|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.73
|
| Rate for Payer: BCN Commercial |
$7.73
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$16.94
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.40
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$16.94
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$13.17
|
| Rate for Payer: BCN Commercial |
$13.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.24
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.40
|
| Rate for Payer: PACE Senior Care Partners |
$4.02
|
| Rate for Payer: PACE SWMI |
$4.24
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.74
|
| Rate for Payer: Priority Health Medicare |
$4.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.33
|
| Rate for Payer: Railroad Medicare Medicare |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: VA VA |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$110.66
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$99.59 |
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: BCBS Trust/PPO |
$85.52
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.53
|
| Rate for Payer: Healthscope Commercial |
$99.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.06
|
| Rate for Payer: PHP Commercial |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.38
|
| Rate for Payer: UHC Core |
$92.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$110.66
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$99.59 |
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.58
|
| Rate for Payer: BCBS Complete |
$44.26
|
| Rate for Payer: BCBS MAPPO |
$27.66
|
| Rate for Payer: BCBS Trust/PPO |
$86.04
|
| Rate for Payer: BCN Commercial |
$86.04
|
| Rate for Payer: BCN Medicare Advantage |
$27.66
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$99.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.06
|
| Rate for Payer: PACE Senior Care Partners |
$26.28
|
| Rate for Payer: PACE SWMI |
$27.66
|
| Rate for Payer: PHP Commercial |
$94.06
|
| Rate for Payer: PHP Medicare Advantage |
$27.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.27
|
| Rate for Payer: Priority Health Medicare |
$27.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.49
|
| Rate for Payer: Railroad Medicare Medicare |
$27.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.38
|
| Rate for Payer: UHC Core |
$92.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.66
|
| Rate for Payer: UHC Medicare Advantage |
$28.49
|
| Rate for Payer: VA VA |
$27.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.00
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$29.85
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: BCBS Trust/PPO |
$23.07
|
| Rate for Payer: BCN Commercial |
$23.07
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$26.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.27
|
| Rate for Payer: UHC Core |
$24.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.39
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$29.85
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.33
|
| Rate for Payer: BCBS Complete |
$11.94
|
| Rate for Payer: BCBS MAPPO |
$7.46
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCN Commercial |
$23.21
|
| Rate for Payer: BCN Medicare Advantage |
$7.46
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$26.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: PACE Senior Care Partners |
$7.09
|
| Rate for Payer: PACE SWMI |
$7.46
|
| Rate for Payer: PHP Commercial |
$25.37
|
| Rate for Payer: PHP Medicare Advantage |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.97
|
| Rate for Payer: Priority Health Medicare |
$7.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.21
|
| Rate for Payer: Railroad Medicare Medicare |
$7.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.27
|
| Rate for Payer: UHC Core |
$24.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.46
|
| Rate for Payer: UHC Medicare Advantage |
$7.69
|
| Rate for Payer: VA VA |
$7.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.39
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.02
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.19
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: BCBS MAPPO |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$30.34
|
| Rate for Payer: BCN Commercial |
$30.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.76
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.17
|
| Rate for Payer: PACE Senior Care Partners |
$9.27
|
| Rate for Payer: PACE SWMI |
$9.76
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: PHP Medicare Advantage |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.95
|
| Rate for Payer: Priority Health Medicare |
$9.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.80
|
| Rate for Payer: Railroad Medicare Medicare |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.34
|
| Rate for Payer: UHC Core |
$32.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.76
|
| Rate for Payer: UHC Medicare Advantage |
$10.05
|
| Rate for Payer: VA VA |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.02
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Commercial |
$30.15
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.17
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.34
|
| Rate for Payer: UHC Core |
$32.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$55.62
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$50.06 |
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: BCBS Trust/PPO |
$42.98
|
| Rate for Payer: BCN Commercial |
$42.98
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$47.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$50.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.28
|
| Rate for Payer: PHP Commercial |
$47.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.95
|
| Rate for Payer: UHC Core |
$46.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.72
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$55.62
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$50.06 |
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna Medicare |
$14.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.38
|
| Rate for Payer: BCBS Complete |
$22.25
|
| Rate for Payer: BCBS MAPPO |
$13.90
|
| Rate for Payer: BCBS Trust/PPO |
$43.24
|
| Rate for Payer: BCN Commercial |
$43.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.90
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$47.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.90
|
| Rate for Payer: Healthscope Commercial |
$50.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.28
|
| Rate for Payer: PACE Senior Care Partners |
$13.21
|
| Rate for Payer: PACE SWMI |
$13.90
|
| Rate for Payer: PHP Commercial |
$47.28
|
| Rate for Payer: PHP Medicare Advantage |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.39
|
| Rate for Payer: Priority Health Medicare |
$13.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.95
|
| Rate for Payer: UHC Core |
$46.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.90
|
| Rate for Payer: UHC Medicare Advantage |
$14.32
|
| Rate for Payer: VA VA |
$13.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.72
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$100.59
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$90.53 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare |
$26.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.43
|
| Rate for Payer: BCBS Complete |
$40.24
|
| Rate for Payer: BCBS MAPPO |
$25.15
|
| Rate for Payer: BCBS Trust/PPO |
$78.21
|
| Rate for Payer: BCN Commercial |
$78.21
|
| Rate for Payer: BCN Medicare Advantage |
$25.15
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cofinity Commercial |
$86.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.15
|
| Rate for Payer: Healthscope Commercial |
$90.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.50
|
| Rate for Payer: PACE Senior Care Partners |
$23.89
|
| Rate for Payer: PACE SWMI |
$25.15
|
| Rate for Payer: PHP Commercial |
$85.50
|
| Rate for Payer: PHP Medicare Advantage |
$25.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.51
|
| Rate for Payer: Priority Health Medicare |
$25.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: Railroad Medicare Medicare |
$25.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.52
|
| Rate for Payer: UHC Core |
$83.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.15
|
| Rate for Payer: UHC Medicare Advantage |
$25.90
|
| Rate for Payer: VA VA |
$25.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.44
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$100.59
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$90.53 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: BCBS Trust/PPO |
$77.74
|
| Rate for Payer: BCN Commercial |
$77.74
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cofinity Commercial |
$86.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.47
|
| Rate for Payer: Healthscope Commercial |
$90.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.50
|
| Rate for Payer: PHP Commercial |
$85.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.52
|
| Rate for Payer: UHC Core |
$83.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.44
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.60
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna Commercial |
$16.66
|
| Rate for Payer: Aetna Medicare |
$5.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: BCBS Complete |
$7.84
|
| Rate for Payer: BCBS MAPPO |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$15.24
|
| Rate for Payer: BCN Commercial |
$15.24
|
| Rate for Payer: BCN Medicare Advantage |
$4.90
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.90
|
| Rate for Payer: Healthscope Commercial |
$17.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.66
|
| Rate for Payer: PACE Senior Care Partners |
$4.66
|
| Rate for Payer: PACE SWMI |
$4.90
|
| Rate for Payer: PHP Commercial |
$16.66
|
| Rate for Payer: PHP Medicare Advantage |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.05
|
| Rate for Payer: Priority Health Medicare |
$4.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.25
|
| Rate for Payer: UHC Core |
$16.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.05
|
| Rate for Payer: VA VA |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.70
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$19.60
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna Commercial |
$16.66
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Commercial |
$15.15
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$17.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.66
|
| Rate for Payer: PHP Commercial |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.25
|
| Rate for Payer: UHC Core |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.70
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$25.18
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$22.66 |
| Rate for Payer: Aetna Commercial |
$21.40
|
| Rate for Payer: Aetna Medicare |
$6.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.87
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$19.58
|
| Rate for Payer: BCN Commercial |
$19.58
|
| Rate for Payer: BCN Medicare Advantage |
$6.30
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$22.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.40
|
| Rate for Payer: PACE Senior Care Partners |
$5.98
|
| Rate for Payer: PACE SWMI |
$6.30
|
| Rate for Payer: PHP Commercial |
$21.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.91
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.36
|
| Rate for Payer: Railroad Medicare Medicare |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.16
|
| Rate for Payer: UHC Core |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.30
|
| Rate for Payer: UHC Medicare Advantage |
$6.48
|
| Rate for Payer: VA VA |
$6.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$25.18
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$22.66 |
| Rate for Payer: Aetna Commercial |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.46
|
| Rate for Payer: BCN Commercial |
$19.46
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$22.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.40
|
| Rate for Payer: PHP Commercial |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.16
|
| Rate for Payer: UHC Core |
$21.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$541.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.48 |
| Max. Negotiated Rate |
$487.67 |
| Rate for Payer: Aetna Commercial |
$460.58
|
| Rate for Payer: BCBS Trust/PPO |
$418.75
|
| Rate for Payer: BCN Commercial |
$418.75
|
| Rate for Payer: Cash Price |
$433.49
|
| Rate for Payer: Cofinity Commercial |
$466.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.49
|
| Rate for Payer: Healthscope Commercial |
$487.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.58
|
| Rate for Payer: PHP Commercial |
$460.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.84
|
| Rate for Payer: UHC Core |
$452.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.40
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$541.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$487.67 |
| Rate for Payer: Aetna Commercial |
$460.58
|
| Rate for Payer: Aetna Medicare |
$140.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.33
|
| Rate for Payer: BCBS Complete |
$216.74
|
| Rate for Payer: BCBS MAPPO |
$135.46
|
| Rate for Payer: BCBS Trust/PPO |
$421.30
|
| Rate for Payer: BCN Commercial |
$421.30
|
| Rate for Payer: BCN Medicare Advantage |
$135.46
|
| Rate for Payer: Cash Price |
$433.49
|
| Rate for Payer: Cofinity Commercial |
$466.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.46
|
| Rate for Payer: Healthscope Commercial |
$487.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.58
|
| Rate for Payer: PACE Senior Care Partners |
$128.69
|
| Rate for Payer: PACE SWMI |
$135.46
|
| Rate for Payer: PHP Commercial |
$460.58
|
| Rate for Payer: PHP Medicare Advantage |
$135.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.42
|
| Rate for Payer: Priority Health Medicare |
$135.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.48
|
| Rate for Payer: Railroad Medicare Medicare |
$135.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.84
|
| Rate for Payer: UHC Core |
$452.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.46
|
| Rate for Payer: UHC Medicare Advantage |
$139.53
|
| Rate for Payer: VA VA |
$135.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.40
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$37.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.15 |
| Max. Negotiated Rate |
$34.16 |
| Rate for Payer: Aetna Commercial |
$32.26
|
| Rate for Payer: BCBS Trust/PPO |
$29.33
|
| Rate for Payer: BCN Commercial |
$29.33
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cofinity Commercial |
$32.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.36
|
| Rate for Payer: Healthscope Commercial |
$34.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.26
|
| Rate for Payer: PHP Commercial |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.40
|
| Rate for Payer: UHC Core |
$31.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.46
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$37.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$34.16 |
| Rate for Payer: Aetna Commercial |
$32.26
|
| Rate for Payer: Aetna Medicare |
$9.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.86
|
| Rate for Payer: BCBS Complete |
$15.18
|
| Rate for Payer: BCBS MAPPO |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.51
|
| Rate for Payer: BCN Commercial |
$29.51
|
| Rate for Payer: BCN Medicare Advantage |
$9.49
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cofinity Commercial |
$32.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.49
|
| Rate for Payer: Healthscope Commercial |
$34.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.26
|
| Rate for Payer: PACE Senior Care Partners |
$9.01
|
| Rate for Payer: PACE SWMI |
$9.49
|
| Rate for Payer: PHP Commercial |
$32.26
|
| Rate for Payer: PHP Medicare Advantage |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.02
|
| Rate for Payer: Priority Health Medicare |
$9.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.15
|
| Rate for Payer: Railroad Medicare Medicare |
$9.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.40
|
| Rate for Payer: UHC Core |
$31.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.49
|
| Rate for Payer: UHC Medicare Advantage |
$9.77
|
| Rate for Payer: VA VA |
$9.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.46
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$527.43
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.68 |
| Max. Negotiated Rate |
$474.69 |
| Rate for Payer: Aetna Commercial |
$448.32
|
| Rate for Payer: BCBS Trust/PPO |
$407.60
|
| Rate for Payer: BCN Commercial |
$407.60
|
| Rate for Payer: Cash Price |
$421.94
|
| Rate for Payer: Cofinity Commercial |
$453.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.94
|
| Rate for Payer: Healthscope Commercial |
$474.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.32
|
| Rate for Payer: PHP Commercial |
$448.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.14
|
| Rate for Payer: UHC Core |
$440.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.57
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$527.43
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$474.69 |
| Rate for Payer: Aetna Commercial |
$448.32
|
| Rate for Payer: Aetna Medicare |
$137.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.82
|
| Rate for Payer: BCBS Complete |
$210.97
|
| Rate for Payer: BCBS MAPPO |
$131.86
|
| Rate for Payer: BCBS Trust/PPO |
$410.08
|
| Rate for Payer: BCN Commercial |
$410.08
|
| Rate for Payer: BCN Medicare Advantage |
$131.86
|
| Rate for Payer: Cash Price |
$421.94
|
| Rate for Payer: Cofinity Commercial |
$453.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.86
|
| Rate for Payer: Healthscope Commercial |
$474.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.32
|
| Rate for Payer: PACE Senior Care Partners |
$125.26
|
| Rate for Payer: PACE SWMI |
$131.86
|
| Rate for Payer: PHP Commercial |
$448.32
|
| Rate for Payer: PHP Medicare Advantage |
$131.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.86
|
| Rate for Payer: Priority Health Medicare |
$131.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.68
|
| Rate for Payer: Railroad Medicare Medicare |
$131.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.14
|
| Rate for Payer: UHC Core |
$440.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.86
|
| Rate for Payer: UHC Medicare Advantage |
$135.81
|
| Rate for Payer: VA VA |
$131.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.57
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$11,640.28
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,099.41 |
| Max. Negotiated Rate |
$10,476.25 |
| Rate for Payer: Aetna Commercial |
$9,894.24
|
| Rate for Payer: BCBS Trust/PPO |
$8,995.61
|
| Rate for Payer: BCN Commercial |
$8,995.61
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cofinity Commercial |
$10,010.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,312.22
|
| Rate for Payer: Healthscope Commercial |
$10,476.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,730.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,894.24
|
| Rate for Payer: PHP Commercial |
$9,894.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,127.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,099.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,243.45
|
| Rate for Payer: UHC Core |
$9,719.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,730.21
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$11,640.28
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,764.57 |
| Max. Negotiated Rate |
$10,476.25 |
| Rate for Payer: Aetna Commercial |
$9,894.24
|
| Rate for Payer: Aetna Medicare |
$3,026.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,637.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,637.59
|
| Rate for Payer: BCBS Complete |
$7,355.10
|
| Rate for Payer: BCBS MAPPO |
$2,910.07
|
| Rate for Payer: BCBS Trust/PPO |
$9,050.32
|
| Rate for Payer: BCN Commercial |
$9,050.32
|
| Rate for Payer: BCN Medicare Advantage |
$2,910.07
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cofinity Commercial |
$10,010.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,312.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,910.07
|
| Rate for Payer: Healthscope Commercial |
$10,476.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,730.21
|
| Rate for Payer: Mclaren Medicaid |
$7,004.86
|
| Rate for Payer: Meridian Medicaid |
$7,355.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,055.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,346.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,894.24
|
| Rate for Payer: PACE Senior Care Partners |
$2,764.57
|
| Rate for Payer: PACE SWMI |
$2,910.07
|
| Rate for Payer: PHP Commercial |
$9,894.24
|
| Rate for Payer: PHP Medicare Advantage |
$2,910.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,004.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,127.04
|
| Rate for Payer: Priority Health Medicare |
$2,910.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,099.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2,910.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,243.45
|
| Rate for Payer: UHC Core |
$9,719.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,910.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,997.37
|
| Rate for Payer: VA VA |
$2,910.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,730.21
|
|
