|
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
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
OP
|
$16,532.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,926.47 |
| Max. Negotiated Rate |
$14,879.25 |
| Rate for Payer: Aetna Commercial |
$14,052.62
|
| Rate for Payer: Aetna Medicare |
$4,298.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,166.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,166.41
|
| Rate for Payer: BCBS Complete |
$6,613.00
|
| Rate for Payer: BCBS MAPPO |
$4,133.12
|
| Rate for Payer: BCBS Trust/PPO |
$12,854.02
|
| Rate for Payer: BCN Commercial |
$12,854.02
|
| Rate for Payer: BCN Medicare Advantage |
$4,133.12
|
| Rate for Payer: Cash Price |
$13,226.00
|
| Rate for Payer: Cofinity Commercial |
$14,217.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,226.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,133.12
|
| Rate for Payer: Healthscope Commercial |
$14,879.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,399.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,339.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,753.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,052.62
|
| Rate for Payer: PACE Senior Care Partners |
$3,926.47
|
| Rate for Payer: PACE SWMI |
$4,133.12
|
| Rate for Payer: PHP Commercial |
$14,052.62
|
| Rate for Payer: PHP Medicare Advantage |
$4,133.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,572.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,383.28
|
| Rate for Payer: Priority Health Medicare |
$4,133.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,083.17
|
| Rate for Payer: Railroad Medicare Medicare |
$4,133.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,548.60
|
| Rate for Payer: UHC Core |
$13,804.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,133.12
|
| Rate for Payer: UHC Medicare Advantage |
$4,257.12
|
| Rate for Payer: VA VA |
$4,133.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,399.38
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 16
|
Facility
|
IP
|
$16,532.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500350
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,083.17 |
| Max. Negotiated Rate |
$14,879.25 |
| Rate for Payer: Aetna Commercial |
$14,052.62
|
| Rate for Payer: BCBS Trust/PPO |
$12,776.32
|
| Rate for Payer: BCN Commercial |
$12,776.32
|
| Rate for Payer: Cash Price |
$13,226.00
|
| Rate for Payer: Cofinity Commercial |
$14,217.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,226.00
|
| Rate for Payer: Healthscope Commercial |
$14,879.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,399.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,052.62
|
| Rate for Payer: PHP Commercial |
$14,052.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,572.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,383.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,083.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,548.60
|
| Rate for Payer: UHC Core |
$13,804.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,399.38
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
OP
|
$6,196.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,471.55 |
| Max. Negotiated Rate |
$5,576.40 |
| Rate for Payer: Aetna Commercial |
$5,266.60
|
| Rate for Payer: Aetna Medicare |
$1,610.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,936.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,936.25
|
| Rate for Payer: BCBS Complete |
$2,478.40
|
| Rate for Payer: BCBS MAPPO |
$1,549.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,817.39
|
| Rate for Payer: BCN Commercial |
$4,817.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,549.00
|
| Rate for Payer: Cash Price |
$4,956.80
|
| Rate for Payer: Cofinity Commercial |
$5,328.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,956.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,549.00
|
| Rate for Payer: Healthscope Commercial |
$5,576.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,647.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,626.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,781.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,266.60
|
| Rate for Payer: PACE Senior Care Partners |
$1,471.55
|
| Rate for Payer: PACE SWMI |
$1,549.00
|
| Rate for Payer: PHP Commercial |
$5,266.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,549.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,337.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,390.52
|
| Rate for Payer: Priority Health Medicare |
$1,549.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,778.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,549.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,452.48
|
| Rate for Payer: UHC Core |
$5,173.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,549.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,595.47
|
| Rate for Payer: VA VA |
$1,549.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,647.00
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 6
|
Facility
|
IP
|
$6,196.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500352
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,778.94 |
| Max. Negotiated Rate |
$5,576.40 |
| Rate for Payer: Aetna Commercial |
$5,266.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,788.27
|
| Rate for Payer: BCN Commercial |
$4,788.27
|
| Rate for Payer: Cash Price |
$4,956.80
|
| Rate for Payer: Cofinity Commercial |
$5,328.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,956.80
|
| Rate for Payer: Healthscope Commercial |
$5,576.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,647.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,266.60
|
| Rate for Payer: PHP Commercial |
$5,266.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,337.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,390.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,778.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,452.48
|
| Rate for Payer: UHC Core |
$5,173.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,647.00
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
OP
|
$8,152.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,936.10 |
| Max. Negotiated Rate |
$7,336.80 |
| Rate for Payer: Aetna Commercial |
$6,929.20
|
| Rate for Payer: Aetna Medicare |
$2,119.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,547.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,547.50
|
| Rate for Payer: BCBS Complete |
$3,260.80
|
| Rate for Payer: BCBS MAPPO |
$2,038.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,338.18
|
| Rate for Payer: BCN Commercial |
$6,338.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,038.00
|
| Rate for Payer: Cash Price |
$6,521.60
|
| Rate for Payer: Cofinity Commercial |
$7,010.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,521.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,038.00
|
| Rate for Payer: Healthscope Commercial |
$7,336.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,114.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,139.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,343.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,929.20
|
| Rate for Payer: PACE Senior Care Partners |
$1,936.10
|
| Rate for Payer: PACE SWMI |
$2,038.00
|
| Rate for Payer: PHP Commercial |
$6,929.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,038.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,706.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,092.24
|
| Rate for Payer: Priority Health Medicare |
$2,038.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,971.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2,038.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,173.76
|
| Rate for Payer: UHC Core |
$6,806.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,038.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,099.14
|
| Rate for Payer: VA VA |
$2,038.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.00
|
|
|
HC PACEMAKER SINGLE CHAMBER LVL 8
|
Facility
|
IP
|
$8,152.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500353
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,971.90 |
| Max. Negotiated Rate |
$7,336.80 |
| Rate for Payer: Aetna Commercial |
$6,929.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,299.87
|
| Rate for Payer: BCN Commercial |
$6,299.87
|
| Rate for Payer: Cash Price |
$6,521.60
|
| Rate for Payer: Cofinity Commercial |
$7,010.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,521.60
|
| Rate for Payer: Healthscope Commercial |
$7,336.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,114.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,929.20
|
| Rate for Payer: PHP Commercial |
$6,929.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,706.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,092.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,971.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,173.76
|
| Rate for Payer: UHC Core |
$6,806.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.00
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
OP
|
$112.44
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$95.57
|
| Rate for Payer: Aetna Medicare |
$29.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.14
|
| Rate for Payer: BCBS Complete |
$44.98
|
| Rate for Payer: BCBS MAPPO |
$28.11
|
| Rate for Payer: BCBS Trust/PPO |
$87.42
|
| Rate for Payer: BCN Commercial |
$87.42
|
| Rate for Payer: BCN Medicare Advantage |
$28.11
|
| Rate for Payer: Cash Price |
$89.95
|
| Rate for Payer: Cofinity Commercial |
$96.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.11
|
| Rate for Payer: Healthscope Commercial |
$101.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.57
|
| Rate for Payer: PACE Senior Care Partners |
$26.70
|
| Rate for Payer: PACE SWMI |
$28.11
|
| Rate for Payer: PHP Commercial |
$95.57
|
| Rate for Payer: PHP Medicare Advantage |
$28.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.82
|
| Rate for Payer: Priority Health Medicare |
$28.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.58
|
| Rate for Payer: Railroad Medicare Medicare |
$28.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.95
|
| Rate for Payer: UHC Core |
$93.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.11
|
| Rate for Payer: UHC Medicare Advantage |
$28.95
|
| Rate for Payer: VA VA |
$28.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.33
|
|
|
HC PACEMAKER TESTING CABLE
|
Facility
|
IP
|
$112.44
|
|
| Hospital Charge Code |
27200143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.58 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$95.57
|
| Rate for Payer: BCBS Trust/PPO |
$86.89
|
| Rate for Payer: BCN Commercial |
$86.89
|
| Rate for Payer: Cash Price |
$89.95
|
| Rate for Payer: Cofinity Commercial |
$96.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.95
|
| Rate for Payer: Healthscope Commercial |
$101.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.57
|
| Rate for Payer: PHP Commercial |
$95.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.95
|
| Rate for Payer: UHC Core |
$93.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.33
|
|
|
HC PACER POCKET REVISION
|
Facility
|
IP
|
$2,701.70
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,647.77 |
| Max. Negotiated Rate |
$2,431.53 |
| Rate for Payer: Aetna Commercial |
$2,296.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,087.87
|
| Rate for Payer: BCN Commercial |
$2,087.87
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,323.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Healthscope Commercial |
$2,431.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,026.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: PHP Commercial |
$2,296.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,350.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,647.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,377.50
|
| Rate for Payer: UHC Core |
$2,255.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,026.28
|
|
|
HC PACER POCKET REVISION
|
Facility
|
OP
|
$2,701.70
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
36100067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$641.65 |
| Max. Negotiated Rate |
$2,431.53 |
| Rate for Payer: Aetna Commercial |
$2,296.44
|
| Rate for Payer: Aetna Medicare |
$702.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.28
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$675.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,100.57
|
| Rate for Payer: BCN Commercial |
$2,100.57
|
| Rate for Payer: BCN Medicare Advantage |
$675.42
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,323.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.42
|
| Rate for Payer: Healthscope Commercial |
$2,431.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,026.28
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$709.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: PACE Senior Care Partners |
$641.65
|
| Rate for Payer: PACE SWMI |
$675.42
|
| Rate for Payer: PHP Commercial |
$2,296.44
|
| Rate for Payer: PHP Medicare Advantage |
$675.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,350.48
|
| Rate for Payer: Priority Health Medicare |
$675.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,647.77
|
| Rate for Payer: Railroad Medicare Medicare |
$675.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,377.50
|
| Rate for Payer: UHC Core |
$2,255.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.42
|
| Rate for Payer: UHC Medicare Advantage |
$695.69
|
| Rate for Payer: VA VA |
$675.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,026.28
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$457.42 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$637.50
|
| Rate for Payer: BCBS Trust/PPO |
$579.60
|
| Rate for Payer: BCN Commercial |
$579.60
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$645.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.00
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$637.50
|
| Rate for Payer: PHP Commercial |
$637.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.00
|
| Rate for Payer: UHC Core |
$626.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$562.50
|
|
|
HC PACK CCS BRONSON FX XC BASE
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
27000682
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.12 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$637.50
|
| Rate for Payer: Aetna Medicare |
$195.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.38
|
| Rate for Payer: BCBS Complete |
$300.00
|
| Rate for Payer: BCBS MAPPO |
$187.50
|
| Rate for Payer: BCBS Trust/PPO |
$583.12
|
| Rate for Payer: BCN Commercial |
$583.12
|
| Rate for Payer: BCN Medicare Advantage |
$187.50
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$645.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.50
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$562.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$196.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$637.50
|
| Rate for Payer: PACE Senior Care Partners |
$178.12
|
| Rate for Payer: PACE SWMI |
$187.50
|
| Rate for Payer: PHP Commercial |
$637.50
|
| Rate for Payer: PHP Medicare Advantage |
$187.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.50
|
| Rate for Payer: Priority Health Medicare |
$187.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.42
|
| Rate for Payer: Railroad Medicare Medicare |
$187.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.00
|
| Rate for Payer: UHC Core |
$626.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.50
|
| Rate for Payer: UHC Medicare Advantage |
$193.12
|
| Rate for Payer: VA VA |
$187.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$562.50
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$809.10
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$728.19 |
| Rate for Payer: Aetna Commercial |
$687.74
|
| Rate for Payer: Aetna Medicare |
$210.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.84
|
| Rate for Payer: BCBS Complete |
$130.72
|
| Rate for Payer: BCBS MAPPO |
$202.28
|
| Rate for Payer: BCBS Trust/PPO |
$629.08
|
| Rate for Payer: BCN Commercial |
$629.08
|
| Rate for Payer: BCN Medicare Advantage |
$202.28
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$695.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.28
|
| Rate for Payer: Healthscope Commercial |
$728.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.82
|
| Rate for Payer: Mclaren Medicaid |
$124.49
|
| Rate for Payer: Meridian Medicaid |
$130.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$212.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PACE Senior Care Partners |
$192.16
|
| Rate for Payer: PACE SWMI |
$202.28
|
| Rate for Payer: PHP Commercial |
$687.74
|
| Rate for Payer: PHP Medicare Advantage |
$202.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.92
|
| Rate for Payer: Priority Health Medicare |
$202.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.47
|
| Rate for Payer: Railroad Medicare Medicare |
$202.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.01
|
| Rate for Payer: UHC Core |
$675.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.28
|
| Rate for Payer: UHC Medicare Advantage |
$208.34
|
| Rate for Payer: VA VA |
$202.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.82
|
|
|
HC PACKED CELLS DIRECT
|
Facility
|
IP
|
$809.10
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$493.47 |
| Max. Negotiated Rate |
$728.19 |
| Rate for Payer: Aetna Commercial |
$687.74
|
| Rate for Payer: BCBS Trust/PPO |
$625.27
|
| Rate for Payer: BCN Commercial |
$625.27
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$695.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.28
|
| Rate for Payer: Healthscope Commercial |
$728.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PHP Commercial |
$687.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.01
|
| Rate for Payer: UHC Core |
$675.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.82
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$173.83 |
| Max. Negotiated Rate |
$1,109.20 |
| Rate for Payer: Aetna Commercial |
$1,047.57
|
| Rate for Payer: Aetna Medicare |
$320.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$385.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$385.14
|
| Rate for Payer: BCBS Complete |
$182.52
|
| Rate for Payer: BCBS MAPPO |
$308.11
|
| Rate for Payer: BCBS Trust/PPO |
$958.22
|
| Rate for Payer: BCN Commercial |
$958.22
|
| Rate for Payer: BCN Medicare Advantage |
$308.11
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$985.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.11
|
| Rate for Payer: Healthscope Commercial |
$1,109.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$924.33
|
| Rate for Payer: Mclaren Medicaid |
$173.83
|
| Rate for Payer: Meridian Medicaid |
$182.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$323.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PACE Senior Care Partners |
$292.70
|
| Rate for Payer: PACE SWMI |
$308.11
|
| Rate for Payer: PHP Commercial |
$1,047.57
|
| Rate for Payer: PHP Medicare Advantage |
$308.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.22
|
| Rate for Payer: Priority Health Medicare |
$308.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$751.67
|
| Rate for Payer: Railroad Medicare Medicare |
$308.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,084.55
|
| Rate for Payer: UHC Core |
$1,029.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.11
|
| Rate for Payer: UHC Medicare Advantage |
$317.35
|
| Rate for Payer: VA VA |
$308.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$924.33
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$751.67 |
| Max. Negotiated Rate |
$1,109.20 |
| Rate for Payer: Aetna Commercial |
$1,047.57
|
| Rate for Payer: BCBS Trust/PPO |
$952.43
|
| Rate for Payer: BCN Commercial |
$952.43
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$985.95
|
| Rate for Payer: Healthscope Commercial |
$1,109.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$924.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PHP Commercial |
$1,047.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$751.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,084.55
|
| Rate for Payer: UHC Core |
$1,029.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$924.33
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: Aetna Medicare |
$24.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.00
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS MAPPO |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$74.64
|
| Rate for Payer: BCN Commercial |
$74.64
|
| Rate for Payer: BCN Medicare Advantage |
$24.00
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$82.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$86.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: PACE Senior Care Partners |
$22.80
|
| Rate for Payer: PACE SWMI |
$24.00
|
| Rate for Payer: PHP Commercial |
$81.60
|
| Rate for Payer: PHP Medicare Advantage |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.52
|
| Rate for Payer: Priority Health Medicare |
$24.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.55
|
| Rate for Payer: Railroad Medicare Medicare |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.48
|
| Rate for Payer: UHC Core |
$80.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.00
|
| Rate for Payer: UHC Medicare Advantage |
$24.72
|
| Rate for Payer: VA VA |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.00
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.55 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$74.19
|
| Rate for Payer: BCN Commercial |
$74.19
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$82.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Healthscope Commercial |
$86.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: PHP Commercial |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.48
|
| Rate for Payer: UHC Core |
$80.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.00
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: Aetna Medicare |
$175.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.94
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS MAPPO |
$168.75
|
| Rate for Payer: BCBS Trust/PPO |
$524.81
|
| Rate for Payer: BCN Commercial |
$524.81
|
| Rate for Payer: BCN Medicare Advantage |
$168.75
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.75
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: PACE Senior Care Partners |
$160.31
|
| Rate for Payer: PACE SWMI |
$168.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: PHP Medicare Advantage |
$168.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.25
|
| Rate for Payer: Priority Health Medicare |
$168.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.68
|
| Rate for Payer: Railroad Medicare Medicare |
$168.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.00
|
| Rate for Payer: UHC Core |
$563.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.75
|
| Rate for Payer: UHC Medicare Advantage |
$173.81
|
| Rate for Payer: VA VA |
$168.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$411.68 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: BCBS Trust/PPO |
$521.64
|
| Rate for Payer: BCN Commercial |
$521.64
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.00
|
| Rate for Payer: UHC Core |
$563.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.25
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$201.00
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.59 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna Commercial |
$170.85
|
| Rate for Payer: BCBS Trust/PPO |
$155.33
|
| Rate for Payer: BCN Commercial |
$155.33
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.80
|
| Rate for Payer: Healthscope Commercial |
$180.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.85
|
| Rate for Payer: PHP Commercial |
$170.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.88
|
| Rate for Payer: UHC Core |
$167.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.75
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$201.00
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna Commercial |
$170.85
|
| Rate for Payer: Aetna Medicare |
$52.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.81
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: BCBS MAPPO |
$50.25
|
| Rate for Payer: BCBS Trust/PPO |
$156.28
|
| Rate for Payer: BCN Commercial |
$156.28
|
| Rate for Payer: BCN Medicare Advantage |
$50.25
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$180.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.85
|
| Rate for Payer: PACE Senior Care Partners |
$47.74
|
| Rate for Payer: PACE SWMI |
$50.25
|
| Rate for Payer: PHP Commercial |
$170.85
|
| Rate for Payer: PHP Medicare Advantage |
$50.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.87
|
| Rate for Payer: Priority Health Medicare |
$50.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.59
|
| Rate for Payer: Railroad Medicare Medicare |
$50.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.88
|
| Rate for Payer: UHC Core |
$167.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.25
|
| Rate for Payer: UHC Medicare Advantage |
$51.76
|
| Rate for Payer: VA VA |
$50.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.75
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$503.17 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: BCBS Trust/PPO |
$637.56
|
| Rate for Payer: BCN Commercial |
$637.56
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$717.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.00
|
| Rate for Payer: UHC Core |
$688.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.75
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.94 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna Medicare |
$214.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$257.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$257.81
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$206.25
|
| Rate for Payer: BCBS Trust/PPO |
$641.44
|
| Rate for Payer: BCN Commercial |
$641.44
|
| Rate for Payer: BCN Medicare Advantage |
$206.25
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.25
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PACE Senior Care Partners |
$195.94
|
| Rate for Payer: PACE SWMI |
$206.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: PHP Medicare Advantage |
$206.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$717.75
|
| Rate for Payer: Priority Health Medicare |
$206.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.17
|
| Rate for Payer: Railroad Medicare Medicare |
$206.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.00
|
| Rate for Payer: UHC Core |
$688.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.25
|
| Rate for Payer: UHC Medicare Advantage |
$212.44
|
| Rate for Payer: VA VA |
$206.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.75
|
|
