|
HC MED PHYSIC DOS EVAL RAD EXPS
|
Facility
|
IP
|
$263.99
|
|
|
Service Code
|
CPT 76145
|
| Hospital Charge Code |
32000333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.59 |
| Max. Negotiated Rate |
$237.59 |
| Rate for Payer: Aetna Commercial |
$224.39
|
| Rate for Payer: BCBS Trust/PPO |
$215.50
|
| Rate for Payer: BCN Commercial |
$204.01
|
| Rate for Payer: Cash Price |
$211.19
|
| Rate for Payer: Cofinity Commercial |
$227.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.19
|
| Rate for Payer: Healthscope Commercial |
$237.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.39
|
| Rate for Payer: Nomi Health Commercial |
$216.47
|
| Rate for Payer: PHP Commercial |
$224.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.59
|
| Rate for Payer: Priority Health HMO/PPO |
$229.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.31
|
| Rate for Payer: UHC Core |
$220.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.99
|
|
|
HC MED SURG ROOM & BOARD
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
11000001
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$3,021.16 |
| Rate for Payer: Aetna Commercial |
$2,853.31
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,740.19
|
| Rate for Payer: BCN Commercial |
$2,594.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$2,886.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$3,021.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,517.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: Nomi Health Commercial |
$2,752.61
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$2,853.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,920.45
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,249.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,954.02
|
| Rate for Payer: UHC Core |
$2,802.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,517.63
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$39.97
|
| Rate for Payer: BCN Commercial |
$37.84
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$40.15
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO |
$42.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$40.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$12.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.30
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS MAPPO |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$40.25
|
| Rate for Payer: BCN Commercial |
$38.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.24
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$8.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.85
|
| Rate for Payer: Meridian Medicaid |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$40.15
|
| Rate for Payer: PACE Senior Care Partners |
$11.63
|
| Rate for Payer: PACE SWMI |
$12.24
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$12.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO |
$42.60
|
| Rate for Payer: Priority Health Medicare |
$12.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$40.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.24
|
| Rate for Payer: UHC Exchange |
$12.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.24
|
| Rate for Payer: UHCCP Medicaid |
$8.66
|
| Rate for Payer: VA VA |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
IP
|
$29,963.52
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$19,476.29 |
| Max. Negotiated Rate |
$26,967.17 |
| Rate for Payer: Aetna Commercial |
$25,468.99
|
| Rate for Payer: BCBS Trust/PPO |
$24,459.22
|
| Rate for Payer: BCN Commercial |
$23,155.81
|
| Rate for Payer: Cash Price |
$23,970.82
|
| Rate for Payer: Cofinity Commercial |
$25,768.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,970.82
|
| Rate for Payer: Healthscope Commercial |
$26,967.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,472.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,468.99
|
| Rate for Payer: Nomi Health Commercial |
$24,570.09
|
| Rate for Payer: PHP Commercial |
$25,468.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,476.29
|
| Rate for Payer: Priority Health HMO/PPO |
$26,068.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,075.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,367.90
|
| Rate for Payer: UHC Core |
$25,019.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,472.64
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
OP
|
$29,963.52
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,116.34 |
| Max. Negotiated Rate |
$26,967.17 |
| Rate for Payer: Aetna Commercial |
$25,468.99
|
| Rate for Payer: Aetna Medicare |
$7,790.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,363.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,363.60
|
| Rate for Payer: BCBS Complete |
$11,985.41
|
| Rate for Payer: BCBS MAPPO |
$7,490.88
|
| Rate for Payer: BCBS Trust/PPO |
$24,633.01
|
| Rate for Payer: BCN Commercial |
$23,296.64
|
| Rate for Payer: BCN Medicare Advantage |
$7,490.88
|
| Rate for Payer: Cash Price |
$23,970.82
|
| Rate for Payer: Cofinity Commercial |
$25,768.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,970.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,490.88
|
| Rate for Payer: Healthscope Commercial |
$26,967.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,472.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,865.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,614.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,468.99
|
| Rate for Payer: Nomi Health Commercial |
$24,570.09
|
| Rate for Payer: PACE Senior Care Partners |
$7,116.34
|
| Rate for Payer: PACE SWMI |
$7,490.88
|
| Rate for Payer: PHP Commercial |
$25,468.99
|
| Rate for Payer: PHP Medicare Advantage |
$7,490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,476.29
|
| Rate for Payer: Priority Health HMO/PPO |
$26,068.26
|
| Rate for Payer: Priority Health Medicare |
$7,565.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,075.56
|
| Rate for Payer: Railroad Medicare Medicare |
$7,490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,367.90
|
| Rate for Payer: UHC Core |
$25,019.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,490.88
|
| Rate for Payer: UHC Exchange |
$7,490.88
|
| Rate for Payer: UHC Medicare Advantage |
$7,490.88
|
| Rate for Payer: VA VA |
$7,490.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,472.64
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
IP
|
$6,207.54
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,034.90 |
| Max. Negotiated Rate |
$5,586.79 |
| Rate for Payer: Aetna Commercial |
$5,276.41
|
| Rate for Payer: BCBS Trust/PPO |
$5,067.21
|
| Rate for Payer: BCN Commercial |
$4,797.19
|
| Rate for Payer: Cash Price |
$4,966.03
|
| Rate for Payer: Cofinity Commercial |
$5,338.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,966.03
|
| Rate for Payer: Healthscope Commercial |
$5,586.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,655.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,276.41
|
| Rate for Payer: Nomi Health Commercial |
$5,090.18
|
| Rate for Payer: PHP Commercial |
$5,276.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,034.90
|
| Rate for Payer: Priority Health HMO/PPO |
$5,400.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,159.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,462.64
|
| Rate for Payer: UHC Core |
$5,183.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,655.66
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
OP
|
$6,207.54
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.29 |
| Max. Negotiated Rate |
$5,586.79 |
| Rate for Payer: Aetna Commercial |
$5,276.41
|
| Rate for Payer: Aetna Medicare |
$1,613.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,939.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,939.86
|
| Rate for Payer: BCBS Complete |
$2,483.02
|
| Rate for Payer: BCBS MAPPO |
$1,551.88
|
| Rate for Payer: BCBS Trust/PPO |
$5,103.22
|
| Rate for Payer: BCN Commercial |
$4,826.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,551.88
|
| Rate for Payer: Cash Price |
$4,966.03
|
| Rate for Payer: Cofinity Commercial |
$5,338.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,966.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,551.88
|
| Rate for Payer: Healthscope Commercial |
$5,586.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,655.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,629.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,784.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,276.41
|
| Rate for Payer: Nomi Health Commercial |
$5,090.18
|
| Rate for Payer: PACE Senior Care Partners |
$1,474.29
|
| Rate for Payer: PACE SWMI |
$1,551.88
|
| Rate for Payer: PHP Commercial |
$5,276.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,551.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,034.90
|
| Rate for Payer: Priority Health HMO/PPO |
$5,400.56
|
| Rate for Payer: Priority Health Medicare |
$1,567.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,159.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,551.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,462.64
|
| Rate for Payer: UHC Core |
$5,183.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,551.88
|
| Rate for Payer: UHC Exchange |
$1,551.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,551.88
|
| Rate for Payer: VA VA |
$1,551.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,655.66
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
OP
|
$8,843.40
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,100.31 |
| Max. Negotiated Rate |
$7,959.06 |
| Rate for Payer: Aetna Commercial |
$7,516.89
|
| Rate for Payer: Aetna Medicare |
$2,299.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,763.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,763.56
|
| Rate for Payer: BCBS Complete |
$3,537.36
|
| Rate for Payer: BCBS MAPPO |
$2,210.85
|
| Rate for Payer: BCBS Trust/PPO |
$7,270.16
|
| Rate for Payer: BCN Commercial |
$6,875.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,210.85
|
| Rate for Payer: Cash Price |
$7,074.72
|
| Rate for Payer: Cofinity Commercial |
$7,605.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,210.85
|
| Rate for Payer: Healthscope Commercial |
$7,959.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,632.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,321.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,542.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.89
|
| Rate for Payer: Nomi Health Commercial |
$7,251.59
|
| Rate for Payer: PACE Senior Care Partners |
$2,100.31
|
| Rate for Payer: PACE SWMI |
$2,210.85
|
| Rate for Payer: PHP Commercial |
$7,516.89
|
| Rate for Payer: PHP Medicare Advantage |
$2,210.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,748.21
|
| Rate for Payer: Priority Health HMO/PPO |
$7,693.76
|
| Rate for Payer: Priority Health Medicare |
$2,232.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,925.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,210.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,782.19
|
| Rate for Payer: UHC Core |
$7,384.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,210.85
|
| Rate for Payer: UHC Exchange |
$2,210.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,210.85
|
| Rate for Payer: VA VA |
$2,210.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,632.55
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
IP
|
$8,843.40
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,748.21 |
| Max. Negotiated Rate |
$7,959.06 |
| Rate for Payer: Aetna Commercial |
$7,516.89
|
| Rate for Payer: BCBS Trust/PPO |
$7,218.87
|
| Rate for Payer: BCN Commercial |
$6,834.18
|
| Rate for Payer: Cash Price |
$7,074.72
|
| Rate for Payer: Cofinity Commercial |
$7,605.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.72
|
| Rate for Payer: Healthscope Commercial |
$7,959.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,632.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.89
|
| Rate for Payer: Nomi Health Commercial |
$7,251.59
|
| Rate for Payer: PHP Commercial |
$7,516.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,748.21
|
| Rate for Payer: Priority Health HMO/PPO |
$7,693.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,925.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,782.19
|
| Rate for Payer: UHC Core |
$7,384.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,632.55
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
IP
|
$26,322.12
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,109.38 |
| Max. Negotiated Rate |
$23,689.91 |
| Rate for Payer: Aetna Commercial |
$22,373.80
|
| Rate for Payer: BCBS Trust/PPO |
$21,486.75
|
| Rate for Payer: BCN Commercial |
$20,341.73
|
| Rate for Payer: Cash Price |
$21,057.70
|
| Rate for Payer: Cofinity Commercial |
$22,637.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,057.70
|
| Rate for Payer: Healthscope Commercial |
$23,689.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,741.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,373.80
|
| Rate for Payer: Nomi Health Commercial |
$21,584.14
|
| Rate for Payer: PHP Commercial |
$22,373.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,109.38
|
| Rate for Payer: Priority Health HMO/PPO |
$22,900.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,635.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,163.47
|
| Rate for Payer: UHC Core |
$21,978.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,741.59
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
OP
|
$26,322.12
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,251.50 |
| Max. Negotiated Rate |
$23,689.91 |
| Rate for Payer: Aetna Commercial |
$22,373.80
|
| Rate for Payer: Aetna Medicare |
$6,843.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,225.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,225.66
|
| Rate for Payer: BCBS Complete |
$10,528.85
|
| Rate for Payer: BCBS MAPPO |
$6,580.53
|
| Rate for Payer: BCBS Trust/PPO |
$21,639.41
|
| Rate for Payer: BCN Commercial |
$20,465.45
|
| Rate for Payer: BCN Medicare Advantage |
$6,580.53
|
| Rate for Payer: Cash Price |
$21,057.70
|
| Rate for Payer: Cofinity Commercial |
$22,637.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,057.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,580.53
|
| Rate for Payer: Healthscope Commercial |
$23,689.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,741.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,909.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,567.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,373.80
|
| Rate for Payer: Nomi Health Commercial |
$21,584.14
|
| Rate for Payer: PACE Senior Care Partners |
$6,251.50
|
| Rate for Payer: PACE SWMI |
$6,580.53
|
| Rate for Payer: PHP Commercial |
$22,373.80
|
| Rate for Payer: PHP Medicare Advantage |
$6,580.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,109.38
|
| Rate for Payer: Priority Health HMO/PPO |
$22,900.24
|
| Rate for Payer: Priority Health Medicare |
$6,646.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,635.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,580.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,163.47
|
| Rate for Payer: UHC Core |
$21,978.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,580.53
|
| Rate for Payer: UHC Exchange |
$6,580.53
|
| Rate for Payer: UHC Medicare Advantage |
$6,580.53
|
| Rate for Payer: VA VA |
$6,580.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,741.59
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
OP
|
$23,825.16
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,658.48 |
| Max. Negotiated Rate |
$21,442.64 |
| Rate for Payer: Aetna Commercial |
$20,251.39
|
| Rate for Payer: Aetna Medicare |
$6,194.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,445.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,445.36
|
| Rate for Payer: BCBS Complete |
$9,530.06
|
| Rate for Payer: BCBS MAPPO |
$5,956.29
|
| Rate for Payer: BCBS Trust/PPO |
$19,586.66
|
| Rate for Payer: BCN Commercial |
$18,524.06
|
| Rate for Payer: BCN Medicare Advantage |
$5,956.29
|
| Rate for Payer: Cash Price |
$19,060.13
|
| Rate for Payer: Cofinity Commercial |
$20,489.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,060.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,956.29
|
| Rate for Payer: Healthscope Commercial |
$21,442.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,868.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,254.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,849.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,251.39
|
| Rate for Payer: Nomi Health Commercial |
$19,536.63
|
| Rate for Payer: PACE Senior Care Partners |
$5,658.48
|
| Rate for Payer: PACE SWMI |
$5,956.29
|
| Rate for Payer: PHP Commercial |
$20,251.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,956.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,486.35
|
| Rate for Payer: Priority Health HMO/PPO |
$20,727.89
|
| Rate for Payer: Priority Health Medicare |
$6,015.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,962.86
|
| Rate for Payer: Railroad Medicare Medicare |
$5,956.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,966.14
|
| Rate for Payer: UHC Core |
$19,894.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,956.29
|
| Rate for Payer: UHC Exchange |
$5,956.29
|
| Rate for Payer: UHC Medicare Advantage |
$5,956.29
|
| Rate for Payer: VA VA |
$5,956.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,868.87
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
IP
|
$23,825.16
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,486.35 |
| Max. Negotiated Rate |
$21,442.64 |
| Rate for Payer: Aetna Commercial |
$20,251.39
|
| Rate for Payer: BCBS Trust/PPO |
$19,448.48
|
| Rate for Payer: BCN Commercial |
$18,412.08
|
| Rate for Payer: Cash Price |
$19,060.13
|
| Rate for Payer: Cofinity Commercial |
$20,489.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,060.13
|
| Rate for Payer: Healthscope Commercial |
$21,442.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,868.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,251.39
|
| Rate for Payer: Nomi Health Commercial |
$19,536.63
|
| Rate for Payer: PHP Commercial |
$20,251.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,486.35
|
| Rate for Payer: Priority Health HMO/PPO |
$20,727.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,962.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,966.14
|
| Rate for Payer: UHC Core |
$19,894.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,868.87
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
IP
|
$13,216.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,590.48 |
| Max. Negotiated Rate |
$11,894.52 |
| Rate for Payer: Aetna Commercial |
$11,233.71
|
| Rate for Payer: BCBS Trust/PPO |
$10,788.33
|
| Rate for Payer: BCN Commercial |
$10,213.43
|
| Rate for Payer: Cash Price |
$10,572.90
|
| Rate for Payer: Cofinity Commercial |
$11,365.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,572.90
|
| Rate for Payer: Healthscope Commercial |
$11,894.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,912.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,233.71
|
| Rate for Payer: Nomi Health Commercial |
$10,837.23
|
| Rate for Payer: PHP Commercial |
$11,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,590.48
|
| Rate for Payer: Priority Health HMO/PPO |
$11,498.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,854.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,630.19
|
| Rate for Payer: UHC Core |
$11,035.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,912.10
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
OP
|
$13,216.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,138.83 |
| Max. Negotiated Rate |
$11,894.52 |
| Rate for Payer: Aetna Commercial |
$11,233.71
|
| Rate for Payer: Aetna Medicare |
$3,436.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,130.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,130.04
|
| Rate for Payer: BCBS Complete |
$5,286.45
|
| Rate for Payer: BCBS MAPPO |
$3,304.03
|
| Rate for Payer: BCBS Trust/PPO |
$10,864.98
|
| Rate for Payer: BCN Commercial |
$10,275.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,304.03
|
| Rate for Payer: Cash Price |
$10,572.90
|
| Rate for Payer: Cofinity Commercial |
$11,365.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,572.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,304.03
|
| Rate for Payer: Healthscope Commercial |
$11,894.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,912.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,469.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,233.71
|
| Rate for Payer: Nomi Health Commercial |
$10,837.23
|
| Rate for Payer: PACE Senior Care Partners |
$3,138.83
|
| Rate for Payer: PACE SWMI |
$3,304.03
|
| Rate for Payer: PHP Commercial |
$11,233.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,304.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,590.48
|
| Rate for Payer: Priority Health HMO/PPO |
$11,498.03
|
| Rate for Payer: Priority Health Medicare |
$3,337.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,854.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,304.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,630.19
|
| Rate for Payer: UHC Core |
$11,035.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,304.03
|
| Rate for Payer: UHC Exchange |
$3,304.03
|
| Rate for Payer: UHC Medicare Advantage |
$3,304.03
|
| Rate for Payer: VA VA |
$3,304.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,912.10
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
OP
|
$15,597.48
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,704.40 |
| Max. Negotiated Rate |
$14,037.73 |
| Rate for Payer: Aetna Commercial |
$13,257.86
|
| Rate for Payer: Aetna Medicare |
$4,055.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,874.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,874.21
|
| Rate for Payer: BCBS Complete |
$6,238.99
|
| Rate for Payer: BCBS MAPPO |
$3,899.37
|
| Rate for Payer: BCBS Trust/PPO |
$12,822.69
|
| Rate for Payer: BCN Commercial |
$12,127.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,899.37
|
| Rate for Payer: Cash Price |
$12,477.98
|
| Rate for Payer: Cofinity Commercial |
$13,413.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,477.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,899.37
|
| Rate for Payer: Healthscope Commercial |
$14,037.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,698.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,094.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,484.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,257.86
|
| Rate for Payer: Nomi Health Commercial |
$12,789.93
|
| Rate for Payer: PACE Senior Care Partners |
$3,704.40
|
| Rate for Payer: PACE SWMI |
$3,899.37
|
| Rate for Payer: PHP Commercial |
$13,257.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,899.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,138.36
|
| Rate for Payer: Priority Health HMO/PPO |
$13,569.81
|
| Rate for Payer: Priority Health Medicare |
$3,938.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,450.31
|
| Rate for Payer: Railroad Medicare Medicare |
$3,899.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,725.78
|
| Rate for Payer: UHC Core |
$13,023.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,899.37
|
| Rate for Payer: UHC Exchange |
$3,899.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,899.37
|
| Rate for Payer: VA VA |
$3,899.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,698.11
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
IP
|
$15,597.48
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,138.36 |
| Max. Negotiated Rate |
$14,037.73 |
| Rate for Payer: Aetna Commercial |
$13,257.86
|
| Rate for Payer: BCBS Trust/PPO |
$12,732.22
|
| Rate for Payer: BCN Commercial |
$12,053.73
|
| Rate for Payer: Cash Price |
$12,477.98
|
| Rate for Payer: Cofinity Commercial |
$13,413.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,477.98
|
| Rate for Payer: Healthscope Commercial |
$14,037.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,698.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,257.86
|
| Rate for Payer: Nomi Health Commercial |
$12,789.93
|
| Rate for Payer: PHP Commercial |
$13,257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,138.36
|
| Rate for Payer: Priority Health HMO/PPO |
$13,569.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,450.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,725.78
|
| Rate for Payer: UHC Core |
$13,023.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,698.11
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
OP
|
$187.27
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.48 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna Medicare |
$48.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.52
|
| Rate for Payer: BCBS Complete |
$74.91
|
| Rate for Payer: BCBS MAPPO |
$46.82
|
| Rate for Payer: BCBS Trust/PPO |
$153.95
|
| Rate for Payer: BCN Commercial |
$145.60
|
| Rate for Payer: BCN Medicare Advantage |
$46.82
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: PACE Senior Care Partners |
$44.48
|
| Rate for Payer: PACE SWMI |
$46.82
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: PHP Medicare Advantage |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health HMO/PPO |
$162.92
|
| Rate for Payer: Priority Health Medicare |
$47.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.47
|
| Rate for Payer: Railroad Medicare Medicare |
$46.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.80
|
| Rate for Payer: UHC Core |
$156.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.82
|
| Rate for Payer: UHC Exchange |
$46.82
|
| Rate for Payer: UHC Medicare Advantage |
$46.82
|
| Rate for Payer: VA VA |
$46.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.45
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: BCBS Trust/PPO |
$152.87
|
| Rate for Payer: BCN Commercial |
$144.72
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health HMO/PPO |
$162.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.80
|
| Rate for Payer: UHC Core |
$156.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.45
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$526.91
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$474.22 |
| Rate for Payer: Aetna Commercial |
$447.87
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.66
|
| Rate for Payer: BCBS Complete |
$210.76
|
| Rate for Payer: BCBS MAPPO |
$131.73
|
| Rate for Payer: BCBS Trust/PPO |
$433.17
|
| Rate for Payer: BCN Commercial |
$409.67
|
| Rate for Payer: BCN Medicare Advantage |
$131.73
|
| Rate for Payer: Cash Price |
$421.53
|
| Rate for Payer: Cofinity Commercial |
$453.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.73
|
| Rate for Payer: Healthscope Commercial |
$474.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.87
|
| Rate for Payer: Nomi Health Commercial |
$432.07
|
| Rate for Payer: PACE Senior Care Partners |
$125.14
|
| Rate for Payer: PACE SWMI |
$131.73
|
| Rate for Payer: PHP Commercial |
$447.87
|
| Rate for Payer: PHP Medicare Advantage |
$131.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.49
|
| Rate for Payer: Priority Health HMO/PPO |
$458.41
|
| Rate for Payer: Priority Health Medicare |
$133.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.03
|
| Rate for Payer: Railroad Medicare Medicare |
$131.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.68
|
| Rate for Payer: UHC Core |
$439.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.73
|
| Rate for Payer: UHC Exchange |
$131.73
|
| Rate for Payer: UHC Medicare Advantage |
$131.73
|
| Rate for Payer: VA VA |
$131.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.18
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$526.91
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$342.49 |
| Max. Negotiated Rate |
$474.22 |
| Rate for Payer: Aetna Commercial |
$447.87
|
| Rate for Payer: BCBS Trust/PPO |
$430.12
|
| Rate for Payer: BCN Commercial |
$407.20
|
| Rate for Payer: Cash Price |
$421.53
|
| Rate for Payer: Cofinity Commercial |
$453.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.53
|
| Rate for Payer: Healthscope Commercial |
$474.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.87
|
| Rate for Payer: Nomi Health Commercial |
$432.07
|
| Rate for Payer: PHP Commercial |
$447.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.49
|
| Rate for Payer: Priority Health HMO/PPO |
$458.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.68
|
| Rate for Payer: UHC Core |
$439.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.18
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
IP
|
$263.16
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.05 |
| Max. Negotiated Rate |
$236.84 |
| Rate for Payer: Aetna Commercial |
$223.69
|
| Rate for Payer: BCBS Trust/PPO |
$214.82
|
| Rate for Payer: BCN Commercial |
$203.37
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Cofinity Commercial |
$226.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.53
|
| Rate for Payer: Healthscope Commercial |
$236.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: Nomi Health Commercial |
$215.79
|
| Rate for Payer: PHP Commercial |
$223.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO |
$228.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.58
|
| Rate for Payer: UHC Core |
$219.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.37
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
OP
|
$263.16
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$236.84 |
| Rate for Payer: Aetna Commercial |
$223.69
|
| Rate for Payer: Aetna Medicare |
$68.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.24
|
| Rate for Payer: BCBS Complete |
$105.26
|
| Rate for Payer: BCBS MAPPO |
$65.79
|
| Rate for Payer: BCBS Trust/PPO |
$216.34
|
| Rate for Payer: BCN Commercial |
$204.61
|
| Rate for Payer: BCN Medicare Advantage |
$65.79
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Cofinity Commercial |
$226.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.79
|
| Rate for Payer: Healthscope Commercial |
$236.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: Nomi Health Commercial |
$215.79
|
| Rate for Payer: PACE Senior Care Partners |
$62.50
|
| Rate for Payer: PACE SWMI |
$65.79
|
| Rate for Payer: PHP Commercial |
$223.69
|
| Rate for Payer: PHP Medicare Advantage |
$65.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO |
$228.95
|
| Rate for Payer: Priority Health Medicare |
$66.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.32
|
| Rate for Payer: Railroad Medicare Medicare |
$65.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.58
|
| Rate for Payer: UHC Core |
$219.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.79
|
| Rate for Payer: UHC Exchange |
$65.79
|
| Rate for Payer: UHC Medicare Advantage |
$65.79
|
| Rate for Payer: VA VA |
$65.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.37
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Mclaren Medicaid |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.71
|
| Rate for Payer: Meridian Medicaid |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
