Payer: BCN Commercial |
$2,926.98
|
| Rate for Payer: Cash Price |
$3,030.00
|
| Rate for Payer: Cofinity Commercial |
$3,257.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,030.00
|
| Rate for Payer: Healthscope Commercial |
$3,408.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,840.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,219.38
|
| Rate for Payer: PHP Commercial |
$3,219.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,295.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,310.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,333.00
|
| Rate for Payer: UHC Core |
$3,162.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,840.62
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$786.48
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$479.67 |
| Max. Negotiated Rate |
$707.83 |
| Rate for Payer: Aetna Commercial |
$668.51
|
| Rate for Payer: BCBS Trust/PPO |
$607.79
|
| Rate for Payer: BCN Commercial |
$607.79
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cofinity Commercial |
$676.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.18
|
| Rate for Payer: Healthscope Commercial |
$707.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$668.51
|
| Rate for Payer: PHP Commercial |
$668.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$684.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$692.10
|
| Rate for Payer: UHC Core |
$656.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.86
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$786.48
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$130.71 |
| Max. Negotiated Rate |
$707.83 |
| Rate for Payer: Aetna Commercial |
$668.51
|
| Rate for Payer: Aetna Medicare |
$204.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.78
|
| Rate for Payer: BCBS Complete |
$137.25
|
| Rate for Payer: BCBS MAPPO |
$196.62
|
| Rate for Payer: BCBS Trust/PPO |
$611.49
|
| Rate for Payer: BCN Commercial |
$611.49
|
| Rate for Payer: BCN Medicare Advantage |
$196.62
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cofinity Commercial |
$676.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.62
|
| Rate for Payer: Healthscope Commercial |
$707.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.86
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Meridian Medicaid |
$137.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$206.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$668.51
|
| Rate for Payer: PACE Senior Care Partners |
$186.79
|
| Rate for Payer: PACE SWMI |
$196.62
|
| Rate for Payer: PHP Commercial |
$668.51
|
| Rate for Payer: PHP Medicare Advantage |
$196.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$684.24
|
| Rate for Payer: Priority Health Medicare |
$196.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.67
|
| Rate for Payer: Railroad Medicare Medicare |
$196.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$692.10
|
| Rate for Payer: UHC Core |
$656.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.62
|
| Rate for Payer: UHC Medicare Advantage |
$202.52
|
| Rate for Payer: VA VA |
$196.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.86
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,849.92 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,145.31
|
| Rate for Payer: BCN Commercial |
$6,145.31
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,964.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,759.20
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,566.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,918.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,849.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,997.76
|
| Rate for Payer: UHC Core |
$6,639.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,964.00
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,888.60 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: Aetna Medicare |
$2,067.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,485.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,485.00
|
| Rate for Payer: BCBS Complete |
$3,180.80
|
| Rate for Payer: BCBS MAPPO |
$1,988.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,182.68
|
| Rate for Payer: BCN Commercial |
$6,182.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,988.00
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,988.00
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,964.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,087.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,286.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,759.20
|
| Rate for Payer: PACE Senior Care Partners |
$1,888.60
|
| Rate for Payer: PACE SWMI |
$1,988.00
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,988.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,566.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,918.24
|
| Rate for Payer: Priority Health Medicare |
$1,988.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,849.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,988.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,997.76
|
| Rate for Payer: UHC Core |
$6,639.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,988.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,047.64
|
| Rate for Payer: VA VA |
$1,988.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,964.00
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
OP
|
$9,052.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,149.85 |
| Max. Negotiated Rate |
$8,146.80 |
| Rate for Payer: Aetna Commercial |
$7,694.20
|
| Rate for Payer: Aetna Medicare |
$2,353.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,828.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,828.75
|
| Rate for Payer: BCBS Complete |
$3,620.80
|
| Rate for Payer: BCBS MAPPO |
$2,263.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,037.93
|
| Rate for Payer: BCN Commercial |
$7,037.93
|
| Rate for Payer: BCN Medicare Advantage |
$2,263.00
|
| Rate for Payer: Cash Price |
$7,241.60
|
| Rate for Payer: Cofinity Commercial |
$7,784.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,241.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,263.00
|
| Rate for Payer: Healthscope Commercial |
$8,146.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,789.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,376.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,602.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,694.20
|
| Rate for Payer: PACE Senior Care Partners |
$2,149.85
|
| Rate for Payer: PACE SWMI |
$2,263.00
|
| Rate for Payer: PHP Commercial |
$7,694.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,263.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,336.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,875.24
|
| Rate for Payer: Priority Health Medicare |
$2,263.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,520.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,263.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,965.76
|
| Rate for Payer: UHC Core |
$7,558.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,263.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,330.89
|
| Rate for Payer: VA VA |
$2,263.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,789.00
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
IP
|
$9,052.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,520.81 |
| Max. Negotiated Rate |
$8,146.80 |
| Rate for Payer: Aetna Commercial |
$7,694.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,995.39
|
| Rate for Payer: BCN Commercial |
$6,995.39
|
| Rate for Payer: Cash Price |
$7,241.60
|
| Rate for Payer: Cofinity Commercial |
$7,784.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,241.60
|
| Rate for Payer: Healthscope Commercial |
$8,146.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,789.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,694.20
|
| Rate for Payer: PHP Commercial |
$7,694.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,336.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,875.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,520.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,965.76
|
| Rate for Payer: UHC Core |
$7,558.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,789.00
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
IP
|
$17,588.23
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,727.06 |
| Max. Negotiated Rate |
$15,829.41 |
| Rate for Payer: Aetna Commercial |
$14,950.00
|
| Rate for Payer: BCBS Trust/PPO |
$13,592.18
|
| Rate for Payer: BCN Commercial |
$13,592.18
|
| Rate for Payer: Cash Price |
$14,070.58
|
| Rate for Payer: Cofinity Commercial |
$15,125.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,070.58
|
| Rate for Payer: Healthscope Commercial |
$15,829.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,191.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,950.00
|
| Rate for Payer: PHP Commercial |
$14,950.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,311.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,301.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,727.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,477.64
|
| Rate for Payer: UHC Core |
$14,686.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,191.17
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
OP
|
$17,588.23
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,177.20 |
| Max. Negotiated Rate |
$15,829.41 |
| Rate for Payer: Aetna Commercial |
$14,950.00
|
| Rate for Payer: Aetna Medicare |
$4,572.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,496.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,496.32
|
| Rate for Payer: BCBS Complete |
$7,355.10
|
| Rate for Payer: BCBS MAPPO |
$4,397.06
|
| Rate for Payer: BCBS Trust/PPO |
$13,674.85
|
| Rate for Payer: BCN Commercial |
$13,674.85
|
| Rate for Payer: BCN Medicare Advantage |
$4,397.06
|
| Rate for Payer: Cash Price |
$14,070.58
|
| Rate for Payer: Cash Price |
$14,070.58
|
| Rate for Payer: Cofinity Commercial |
$15,125.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,070.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,397.06
|
| Rate for Payer: Healthscope Commercial |
$15,829.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,191.17
|
| Rate for Payer: Mclaren Medicaid |
$7,004.86
|
| Rate for Payer: Meridian Medicaid |
$7,355.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,616.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,056.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,950.00
|
| Rate for Payer: PACE Senior Care Partners |
$4,177.20
|
| Rate for Payer: PACE SWMI |
$4,397.06
|
| Rate for Payer: PHP Commercial |
$14,950.00
|
| Rate for Payer: PHP Medicare Advantage |
$4,397.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,004.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,311.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,301.76
|
| Rate for Payer: Priority Health Medicare |
$4,397.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,727.06
|
| Rate for Payer: Railroad Medicare Medicare |
$4,397.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,477.64
|
| Rate for Payer: UHC Core |
$14,686.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,397.06
|
| Rate for Payer: UHC Medicare Advantage |
$4,528.97
|
| Rate for Payer: VA VA |
$4,397.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,191.17
|
|
|
HC PACEMAKER LEAD
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.86 |
| Max. Negotiated Rate |
$1,719.90 |
| Rate for Payer: Aetna Commercial |
$1,624.35
|
| Rate for Payer: Aetna Medicare |
$496.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$597.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$597.19
|
| Rate for Payer: BCBS Complete |
$764.40
|
| Rate for Payer: BCBS MAPPO |
$477.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,485.80
|
| Rate for Payer: BCN Commercial |
$1,485.80
|
| Rate for Payer: BCN Medicare Advantage |
$477.75
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,643.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.75
|
| Rate for Payer: Healthscope Commercial |
$1,719.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,433.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$501.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$549.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,624.35
|
| Rate for Payer: PACE Senior Care Partners |
$453.86
|
| Rate for Payer: PACE SWMI |
$477.75
|
| Rate for Payer: PHP Commercial |
$1,624.35
|
| Rate for Payer: PHP Medicare Advantage |
$477.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,662.57
|
| Rate for Payer: Priority Health Medicare |
$477.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,165.52
|
| Rate for Payer: Railroad Medicare Medicare |
$477.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,681.68
|
| Rate for Payer: UHC Core |
$1,595.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.75
|
| Rate for Payer: UHC Medicare Advantage |
$492.08
|
| Rate for Payer: VA VA |
$477.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,433.25
|
|
|
HC PACEMAKER LEAD
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.52 |
| Max. Negotiated Rate |
$1,719.90 |
| Rate for Payer: Aetna Commercial |
$1,624.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.82
|
| Rate for Payer: BCN Commercial |
$1,476.82
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,643.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.80
|
| Rate for Payer: Healthscope Commercial |
$1,719.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,433.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,624.35
|
| Rate for Payer: PHP Commercial |
$1,624.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,662.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,165.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,681.68
|
| Rate for Payer: UHC Core |
$1,595.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,433.25
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
IP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,251.10 |
| Max. Negotiated Rate |
$10,700.10 |
| Rate for Payer: Aetna Commercial |
$10,105.65
|
| Rate for Payer: BCBS Trust/PPO |
$9,187.82
|
| Rate for Payer: BCN Commercial |
$9,187.82
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$10,224.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Healthscope Commercial |
$10,700.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,916.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,105.65
|
| Rate for Payer: PHP Commercial |
$10,105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,322.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,343.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,251.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,462.32
|
| Rate for Payer: UHC Core |
$9,927.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,916.75
|
|
|
HC PACEMAKER OTHER SINGLE OR DUAL LVL 11
|
Facility
|
OP
|
$11,889.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27500348
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,823.64 |
| Max. Negotiated Rate |
$10,700.10 |
| Rate for Payer: Aetna Commercial |
$10,105.65
|
| Rate for Payer: Aetna Medicare |
$3,091.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,715.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,715.31
|
| Rate for Payer: BCBS Complete |
$4,755.60
|
| Rate for Payer: BCBS MAPPO |
$2,972.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,243.70
|
| Rate for Payer: BCN Commercial |
$9,243.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,972.25
|
| Rate for Payer: Cash Price |
$9,511.20
|
| Rate for Payer: Cofinity Commercial |
$10,224.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,511.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,972.25
|
| Rate for Payer: Healthscope Commercial |
$10,700.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,916.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,120.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,418.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,105.65
|
| Rate for Payer: PACE Senior Care Partners |
$2,823.64
|
| Rate for Payer: PACE SWMI |
$2,972.25
|
| Rate for Payer: PHP Commercial |
$10,105.65
|
| Rate for Payer: PHP Medicare Advantage |
$2,972.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,322.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,343.43
|
| Rate for Payer: Priority Health Medicare |
$2,972.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,251.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2,972.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,462.32
|
| Rate for Payer: UHC Core |
$9,927.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,972.25
|
| Rate for Payer: UHC Medicare Advantage |
$3,061.42
|
| Rate for Payer: VA VA |
$2,972.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,916.75
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 13
|
Facility
|
IP
|
$13,500.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500351
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,233.65 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Aetna Commercial |
$11,475.00
|
| Rate for Payer: BCBS Trust/PPO |
$10,432.80
|
| Rate for Payer: BCN Commercial |
$10,432.80
|
| Rate for Payer: Cash Price |
$10,800.00
|
| Rate for Payer: Cofinity Commercial |
$11,610.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,800.00
|
| Rate for Payer: Healthscope Commercial |
$12,150.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,475.00
|
| Rate for Payer: PHP Commercial |
$11,475.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,450.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,745.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,233.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,880.00
|
| Rate for Payer: UHC Core |
$11,272.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,125.00
|
|
