|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
IP
|
$508.61
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
76100228
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.99 |
| Max. Negotiated Rate |
$457.75 |
| Rate for Payer: Aetna Commercial |
$432.32
|
| Rate for Payer: BCBS Trust/PPO |
$420.06
|
| Rate for Payer: BCN Commercial |
$420.06
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cofinity Commercial |
$437.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.89
|
| Rate for Payer: Healthscope Commercial |
$457.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.32
|
| Rate for Payer: Nomi Health Commercial |
$417.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.46
|
| Rate for Payer: PHP Commercial |
$432.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$442.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.58
|
| Rate for Payer: UHC Core |
$424.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.46
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
OP
|
$11,233.61
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,980.49 |
| Max. Negotiated Rate |
$10,110.25 |
| Rate for Payer: Aetna Commercial |
$9,548.57
|
| Rate for Payer: Aetna Medicare |
$2,920.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,510.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,510.50
|
| Rate for Payer: BCBS Complete |
$2,079.34
|
| Rate for Payer: BCBS MAPPO |
$2,808.40
|
| Rate for Payer: BCBS Trust/PPO |
$9,235.15
|
| Rate for Payer: BCN Commercial |
$9,235.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,808.40
|
| Rate for Payer: Cash Price |
$8,986.89
|
| Rate for Payer: Cofinity Commercial |
$9,660.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,986.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,808.40
|
| Rate for Payer: Healthscope Commercial |
$10,110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,425.21
|
| Rate for Payer: Mclaren Medicaid |
$1,980.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,948.82
|
| Rate for Payer: Meridian Medicaid |
$2,079.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,229.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,089.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,548.57
|
| Rate for Payer: Nomi Health Commercial |
$9,211.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,425.21
|
| Rate for Payer: PACE Senior Care Partners |
$2,667.98
|
| Rate for Payer: PACE SWMI |
$2,808.40
|
| Rate for Payer: PHP Commercial |
$9,548.57
|
| Rate for Payer: PHP Medicare Advantage |
$2,808.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,980.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,773.24
|
| Rate for Payer: Priority Health Medicare |
$2,836.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,818.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,808.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,885.58
|
| Rate for Payer: UHC Core |
$9,380.06
|
| Rate for Payer: UHC Exchange |
$2,808.40
|
| Rate for Payer: UHC Medicaid |
$1,980.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,808.40
|
| Rate for Payer: UHCCP Medicaid |
$1,980.49
|
| Rate for Payer: VA VA |
$2,808.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,425.21
|
|
|
HC LC/CABG'S W INTERVENTION
|
Facility
|
IP
|
$11,233.61
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,818.59 |
| Max. Negotiated Rate |
$10,110.25 |
| Rate for Payer: Aetna Commercial |
$9,548.57
|
| Rate for Payer: BCBS Trust/PPO |
$9,277.84
|
| Rate for Payer: BCN Commercial |
$9,277.84
|
| Rate for Payer: Cash Price |
$8,986.89
|
| Rate for Payer: Cofinity Commercial |
$9,660.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,986.89
|
| Rate for Payer: Healthscope Commercial |
$10,110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,425.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,548.57
|
| Rate for Payer: Nomi Health Commercial |
$9,211.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,425.21
|
| Rate for Payer: PHP Commercial |
$9,548.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,773.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,818.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,885.58
|
| Rate for Payer: UHC Core |
$9,380.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,425.21
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
IP
|
$60.97
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.44 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: BCBS Trust/PPO |
$50.36
|
| Rate for Payer: BCN Commercial |
$50.36
|
| Rate for Payer: Cash Price |
$48.78
|
| Rate for Payer: Cofinity Commercial |
$52.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.78
|
| Rate for Payer: Healthscope Commercial |
$54.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.82
|
| Rate for Payer: Nomi Health Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.73
|
| Rate for Payer: PHP Commercial |
$51.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.65
|
| Rate for Payer: UHC Core |
$50.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.73
|
|
|
HC LDL DIRECT MEASURE
|
Facility
|
OP
|
$60.97
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
30100283
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.05
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$15.24
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$50.12
|
| Rate for Payer: BCN Medicare Advantage |
$15.24
|
| Rate for Payer: Cash Price |
$48.78
|
| Rate for Payer: Cofinity Commercial |
$52.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$54.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.73
|
| Rate for Payer: Mclaren Medicaid |
$10.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.00
|
| Rate for Payer: Meridian Medicaid |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.82
|
| Rate for Payer: Nomi Health Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.73
|
| Rate for Payer: PACE Senior Care Partners |
$14.48
|
| Rate for Payer: PACE SWMI |
$15.24
|
| Rate for Payer: PHP Commercial |
$51.82
|
| Rate for Payer: PHP Medicare Advantage |
$15.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$53.04
|
| Rate for Payer: Priority Health Medicare |
$15.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.65
|
| Rate for Payer: UHC Core |
$50.91
|
| Rate for Payer: UHC Exchange |
$15.24
|
| Rate for Payer: UHC Medicaid |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$15.24
|
| Rate for Payer: UHCCP Medicaid |
$10.75
|
| Rate for Payer: VA VA |
$15.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.73
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
IP
|
$1,499.27
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,043.49 |
| Max. Negotiated Rate |
$1,349.34 |
| Rate for Payer: Aetna Commercial |
$1,274.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.25
|
| Rate for Payer: BCN Commercial |
$1,238.25
|
| Rate for Payer: Cash Price |
$1,199.42
|
| Rate for Payer: Cofinity Commercial |
$1,289.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.42
|
| Rate for Payer: Healthscope Commercial |
$1,349.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,124.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.38
|
| Rate for Payer: Nomi Health Commercial |
$1,229.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.45
|
| Rate for Payer: PHP Commercial |
$1,274.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,304.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,319.36
|
| Rate for Payer: UHC Core |
$1,251.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,124.45
|
|
|
HC LD RECOVERY 0-2 HRS
|
Facility
|
OP
|
$1,499.27
|
|
| Hospital Charge Code |
71000012
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$264.32 |
| Max. Negotiated Rate |
$1,349.34 |
| Rate for Payer: Aetna Commercial |
$1,274.38
|
| Rate for Payer: Aetna Medicare |
$389.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$468.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$468.52
|
| Rate for Payer: BCBS Complete |
$277.51
|
| Rate for Payer: BCBS MAPPO |
$374.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.55
|
| Rate for Payer: BCN Commercial |
$1,232.55
|
| Rate for Payer: BCN Medicare Advantage |
$374.82
|
| Rate for Payer: Cash Price |
$1,199.42
|
| Rate for Payer: Cofinity Commercial |
$1,289.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.82
|
| Rate for Payer: Healthscope Commercial |
$1,349.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,124.45
|
| Rate for Payer: Mclaren Medicaid |
$264.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.56
|
| Rate for Payer: Meridian Medicaid |
$277.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$431.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$412.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.38
|
| Rate for Payer: Nomi Health Commercial |
$1,229.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.45
|
| Rate for Payer: PACE Senior Care Partners |
$356.08
|
| Rate for Payer: PACE SWMI |
$374.82
|
| Rate for Payer: PHP Commercial |
$1,274.38
|
| Rate for Payer: PHP Medicare Advantage |
$374.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,304.36
|
| Rate for Payer: Priority Health Medicare |
$378.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,043.49
|
| Rate for Payer: Railroad Medicare Medicare |
$374.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,319.36
|
| Rate for Payer: UHC Core |
$1,251.89
|
| Rate for Payer: UHC Exchange |
$374.82
|
| Rate for Payer: UHC Medicaid |
$264.32
|
| Rate for Payer: UHC Medicare Advantage |
$374.82
|
| Rate for Payer: UHCCP Medicaid |
$264.32
|
| Rate for Payer: VA VA |
$374.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,124.45
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
IP
|
$3,747.95
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,608.57 |
| Max. Negotiated Rate |
$3,373.16 |
| Rate for Payer: Aetna Commercial |
$3,185.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,095.43
|
| Rate for Payer: BCN Commercial |
$3,095.43
|
| Rate for Payer: Cash Price |
$2,998.36
|
| Rate for Payer: Cofinity Commercial |
$3,223.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.36
|
| Rate for Payer: Healthscope Commercial |
$3,373.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,810.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.76
|
| Rate for Payer: Nomi Health Commercial |
$3,073.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.96
|
| Rate for Payer: PHP Commercial |
$3,185.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,260.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,608.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,298.20
|
| Rate for Payer: UHC Core |
$3,129.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,810.96
|
|
|
HC LD RECOVERY 10 OR MORE HOURS
|
Facility
|
OP
|
$3,747.95
|
|
| Hospital Charge Code |
71000013
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$660.76 |
| Max. Negotiated Rate |
$3,373.16 |
| Rate for Payer: Aetna Commercial |
$3,185.76
|
| Rate for Payer: Aetna Medicare |
$974.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,171.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,171.23
|
| Rate for Payer: BCBS Complete |
$693.75
|
| Rate for Payer: BCBS MAPPO |
$936.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,081.19
|
| Rate for Payer: BCN Commercial |
$3,081.19
|
| Rate for Payer: BCN Medicare Advantage |
$936.99
|
| Rate for Payer: Cash Price |
$2,998.36
|
| Rate for Payer: Cofinity Commercial |
$3,223.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$936.99
|
| Rate for Payer: Healthscope Commercial |
$3,373.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,810.96
|
| Rate for Payer: Mclaren Medicaid |
$660.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$983.84
|
| Rate for Payer: Meridian Medicaid |
$693.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,077.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,030.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.76
|
| Rate for Payer: Nomi Health Commercial |
$3,073.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.96
|
| Rate for Payer: PACE Senior Care Partners |
$890.14
|
| Rate for Payer: PACE SWMI |
$936.99
|
| Rate for Payer: PHP Commercial |
$3,185.76
|
| Rate for Payer: PHP Medicare Advantage |
$936.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$660.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,260.72
|
| Rate for Payer: Priority Health Medicare |
$946.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,608.57
|
| Rate for Payer: Railroad Medicare Medicare |
$936.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,298.20
|
| Rate for Payer: UHC Core |
$3,129.54
|
| Rate for Payer: UHC Exchange |
$936.99
|
| Rate for Payer: UHC Medicaid |
$660.76
|
| Rate for Payer: UHC Medicare Advantage |
$936.99
|
| Rate for Payer: UHCCP Medicaid |
$660.76
|
| Rate for Payer: VA VA |
$936.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,810.96
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
OP
|
$2,998.26
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$528.59 |
| Max. Negotiated Rate |
$2,698.43 |
| Rate for Payer: Aetna Commercial |
$2,548.52
|
| Rate for Payer: Aetna Medicare |
$779.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$936.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$936.96
|
| Rate for Payer: BCBS Complete |
$554.98
|
| Rate for Payer: BCBS MAPPO |
$749.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,464.87
|
| Rate for Payer: BCN Commercial |
$2,464.87
|
| Rate for Payer: BCN Medicare Advantage |
$749.57
|
| Rate for Payer: Cash Price |
$2,398.61
|
| Rate for Payer: Cofinity Commercial |
$2,578.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,398.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.57
|
| Rate for Payer: Healthscope Commercial |
$2,698.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,248.70
|
| Rate for Payer: Mclaren Medicaid |
$528.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$787.04
|
| Rate for Payer: Meridian Medicaid |
$554.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$862.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$824.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,548.52
|
| Rate for Payer: Nomi Health Commercial |
$2,458.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,248.70
|
| Rate for Payer: PACE Senior Care Partners |
$712.09
|
| Rate for Payer: PACE SWMI |
$749.57
|
| Rate for Payer: PHP Commercial |
$2,548.52
|
| Rate for Payer: PHP Medicare Advantage |
$749.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$528.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,608.49
|
| Rate for Payer: Priority Health Medicare |
$757.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,086.79
|
| Rate for Payer: Railroad Medicare Medicare |
$749.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,638.47
|
| Rate for Payer: UHC Core |
$2,503.55
|
| Rate for Payer: UHC Exchange |
$749.57
|
| Rate for Payer: UHC Medicaid |
$528.59
|
| Rate for Payer: UHC Medicare Advantage |
$749.57
|
| Rate for Payer: UHCCP Medicaid |
$528.59
|
| Rate for Payer: VA VA |
$749.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,248.70
|
|
|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,998.26
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,086.79 |
| Max. Negotiated Rate |
$2,698.43 |
| Rate for Payer: Aetna Commercial |
$2,548.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,476.26
|
| Rate for Payer: BCN Commercial |
$2,476.26
|
| Rate for Payer: Cash Price |
$2,398.61
|
| Rate for Payer: Cofinity Commercial |
$2,578.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,398.61
|
| Rate for Payer: Healthscope Commercial |
$2,698.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,248.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,548.52
|
| Rate for Payer: Nomi Health Commercial |
$2,458.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,248.70
|
| Rate for Payer: PHP Commercial |
$2,548.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,608.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,086.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,638.47
|
| Rate for Payer: UHC Core |
$2,503.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,248.70
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,331.45
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2,318.69 |
| Max. Negotiated Rate |
$2,998.30 |
| Rate for Payer: Aetna Commercial |
$2,831.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.44
|
| Rate for Payer: BCN Commercial |
$2,751.44
|
| Rate for Payer: Cash Price |
$2,665.16
|
| Rate for Payer: Cofinity Commercial |
$2,865.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,665.16
|
| Rate for Payer: Healthscope Commercial |
$2,998.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,498.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,831.73
|
| Rate for Payer: Nomi Health Commercial |
$2,731.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,498.59
|
| Rate for Payer: PHP Commercial |
$2,831.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,898.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,318.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,931.68
|
| Rate for Payer: UHC Core |
$2,781.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,498.59
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,331.45
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$587.33 |
| Max. Negotiated Rate |
$2,998.30 |
| Rate for Payer: Aetna Commercial |
$2,831.73
|
| Rate for Payer: Aetna Medicare |
$866.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,041.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,041.08
|
| Rate for Payer: BCBS Complete |
$616.65
|
| Rate for Payer: BCBS MAPPO |
$832.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,738.79
|
| Rate for Payer: BCN Commercial |
$2,738.79
|
| Rate for Payer: BCN Medicare Advantage |
$832.86
|
| Rate for Payer: Cash Price |
$2,665.16
|
| Rate for Payer: Cofinity Commercial |
$2,865.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,665.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$832.86
|
| Rate for Payer: Healthscope Commercial |
$2,998.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,498.59
|
| Rate for Payer: Mclaren Medicaid |
$587.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$874.51
|
| Rate for Payer: Meridian Medicaid |
$616.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$957.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$916.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,831.73
|
| Rate for Payer: Nomi Health Commercial |
$2,731.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,498.59
|
| Rate for Payer: PACE Senior Care Partners |
$791.22
|
| Rate for Payer: PACE SWMI |
$832.86
|
| Rate for Payer: PHP Commercial |
$2,831.73
|
| Rate for Payer: PHP Medicare Advantage |
$832.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,898.36
|
| Rate for Payer: Priority Health Medicare |
$841.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,318.69
|
| Rate for Payer: Railroad Medicare Medicare |
$832.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,931.68
|
| Rate for Payer: UHC Core |
$2,781.76
|
| Rate for Payer: UHC Exchange |
$832.86
|
| Rate for Payer: UHC Medicaid |
$587.33
|
| Rate for Payer: UHC Medicare Advantage |
$832.86
|
| Rate for Payer: UHCCP Medicaid |
$587.33
|
| Rate for Payer: VA VA |
$832.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,498.59
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
IP
|
$1,236.61
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$1,112.95 |
| Rate for Payer: Aetna Commercial |
$1,051.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.32
|
| Rate for Payer: BCN Commercial |
$1,021.32
|
| Rate for Payer: Cash Price |
$989.29
|
| Rate for Payer: Cofinity Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.29
|
| Rate for Payer: Healthscope Commercial |
$1,112.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.12
|
| Rate for Payer: Nomi Health Commercial |
$1,014.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.46
|
| Rate for Payer: PHP Commercial |
$1,051.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,075.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$860.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,088.22
|
| Rate for Payer: UHC Core |
$1,032.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.46
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
OP
|
$1,236.61
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$218.01 |
| Max. Negotiated Rate |
$1,112.95 |
| Rate for Payer: Aetna Commercial |
$1,051.12
|
| Rate for Payer: Aetna Medicare |
$321.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$386.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$386.44
|
| Rate for Payer: BCBS Complete |
$228.90
|
| Rate for Payer: BCBS MAPPO |
$309.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,016.62
|
| Rate for Payer: BCN Commercial |
$1,016.62
|
| Rate for Payer: BCN Medicare Advantage |
$309.15
|
| Rate for Payer: Cash Price |
$989.29
|
| Rate for Payer: Cofinity Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.15
|
| Rate for Payer: Healthscope Commercial |
$1,112.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.46
|
| Rate for Payer: Mclaren Medicaid |
$218.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.61
|
| Rate for Payer: Meridian Medicaid |
$228.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.12
|
| Rate for Payer: Nomi Health Commercial |
$1,014.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.46
|
| Rate for Payer: PACE Senior Care Partners |
$293.69
|
| Rate for Payer: PACE SWMI |
$309.15
|
| Rate for Payer: PHP Commercial |
$1,051.12
|
| Rate for Payer: PHP Medicare Advantage |
$309.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,075.85
|
| Rate for Payer: Priority Health Medicare |
$312.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$860.68
|
| Rate for Payer: Railroad Medicare Medicare |
$309.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,088.22
|
| Rate for Payer: UHC Core |
$1,032.57
|
| Rate for Payer: UHC Exchange |
$309.15
|
| Rate for Payer: UHC Medicaid |
$218.01
|
| Rate for Payer: UHC Medicare Advantage |
$309.15
|
| Rate for Payer: UHCCP Medicaid |
$218.01
|
| Rate for Payer: VA VA |
$309.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.46
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
IP
|
$1,484.78
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,033.41 |
| Max. Negotiated Rate |
$1,336.30 |
| Rate for Payer: Aetna Commercial |
$1,262.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.28
|
| Rate for Payer: BCN Commercial |
$1,226.28
|
| Rate for Payer: Cash Price |
$1,187.82
|
| Rate for Payer: Cofinity Commercial |
$1,276.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.82
|
| Rate for Payer: Healthscope Commercial |
$1,336.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.06
|
| Rate for Payer: Nomi Health Commercial |
$1,217.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,113.59
|
| Rate for Payer: PHP Commercial |
$1,262.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,291.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,033.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.61
|
| Rate for Payer: UHC Core |
$1,239.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.59
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
OP
|
$1,484.78
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$261.77 |
| Max. Negotiated Rate |
$1,336.30 |
| Rate for Payer: Aetna Commercial |
$1,262.06
|
| Rate for Payer: Aetna Medicare |
$386.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.99
|
| Rate for Payer: BCBS Complete |
$274.83
|
| Rate for Payer: BCBS MAPPO |
$371.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.64
|
| Rate for Payer: BCN Commercial |
$1,220.64
|
| Rate for Payer: BCN Medicare Advantage |
$371.19
|
| Rate for Payer: Cash Price |
$1,187.82
|
| Rate for Payer: Cofinity Commercial |
$1,276.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.19
|
| Rate for Payer: Healthscope Commercial |
$1,336.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.59
|
| Rate for Payer: Mclaren Medicaid |
$261.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.75
|
| Rate for Payer: Meridian Medicaid |
$274.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$408.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.06
|
| Rate for Payer: Nomi Health Commercial |
$1,217.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,113.59
|
| Rate for Payer: PACE Senior Care Partners |
$352.64
|
| Rate for Payer: PACE SWMI |
$371.19
|
| Rate for Payer: PHP Commercial |
$1,262.06
|
| Rate for Payer: PHP Medicare Advantage |
$371.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,291.76
|
| Rate for Payer: Priority Health Medicare |
$374.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,033.41
|
| Rate for Payer: Railroad Medicare Medicare |
$371.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.61
|
| Rate for Payer: UHC Core |
$1,239.79
|
| Rate for Payer: UHC Exchange |
$371.19
|
| Rate for Payer: UHC Medicaid |
$261.77
|
| Rate for Payer: UHC Medicare Advantage |
$371.19
|
| Rate for Payer: UHCCP Medicaid |
$261.77
|
| Rate for Payer: VA VA |
$371.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.59
|
|
|
HC LEAD
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$37.81
|
| Rate for Payer: BCN Commercial |
$37.81
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC LEAD
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.31
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$11.45
|
| Rate for Payer: BCBS Trust/PPO |
$37.64
|
| Rate for Payer: BCN Commercial |
$37.64
|
| Rate for Payer: BCN Medicare Advantage |
$11.45
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.45
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.02
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.34
|
| Rate for Payer: PACE Senior Care Partners |
$10.87
|
| Rate for Payer: PACE SWMI |
$11.45
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Medicare |
$11.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.86
|
| Rate for Payer: Railroad Medicare Medicare |
$11.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: UHC Exchange |
$11.45
|
| Rate for Payer: UHC Medicaid |
$8.07
|
| Rate for Payer: UHC Medicare Advantage |
$11.45
|
| Rate for Payer: UHCCP Medicaid |
$8.07
|
| Rate for Payer: VA VA |
$11.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
OP
|
$15,033.78
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,650.46 |
| Max. Negotiated Rate |
$13,530.40 |
| Rate for Payer: Aetna Commercial |
$12,778.71
|
| Rate for Payer: Aetna Medicare |
$3,908.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,698.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,698.06
|
| Rate for Payer: BCBS Complete |
$2,782.75
|
| Rate for Payer: BCBS MAPPO |
$3,758.45
|
| Rate for Payer: BCBS Trust/PPO |
$12,359.27
|
| Rate for Payer: BCN Commercial |
$12,359.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,758.45
|
| Rate for Payer: Cash Price |
$12,027.02
|
| Rate for Payer: Cofinity Commercial |
$12,929.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,027.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,758.45
|
| Rate for Payer: Healthscope Commercial |
$13,530.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,275.33
|
| Rate for Payer: Mclaren Medicaid |
$2,650.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,946.37
|
| Rate for Payer: Meridian Medicaid |
$2,782.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,322.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,134.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,778.71
|
| Rate for Payer: Nomi Health Commercial |
$12,327.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,275.33
|
| Rate for Payer: PACE Senior Care Partners |
$3,570.52
|
| Rate for Payer: PACE SWMI |
$3,758.45
|
| Rate for Payer: PHP Commercial |
$12,778.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,758.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,650.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,079.39
|
| Rate for Payer: Priority Health Medicare |
$3,796.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,463.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3,758.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,229.73
|
| Rate for Payer: UHC Core |
$12,553.21
|
| Rate for Payer: UHC Exchange |
$3,758.45
|
| Rate for Payer: UHC Medicaid |
$2,650.46
|
| Rate for Payer: UHC Medicare Advantage |
$3,758.45
|
| Rate for Payer: UHCCP Medicaid |
$2,650.46
|
| Rate for Payer: VA VA |
$3,758.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,275.33
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
IP
|
$15,033.78
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,463.51 |
| Max. Negotiated Rate |
$13,530.40 |
| Rate for Payer: Aetna Commercial |
$12,778.71
|
| Rate for Payer: BCBS Trust/PPO |
$12,416.40
|
| Rate for Payer: BCN Commercial |
$12,416.40
|
| Rate for Payer: Cash Price |
$12,027.02
|
| Rate for Payer: Cofinity Commercial |
$12,929.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,027.02
|
| Rate for Payer: Healthscope Commercial |
$13,530.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,275.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,778.71
|
| Rate for Payer: Nomi Health Commercial |
$12,327.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,275.33
|
| Rate for Payer: PHP Commercial |
$12,778.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13,079.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,463.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,229.73
|
| Rate for Payer: UHC Core |
$12,553.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,275.33
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
OP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.85 |
| Max. Negotiated Rate |
$1,872.72 |
| Rate for Payer: Aetna Commercial |
$1,768.68
|
| Rate for Payer: Aetna Medicare |
$541.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$650.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$650.25
|
| Rate for Payer: BCBS Complete |
$385.16
|
| Rate for Payer: BCBS MAPPO |
$520.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.63
|
| Rate for Payer: BCN Commercial |
$1,710.63
|
| Rate for Payer: BCN Medicare Advantage |
$520.20
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,664.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$1,872.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,560.60
|
| Rate for Payer: Mclaren Medicaid |
$366.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.21
|
| Rate for Payer: Meridian Medicaid |
$385.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$598.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$572.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,768.68
|
| Rate for Payer: Nomi Health Commercial |
$1,706.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,560.60
|
| Rate for Payer: PACE Senior Care Partners |
$494.19
|
| Rate for Payer: PACE SWMI |
$520.20
|
| Rate for Payer: PHP Commercial |
$1,768.68
|
| Rate for Payer: PHP Medicare Advantage |
$520.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,810.30
|
| Rate for Payer: Priority Health Medicare |
$525.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,448.24
|
| Rate for Payer: Railroad Medicare Medicare |
$520.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,831.10
|
| Rate for Payer: UHC Core |
$1,737.47
|
| Rate for Payer: UHC Exchange |
$520.20
|
| Rate for Payer: UHC Medicaid |
$366.85
|
| Rate for Payer: UHC Medicare Advantage |
$520.20
|
| Rate for Payer: UHCCP Medicaid |
$366.85
|
| Rate for Payer: VA VA |
$520.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,560.60
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
IP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.24 |
| Max. Negotiated Rate |
$1,872.72 |
| Rate for Payer: Aetna Commercial |
$1,768.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,718.53
|
| Rate for Payer: BCN Commercial |
$1,718.53
|
| Rate for Payer: Cash Price |
$1,664.64
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,664.64
|
| Rate for Payer: Healthscope Commercial |
$1,872.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,560.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,768.68
|
| Rate for Payer: Nomi Health Commercial |
$1,706.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,560.60
|
| Rate for Payer: PHP Commercial |
$1,768.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,810.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,448.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,831.10
|
| Rate for Payer: UHC Core |
$1,737.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,560.60
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
IP
|
$7,965.30
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,543.85 |
| Max. Negotiated Rate |
$7,168.77 |
| Rate for Payer: Aetna Commercial |
$6,770.51
|
| Rate for Payer: BCBS Trust/PPO |
$6,578.54
|
| Rate for Payer: BCN Commercial |
$6,578.54
|
| Rate for Payer: Cash Price |
$6,372.24
|
| Rate for Payer: Cofinity Commercial |
$6,850.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,372.24
|
| Rate for Payer: Healthscope Commercial |
$7,168.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,973.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,770.51
|
| Rate for Payer: Nomi Health Commercial |
$6,531.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,973.98
|
| Rate for Payer: PHP Commercial |
$6,770.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,929.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,543.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,009.46
|
| Rate for Payer: UHC Core |
$6,651.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,973.98
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
OP
|
$7,965.30
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.28 |
| Max. Negotiated Rate |
$7,168.77 |
| Rate for Payer: Aetna Commercial |
$6,770.51
|
| Rate for Payer: Aetna Medicare |
$2,070.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,489.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,489.16
|
| Rate for Payer: BCBS Complete |
$1,474.38
|
| Rate for Payer: BCBS MAPPO |
$1,991.33
|
| Rate for Payer: BCBS Trust/PPO |
$6,548.27
|
| Rate for Payer: BCN Commercial |
$6,548.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,991.33
|
| Rate for Payer: Cash Price |
$6,372.24
|
| Rate for Payer: Cofinity Commercial |
$6,850.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,372.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,991.33
|
| Rate for Payer: Healthscope Commercial |
$7,168.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,973.98
|
| Rate for Payer: Mclaren Medicaid |
$1,404.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,090.89
|
| Rate for Payer: Meridian Medicaid |
$1,474.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,290.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,190.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,770.51
|
| Rate for Payer: Nomi Health Commercial |
$6,531.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,973.98
|
| Rate for Payer: PACE Senior Care Partners |
$1,891.76
|
| Rate for Payer: PACE SWMI |
$1,991.33
|
| Rate for Payer: PHP Commercial |
$6,770.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,991.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,404.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,929.81
|
| Rate for Payer: Priority Health Medicare |
$2,011.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,543.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,991.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,009.46
|
| Rate for Payer: UHC Core |
$6,651.03
|
| Rate for Payer: UHC Exchange |
$1,991.33
|
| Rate for Payer: UHC Medicaid |
$1,404.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,991.33
|
| Rate for Payer: UHCCP Medicaid |
$1,404.28
|
| Rate for Payer: VA VA |
$1,991.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,973.98
|
|
