|
HC OXALATE URINE
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.57
|
| Rate for Payer: BCN Commercial |
$38.57
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.10
|
| Rate for Payer: UHC Core |
$38.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
|
HC OXALATE URINE
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$11.68
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Commercial |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.68
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.68
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.02
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.26
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Senior Care Partners |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.68
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: PHP Medicare Advantage |
$11.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.63
|
| Rate for Payer: Priority Health Medicare |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.10
|
| Rate for Payer: UHC Core |
$38.99
|
| Rate for Payer: UHC Exchange |
$11.68
|
| Rate for Payer: UHC Medicaid |
$8.23
|
| Rate for Payer: UHC Medicare Advantage |
$11.68
|
| Rate for Payer: UHCCP Medicaid |
$8.23
|
| Rate for Payer: VA VA |
$11.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$75.35
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$64.05
|
| Rate for Payer: BCBS Trust/PPO |
$62.23
|
| Rate for Payer: BCN Commercial |
$62.23
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$64.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Nomi Health Commercial |
$61.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PHP Commercial |
$64.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.31
|
| Rate for Payer: UHC Core |
$62.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.51
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$75.35
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$64.05
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.55
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| Rate for Payer: BCBS Trust/PPO |
$61.95
|
| Rate for Payer: BCN Commercial |
$61.95
|
| Rate for Payer: BCN Medicare Advantage |
$18.84
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$64.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.51
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.78
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Nomi Health Commercial |
$61.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PACE Senior Care Partners |
$17.90
|
| Rate for Payer: PACE SWMI |
$18.84
|
| Rate for Payer: PHP Commercial |
$64.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.55
|
| Rate for Payer: Priority Health Medicare |
$19.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.44
|
| Rate for Payer: Railroad Medicare Medicare |
$18.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.31
|
| Rate for Payer: UHC Core |
$62.92
|
| Rate for Payer: UHC Exchange |
$18.84
|
| Rate for Payer: UHC Medicaid |
$13.28
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.51
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.48 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: BCBS Trust/PPO |
$67.02
|
| Rate for Payer: BCN Commercial |
$67.02
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.41
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC OXYCODONE LVL
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$21.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.36
|
| Rate for Payer: BCBS Complete |
$15.02
|
| Rate for Payer: BCBS MAPPO |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$66.71
|
| Rate for Payer: BCN Commercial |
$66.71
|
| Rate for Payer: BCN Medicare Advantage |
$20.29
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Mclaren Medicaid |
$14.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.30
|
| Rate for Payer: Meridian Medicaid |
$15.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PACE Senior Care Partners |
$19.27
|
| Rate for Payer: PACE SWMI |
$20.29
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: PHP Medicare Advantage |
$20.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.60
|
| Rate for Payer: Priority Health Medicare |
$20.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.48
|
| Rate for Payer: Railroad Medicare Medicare |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.41
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Exchange |
$20.29
|
| Rate for Payer: UHC Medicaid |
$14.31
|
| Rate for Payer: UHC Medicare Advantage |
$20.29
|
| Rate for Payer: UHCCP Medicaid |
$14.31
|
| Rate for Payer: VA VA |
$20.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$28.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.77
|
| Rate for Payer: BCBS Complete |
$20.59
|
| Rate for Payer: BCBS MAPPO |
$27.81
|
| Rate for Payer: BCBS Trust/PPO |
$91.46
|
| Rate for Payer: BCN Commercial |
$91.46
|
| Rate for Payer: BCN Medicare Advantage |
$27.81
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.81
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Mclaren Medicaid |
$19.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.20
|
| Rate for Payer: Meridian Medicaid |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Senior Care Partners |
$26.42
|
| Rate for Payer: PACE SWMI |
$27.81
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$27.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.79
|
| Rate for Payer: Priority Health Medicare |
$28.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.43
|
| Rate for Payer: Railroad Medicare Medicare |
$27.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.90
|
| Rate for Payer: UHC Core |
$92.89
|
| Rate for Payer: UHC Exchange |
$27.81
|
| Rate for Payer: UHC Medicaid |
$19.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.81
|
| Rate for Payer: UHCCP Medicaid |
$19.61
|
| Rate for Payer: VA VA |
$27.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC OXYCODONE URINE.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.43 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$91.88
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.90
|
| Rate for Payer: UHC Core |
$92.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: BCBS Trust/PPO |
$46.40
|
| Rate for Payer: BCN Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.13
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$46.19
|
| Rate for Payer: BCN Commercial |
$46.19
|
| Rate for Payer: BCN Medicare Advantage |
$14.04
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.13
|
| Rate for Payer: Mclaren Medicaid |
$9.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: Meridian Medicaid |
$10.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: PACE Senior Care Partners |
$13.34
|
| Rate for Payer: PACE SWMI |
$14.04
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.88
|
| Rate for Payer: Priority Health Medicare |
$14.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.10
|
| Rate for Payer: Railroad Medicare Medicare |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: UHC Exchange |
$14.04
|
| Rate for Payer: UHC Medicaid |
$9.90
|
| Rate for Payer: UHC Medicare Advantage |
$14.04
|
| Rate for Payer: UHCCP Medicaid |
$9.90
|
| Rate for Payer: VA VA |
$14.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.13
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,498.21
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.13 |
| Max. Negotiated Rate |
$1,348.39 |
| Rate for Payer: Aetna Commercial |
$1,273.48
|
| Rate for Payer: Aetna Medicare |
$389.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$468.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$468.19
|
| Rate for Payer: BCBS Complete |
$277.32
|
| Rate for Payer: BCBS MAPPO |
$374.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,231.68
|
| Rate for Payer: BCN Commercial |
$1,231.68
|
| Rate for Payer: BCN Medicare Advantage |
$374.55
|
| Rate for Payer: Cash Price |
$1,198.57
|
| Rate for Payer: Cofinity Commercial |
$1,288.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.55
|
| Rate for Payer: Healthscope Commercial |
$1,348.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,123.66
|
| Rate for Payer: Mclaren Medicaid |
$264.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.28
|
| Rate for Payer: Meridian Medicaid |
$277.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$430.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$412.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.48
|
| Rate for Payer: Nomi Health Commercial |
$1,228.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.66
|
| Rate for Payer: PACE Senior Care Partners |
$355.82
|
| Rate for Payer: PACE SWMI |
$374.55
|
| Rate for Payer: PHP Commercial |
$1,273.48
|
| Rate for Payer: PHP Medicare Advantage |
$374.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,303.44
|
| Rate for Payer: Priority Health Medicare |
$378.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,042.75
|
| Rate for Payer: Railroad Medicare Medicare |
$374.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,318.42
|
| Rate for Payer: UHC Core |
$1,251.01
|
| Rate for Payer: UHC Exchange |
$374.55
|
| Rate for Payer: UHC Medicaid |
$264.13
|
| Rate for Payer: UHC Medicare Advantage |
$374.55
|
| Rate for Payer: UHCCP Medicaid |
$264.13
|
| Rate for Payer: VA VA |
$374.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,123.66
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,498.21
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,042.75 |
| Max. Negotiated Rate |
$1,348.39 |
| Rate for Payer: Aetna Commercial |
$1,273.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,237.37
|
| Rate for Payer: BCN Commercial |
$1,237.37
|
| Rate for Payer: Cash Price |
$1,198.57
|
| Rate for Payer: Cofinity Commercial |
$1,288.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.57
|
| Rate for Payer: Healthscope Commercial |
$1,348.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,123.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.48
|
| Rate for Payer: Nomi Health Commercial |
$1,228.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.66
|
| Rate for Payer: PHP Commercial |
$1,273.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,303.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,042.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,318.42
|
| Rate for Payer: UHC Core |
$1,251.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,123.66
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,264.09
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.86 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna Commercial |
$1,074.48
|
| Rate for Payer: Aetna Medicare |
$328.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$395.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$395.03
|
| Rate for Payer: BCBS Complete |
$233.98
|
| Rate for Payer: BCBS MAPPO |
$316.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.21
|
| Rate for Payer: BCN Commercial |
$1,039.21
|
| Rate for Payer: BCN Medicare Advantage |
$316.02
|
| Rate for Payer: Cash Price |
$1,011.27
|
| Rate for Payer: Cofinity Commercial |
$1,087.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.02
|
| Rate for Payer: Healthscope Commercial |
$1,137.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.07
|
| Rate for Payer: Mclaren Medicaid |
$222.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.82
|
| Rate for Payer: Meridian Medicaid |
$233.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$347.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.48
|
| Rate for Payer: Nomi Health Commercial |
$1,036.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.07
|
| Rate for Payer: PACE Senior Care Partners |
$300.22
|
| Rate for Payer: PACE SWMI |
$316.02
|
| Rate for Payer: PHP Commercial |
$1,074.48
|
| Rate for Payer: PHP Medicare Advantage |
$316.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$319.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$879.81
|
| Rate for Payer: Railroad Medicare Medicare |
$316.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.40
|
| Rate for Payer: UHC Core |
$1,055.52
|
| Rate for Payer: UHC Exchange |
$316.02
|
| Rate for Payer: UHC Medicaid |
$222.86
|
| Rate for Payer: UHC Medicare Advantage |
$316.02
|
| Rate for Payer: UHCCP Medicaid |
$222.86
|
| Rate for Payer: VA VA |
$316.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.07
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,264.09
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$879.81 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna Commercial |
$1,074.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.01
|
| Rate for Payer: BCN Commercial |
$1,044.01
|
| Rate for Payer: Cash Price |
$1,011.27
|
| Rate for Payer: Cofinity Commercial |
$1,087.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.27
|
| Rate for Payer: Healthscope Commercial |
$1,137.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$948.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.48
|
| Rate for Payer: Nomi Health Commercial |
$1,036.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.07
|
| Rate for Payer: PHP Commercial |
$1,074.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,099.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$879.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.40
|
| Rate for Payer: UHC Core |
$1,055.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$948.07
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,279.69
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$890.66 |
| Max. Negotiated Rate |
$1,151.72 |
| Rate for Payer: Aetna Commercial |
$1,087.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.90
|
| Rate for Payer: BCN Commercial |
$1,056.90
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cofinity Commercial |
$1,100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.75
|
| Rate for Payer: Healthscope Commercial |
$1,151.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$959.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.74
|
| Rate for Payer: Nomi Health Commercial |
$1,049.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.77
|
| Rate for Payer: PHP Commercial |
$1,087.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,113.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$890.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.13
|
| Rate for Payer: UHC Core |
$1,068.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$959.77
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,279.69
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.61 |
| Max. Negotiated Rate |
$1,151.72 |
| Rate for Payer: Aetna Commercial |
$1,087.74
|
| Rate for Payer: Aetna Medicare |
$332.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.90
|
| Rate for Payer: BCBS Complete |
$236.87
|
| Rate for Payer: BCBS MAPPO |
$319.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,052.03
|
| Rate for Payer: BCN Commercial |
$1,052.03
|
| Rate for Payer: BCN Medicare Advantage |
$319.92
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cofinity Commercial |
$1,100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.92
|
| Rate for Payer: Healthscope Commercial |
$1,151.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$959.77
|
| Rate for Payer: Mclaren Medicaid |
$225.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.92
|
| Rate for Payer: Meridian Medicaid |
$236.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$351.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.74
|
| Rate for Payer: Nomi Health Commercial |
$1,049.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.77
|
| Rate for Payer: PACE Senior Care Partners |
$303.93
|
| Rate for Payer: PACE SWMI |
$319.92
|
| Rate for Payer: PHP Commercial |
$1,087.74
|
| Rate for Payer: PHP Medicare Advantage |
$319.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,113.33
|
| Rate for Payer: Priority Health Medicare |
$323.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$890.66
|
| Rate for Payer: Railroad Medicare Medicare |
$319.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.13
|
| Rate for Payer: UHC Core |
$1,068.54
|
| Rate for Payer: UHC Exchange |
$319.92
|
| Rate for Payer: UHC Medicaid |
$225.61
|
| Rate for Payer: UHC Medicare Advantage |
$319.92
|
| Rate for Payer: UHCCP Medicaid |
$225.61
|
| Rate for Payer: VA VA |
$319.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$959.77
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,940.52
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,742.60 |
| Max. Negotiated Rate |
$3,546.47 |
| Rate for Payer: Aetna Commercial |
$3,349.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,254.48
|
| Rate for Payer: BCN Commercial |
$3,254.48
|
| Rate for Payer: Cash Price |
$3,152.42
|
| Rate for Payer: Cofinity Commercial |
$3,388.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,152.42
|
| Rate for Payer: Healthscope Commercial |
$3,546.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,955.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,349.44
|
| Rate for Payer: Nomi Health Commercial |
$3,231.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,955.39
|
| Rate for Payer: PHP Commercial |
$3,349.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,428.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,742.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,467.66
|
| Rate for Payer: UHC Core |
$3,290.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,955.39
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,940.52
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$694.71 |
| Max. Negotiated Rate |
$3,546.47 |
| Rate for Payer: Aetna Commercial |
$3,349.44
|
| Rate for Payer: Aetna Medicare |
$1,024.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,231.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,231.41
|
| Rate for Payer: BCBS Complete |
$729.39
|
| Rate for Payer: BCBS MAPPO |
$985.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,239.50
|
| Rate for Payer: BCN Commercial |
$3,239.50
|
| Rate for Payer: BCN Medicare Advantage |
$985.13
|
| Rate for Payer: Cash Price |
$3,152.42
|
| Rate for Payer: Cofinity Commercial |
$3,388.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,152.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$985.13
|
| Rate for Payer: Healthscope Commercial |
$3,546.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,955.39
|
| Rate for Payer: Mclaren Medicaid |
$694.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,034.39
|
| Rate for Payer: Meridian Medicaid |
$729.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,132.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,083.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,349.44
|
| Rate for Payer: Nomi Health Commercial |
$3,231.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,955.39
|
| Rate for Payer: PACE Senior Care Partners |
$935.87
|
| Rate for Payer: PACE SWMI |
$985.13
|
| Rate for Payer: PHP Commercial |
$3,349.44
|
| Rate for Payer: PHP Medicare Advantage |
$985.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,428.25
|
| Rate for Payer: Priority Health Medicare |
$994.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,742.60
|
| Rate for Payer: Railroad Medicare Medicare |
$985.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,467.66
|
| Rate for Payer: UHC Core |
$3,290.33
|
| Rate for Payer: UHC Exchange |
$985.13
|
| Rate for Payer: UHC Medicaid |
$694.71
|
| Rate for Payer: UHC Medicare Advantage |
$985.13
|
| Rate for Payer: UHCCP Medicaid |
$694.71
|
| Rate for Payer: VA VA |
$985.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,955.39
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$818.25
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$144.26 |
| Max. Negotiated Rate |
$736.42 |
| Rate for Payer: Aetna Commercial |
$695.51
|
| Rate for Payer: Aetna Medicare |
$212.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$255.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$255.70
|
| Rate for Payer: BCBS Complete |
$151.46
|
| Rate for Payer: BCBS MAPPO |
$204.56
|
| Rate for Payer: BCBS Trust/PPO |
$672.68
|
| Rate for Payer: BCN Commercial |
$672.68
|
| Rate for Payer: BCN Medicare Advantage |
$204.56
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cofinity Commercial |
$703.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$654.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.56
|
| Rate for Payer: Healthscope Commercial |
$736.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$613.69
|
| Rate for Payer: Mclaren Medicaid |
$144.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.79
|
| Rate for Payer: Meridian Medicaid |
$151.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$695.51
|
| Rate for Payer: Nomi Health Commercial |
$670.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.69
|
| Rate for Payer: PACE Senior Care Partners |
$194.33
|
| Rate for Payer: PACE SWMI |
$204.56
|
| Rate for Payer: PHP Commercial |
$695.51
|
| Rate for Payer: PHP Medicare Advantage |
$204.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$711.88
|
| Rate for Payer: Priority Health Medicare |
$206.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$569.50
|
| Rate for Payer: Railroad Medicare Medicare |
$204.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.06
|
| Rate for Payer: UHC Core |
$683.24
|
| Rate for Payer: UHC Exchange |
$204.56
|
| Rate for Payer: UHC Medicaid |
$144.26
|
| Rate for Payer: UHC Medicare Advantage |
$204.56
|
| Rate for Payer: UHCCP Medicaid |
$144.26
|
| Rate for Payer: VA VA |
$204.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.69
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$818.25
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$569.50 |
| Max. Negotiated Rate |
$736.42 |
| Rate for Payer: Aetna Commercial |
$695.51
|
| Rate for Payer: BCBS Trust/PPO |
$675.79
|
| Rate for Payer: BCN Commercial |
$675.79
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cofinity Commercial |
$703.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$654.60
|
| Rate for Payer: Healthscope Commercial |
$736.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$613.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$695.51
|
| Rate for Payer: Nomi Health Commercial |
$670.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.69
|
| Rate for Payer: PHP Commercial |
$695.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$711.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$569.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.06
|
| Rate for Payer: UHC Core |
$683.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.69
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC PACEMAKER AVEIR LEADLESS DUAL CHAMBER
|
Facility
|
OP
|
$87,549.66
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$15,435.01 |
| Max. Negotiated Rate |
$78,794.69 |
| Rate for Payer: Aetna Commercial |
$74,417.21
|
| Rate for Payer: Aetna Medicare |
$22,762.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,359.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,359.27
|
| Rate for Payer: BCBS Complete |
$16,205.44
|
| Rate for Payer: BCBS MAPPO |
$21,887.42
|
| Rate for Payer: BCBS Trust/PPO |
$71,974.58
|
| Rate for Payer: BCN Commercial |
$71,974.58
|
| Rate for Payer: BCN Medicare Advantage |
$21,887.42
|
| Rate for Payer: Cash Price |
$70,039.73
|
| Rate for Payer: Cofinity Commercial |
$75,292.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70,039.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,887.42
|
| Rate for Payer: Healthscope Commercial |
$78,794.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65,662.24
|
| Rate for Payer: Mclaren Medicaid |
$15,435.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,981.79
|
| Rate for Payer: Meridian Medicaid |
$16,205.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,170.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,076.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74,417.21
|
| Rate for Payer: Nomi Health Commercial |
$71,790.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65,662.24
|
| Rate for Payer: PACE Senior Care Partners |
$20,793.04
|
| Rate for Payer: PACE SWMI |
$21,887.42
|
| Rate for Payer: PHP Commercial |
$74,417.21
|
| Rate for Payer: PHP Medicare Advantage |
$21,887.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,435.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76,168.20
|
| Rate for Payer: Priority Health Medicare |
$22,106.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60,934.56
|
| Rate for Payer: Railroad Medicare Medicare |
$21,887.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77,043.70
|
| Rate for Payer: UHC Core |
$73,103.97
|
| Rate for Payer: UHC Exchange |
$21,887.42
|
| Rate for Payer: UHC Medicaid |
$15,435.01
|
| Rate for Payer: UHC Medicare Advantage |
$21,887.42
|
| Rate for Payer: UHCCP Medicaid |
$15,435.01
|
| Rate for Payer: VA VA |
$21,887.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65,662.24
|
|
|
HC PACEMAKER AVEIR LEADLESS DUAL CHAMBER
|
Facility
|
IP
|
$87,549.66
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$60,934.56 |
| Max. Negotiated Rate |
$78,794.69 |
| Rate for Payer: Aetna Commercial |
$74,417.21
|
| Rate for Payer: BCBS Trust/PPO |
$72,307.26
|
| Rate for Payer: BCN Commercial |
$72,307.26
|
| Rate for Payer: Cash Price |
$70,039.73
|
| Rate for Payer: Cofinity Commercial |
$75,292.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70,039.73
|
| Rate for Payer: Healthscope Commercial |
$78,794.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65,662.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74,417.21
|
| Rate for Payer: Nomi Health Commercial |
$71,790.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65,662.24
|
| Rate for Payer: PHP Commercial |
$74,417.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76,168.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60,934.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77,043.70
|
| Rate for Payer: UHC Core |
$73,103.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65,662.24
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,534.59 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,567.56
|
| Rate for Payer: BCN Commercial |
$6,567.56
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,964.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: Nomi Health Commercial |
$6,520.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,964.00
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,918.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,534.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,997.76
|
| Rate for Payer: UHC Core |
$6,639.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,964.00
|
|
