|
HC OXALATE URINE
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.31
|
| Rate for Payer: BCBS Complete |
$10.97
|
| Rate for Payer: BCBS MAPPO |
$11.44
|
| Rate for Payer: BCBS Trust/PPO |
$37.64
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.44
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Mclaren Medicaid |
$10.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.02
|
| Rate for Payer: Meridian Medicaid |
$10.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Senior Care Partners |
$10.87
|
| Rate for Payer: PACE SWMI |
$11.44
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Medicare |
$11.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.44
|
| Rate for Payer: UHC Exchange |
$11.44
|
| Rate for Payer: UHC Medicare Advantage |
$11.44
|
| Rate for Payer: UHCCP Medicaid |
$10.45
|
| Rate for Payer: VA VA |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC OXALATE URINE
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$37.37
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna Medicare |
$19.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.08
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS MAPPO |
$18.47
|
| Rate for Payer: BCBS Trust/PPO |
$60.73
|
| Rate for Payer: BCN Commercial |
$57.43
|
| Rate for Payer: BCN Medicare Advantage |
$18.47
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.47
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Mclaren Medicaid |
$9.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.39
|
| Rate for Payer: Meridian Medicaid |
$10.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PACE Senior Care Partners |
$17.54
|
| Rate for Payer: PACE SWMI |
$18.47
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: PHP Medicare Advantage |
$18.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health HMO/PPO |
$64.27
|
| Rate for Payer: Priority Health Medicare |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.49
|
| Rate for Payer: Railroad Medicare Medicare |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.01
|
| Rate for Payer: UHC Core |
$61.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.47
|
| Rate for Payer: UHC Exchange |
$18.47
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: UHCCP Medicaid |
$9.58
|
| Rate for Payer: VA VA |
$18.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: BCBS Trust/PPO |
$60.30
|
| Rate for Payer: BCN Commercial |
$57.09
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health HMO/PPO |
$64.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.01
|
| Rate for Payer: UHC Core |
$61.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: BCBS Trust/PPO |
$64.94
|
| Rate for Payer: BCN Commercial |
$61.48
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO |
$69.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.01
|
| Rate for Payer: UHC Core |
$66.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC OXYCODONE LVL
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.86
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS MAPPO |
$19.89
|
| Rate for Payer: BCBS Trust/PPO |
$65.41
|
| Rate for Payer: BCN Commercial |
$61.86
|
| Rate for Payer: BCN Medicare Advantage |
$19.89
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.89
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.89
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: PHP Medicare Advantage |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO |
$69.22
|
| Rate for Payer: Priority Health Medicare |
$20.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.31
|
| Rate for Payer: Railroad Medicare Medicare |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.01
|
| Rate for Payer: UHC Core |
$66.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.89
|
| Rate for Payer: UHC Exchange |
$19.89
|
| Rate for Payer: UHC Medicare Advantage |
$19.89
|
| Rate for Payer: VA VA |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC OXYCODONE URINE.
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: BCBS Trust/PPO |
$82.99
|
| Rate for Payer: BCN Commercial |
$78.56
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.77
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$25.42
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.42
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.42
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.69
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.42
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$25.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: Railroad Medicare Medicare |
$25.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.42
|
| Rate for Payer: UHC Exchange |
$25.42
|
| Rate for Payer: UHC Medicare Advantage |
$25.42
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.21
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$45.28
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: PACE Senior Care Partners |
$13.08
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health HMO/PPO |
$47.92
|
| Rate for Payer: Priority Health Medicare |
$13.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.90
|
| Rate for Payer: Railroad Medicare Medicare |
$13.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.47
|
| Rate for Payer: UHC Core |
$45.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.77
|
| Rate for Payer: UHC Exchange |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$13.77
|
| Rate for Payer: VA VA |
$13.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: BCBS Trust/PPO |
$44.96
|
| Rate for Payer: BCN Commercial |
$42.57
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health HMO/PPO |
$47.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.47
|
| Rate for Payer: UHC Core |
$45.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$954.74 |
| Max. Negotiated Rate |
$1,321.95 |
| Rate for Payer: Aetna Commercial |
$1,248.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.01
|
| Rate for Payer: BCN Commercial |
$1,135.11
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,263.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,321.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,101.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: Nomi Health Commercial |
$1,204.44
|
| Rate for Payer: PHP Commercial |
$1,248.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,277.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.57
|
| Rate for Payer: UHC Core |
$1,226.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,101.62
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.85 |
| Max. Negotiated Rate |
$1,321.95 |
| Rate for Payer: Aetna Commercial |
$1,248.51
|
| Rate for Payer: Aetna Medicare |
$381.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$459.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$459.01
|
| Rate for Payer: BCBS Complete |
$587.53
|
| Rate for Payer: BCBS MAPPO |
$367.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.53
|
| Rate for Payer: BCN Commercial |
$1,142.02
|
| Rate for Payer: BCN Medicare Advantage |
$367.21
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,263.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$367.21
|
| Rate for Payer: Healthscope Commercial |
$1,321.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,101.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$385.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: Nomi Health Commercial |
$1,204.44
|
| Rate for Payer: PACE Senior Care Partners |
$348.85
|
| Rate for Payer: PACE SWMI |
$367.21
|
| Rate for Payer: PHP Commercial |
$1,248.51
|
| Rate for Payer: PHP Medicare Advantage |
$367.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,277.88
|
| Rate for Payer: Priority Health Medicare |
$370.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.12
|
| Rate for Payer: Railroad Medicare Medicare |
$367.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.57
|
| Rate for Payer: UHC Core |
$1,226.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$367.21
|
| Rate for Payer: UHC Exchange |
$367.21
|
| Rate for Payer: UHC Medicare Advantage |
$367.21
|
| Rate for Payer: VA VA |
$367.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,101.62
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$805.54 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.64
|
| Rate for Payer: BCN Commercial |
$957.73
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health HMO/PPO |
$1,078.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$830.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.58
|
| Rate for Payer: UHC Core |
$1,034.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.48
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$294.33 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: Aetna Medicare |
$322.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$387.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$387.28
|
| Rate for Payer: BCBS Complete |
$495.72
|
| Rate for Payer: BCBS MAPPO |
$309.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,018.83
|
| Rate for Payer: BCN Commercial |
$963.56
|
| Rate for Payer: BCN Medicare Advantage |
$309.82
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.82
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: PACE Senior Care Partners |
$294.33
|
| Rate for Payer: PACE SWMI |
$309.82
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: PHP Medicare Advantage |
$309.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health HMO/PPO |
$1,078.19
|
| Rate for Payer: Priority Health Medicare |
$312.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$830.33
|
| Rate for Payer: Railroad Medicare Medicare |
$309.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.58
|
| Rate for Payer: UHC Core |
$1,034.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.82
|
| Rate for Payer: UHC Exchange |
$309.82
|
| Rate for Payer: UHC Medicare Advantage |
$309.82
|
| Rate for Payer: VA VA |
$309.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.48
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$297.97 |
| Max. Negotiated Rate |
$1,129.14 |
| Rate for Payer: Aetna Commercial |
$1,066.41
|
| Rate for Payer: Aetna Medicare |
$326.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.06
|
| Rate for Payer: BCBS Complete |
$501.84
|
| Rate for Payer: BCBS MAPPO |
$313.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.41
|
| Rate for Payer: BCN Commercial |
$975.45
|
| Rate for Payer: BCN Medicare Advantage |
$313.65
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,078.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.65
|
| Rate for Payer: Healthscope Commercial |
$1,129.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: Nomi Health Commercial |
$1,028.77
|
| Rate for Payer: PACE Senior Care Partners |
$297.97
|
| Rate for Payer: PACE SWMI |
$313.65
|
| Rate for Payer: PHP Commercial |
$1,066.41
|
| Rate for Payer: PHP Medicare Advantage |
$313.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,091.50
|
| Rate for Payer: Priority Health Medicare |
$316.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$840.58
|
| Rate for Payer: Railroad Medicare Medicare |
$313.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,104.05
|
| Rate for Payer: UHC Core |
$1,047.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.65
|
| Rate for Payer: UHC Exchange |
$313.65
|
| Rate for Payer: UHC Medicare Advantage |
$313.65
|
| Rate for Payer: VA VA |
$313.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.95
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$815.49 |
| Max. Negotiated Rate |
$1,129.14 |
| Rate for Payer: Aetna Commercial |
$1,066.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.13
|
| Rate for Payer: BCN Commercial |
$969.55
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,078.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,129.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$940.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: Nomi Health Commercial |
$1,028.77
|
| Rate for Payer: PHP Commercial |
$1,066.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,091.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$840.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,104.05
|
| Rate for Payer: UHC Core |
$1,047.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$940.95
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$917.52 |
| Max. Negotiated Rate |
$3,476.92 |
| Rate for Payer: Aetna Commercial |
$3,283.76
|
| Rate for Payer: Aetna Medicare |
$1,004.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,207.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,207.27
|
| Rate for Payer: BCBS Complete |
$1,545.30
|
| Rate for Payer: BCBS MAPPO |
$965.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,175.98
|
| Rate for Payer: BCN Commercial |
$3,003.68
|
| Rate for Payer: BCN Medicare Advantage |
$965.81
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$3,322.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$965.81
|
| Rate for Payer: Healthscope Commercial |
$3,476.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,897.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,110.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: Nomi Health Commercial |
$3,167.86
|
| Rate for Payer: PACE Senior Care Partners |
$917.52
|
| Rate for Payer: PACE SWMI |
$965.81
|
| Rate for Payer: PHP Commercial |
$3,283.76
|
| Rate for Payer: PHP Medicare Advantage |
$965.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health HMO/PPO |
$3,361.03
|
| Rate for Payer: Priority Health Medicare |
$975.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,588.38
|
| Rate for Payer: Railroad Medicare Medicare |
$965.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,399.66
|
| Rate for Payer: UHC Core |
$3,225.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$965.81
|
| Rate for Payer: UHC Exchange |
$965.81
|
| Rate for Payer: UHC Medicare Advantage |
$965.81
|
| Rate for Payer: VA VA |
$965.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,897.44
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,511.11 |
| Max. Negotiated Rate |
$3,476.92 |
| Rate for Payer: Aetna Commercial |
$3,283.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,153.57
|
| Rate for Payer: BCN Commercial |
$2,985.52
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$3,322.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,476.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,897.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: Nomi Health Commercial |
$3,167.86
|
| Rate for Payer: PHP Commercial |
$3,283.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health HMO/PPO |
$3,361.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,588.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,399.66
|
| Rate for Payer: UHC Core |
$3,225.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,897.44
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$521.44 |
| Max. Negotiated Rate |
$721.99 |
| Rate for Payer: Aetna Commercial |
$681.88
|
| Rate for Payer: BCBS Trust/PPO |
$654.84
|
| Rate for Payer: BCN Commercial |
$619.95
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$689.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Healthscope Commercial |
$721.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: Nomi Health Commercial |
$657.81
|
| Rate for Payer: PHP Commercial |
$681.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health HMO/PPO |
$697.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.94
|
| Rate for Payer: UHC Core |
$669.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.66
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$721.99 |
| Rate for Payer: Aetna Commercial |
$681.88
|
| Rate for Payer: Aetna Medicare |
$208.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.69
|
| Rate for Payer: BCBS Complete |
$149.64
|
| Rate for Payer: BCBS MAPPO |
$200.55
|
| Rate for Payer: BCBS Trust/PPO |
$659.50
|
| Rate for Payer: BCN Commercial |
$623.72
|
| Rate for Payer: BCN Medicare Advantage |
$200.55
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$689.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.55
|
| Rate for Payer: Healthscope Commercial |
$721.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.66
|
| Rate for Payer: Mclaren Medicaid |
$142.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.58
|
| Rate for Payer: Meridian Medicaid |
$149.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: Nomi Health Commercial |
$657.81
|
| Rate for Payer: PACE Senior Care Partners |
$190.52
|
| Rate for Payer: PACE SWMI |
$200.55
|
| Rate for Payer: PHP Commercial |
$681.88
|
| Rate for Payer: PHP Medicare Advantage |
$200.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health HMO/PPO |
$697.92
|
| Rate for Payer: Priority Health Medicare |
$202.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.48
|
| Rate for Payer: Railroad Medicare Medicare |
$200.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.94
|
| Rate for Payer: UHC Core |
$669.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.55
|
| Rate for Payer: UHC Exchange |
$200.55
|
| Rate for Payer: UHC Medicare Advantage |
$200.55
|
| Rate for Payer: UHCCP Medicaid |
$142.50
|
| Rate for Payer: VA VA |
$200.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.66
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
OP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$20,385.34 |
| Max. Negotiated Rate |
$77,249.70 |
| Rate for Payer: Aetna Commercial |
$72,958.05
|
| Rate for Payer: Aetna Medicare |
$22,316.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,822.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,822.81
|
| Rate for Payer: BCBS Complete |
$34,333.20
|
| Rate for Payer: BCBS MAPPO |
$21,458.25
|
| Rate for Payer: BCBS Trust/PPO |
$70,563.31
|
| Rate for Payer: BCN Commercial |
$66,735.16
|
| Rate for Payer: BCN Medicare Advantage |
$21,458.25
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$73,816.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,458.25
|
| Rate for Payer: Healthscope Commercial |
$77,249.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64,374.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,531.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,676.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: Nomi Health Commercial |
$70,383.06
|
| Rate for Payer: PACE Senior Care Partners |
$20,385.34
|
| Rate for Payer: PACE SWMI |
$21,458.25
|
| Rate for Payer: PHP Commercial |
$72,958.05
|
| Rate for Payer: PHP Medicare Advantage |
$21,458.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health HMO/PPO |
$74,674.71
|
| Rate for Payer: Priority Health Medicare |
$21,672.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57,508.11
|
| Rate for Payer: Railroad Medicare Medicare |
$21,458.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75,533.04
|
| Rate for Payer: UHC Core |
$71,670.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,458.25
|
| Rate for Payer: UHC Exchange |
$21,458.25
|
| Rate for Payer: UHC Medicare Advantage |
$21,458.25
|
| Rate for Payer: VA VA |
$21,458.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64,374.75
|
|
|
HC PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
IP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$55,791.45 |
| Max. Negotiated Rate |
$77,249.70 |
| Rate for Payer: Aetna Commercial |
$72,958.05
|
| Rate for Payer: BCBS Trust/PPO |
$70,065.48
|
| Rate for Payer: BCN Commercial |
$66,331.74
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$73,816.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$77,249.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64,374.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: Nomi Health Commercial |
$70,383.06
|
| Rate for Payer: PHP Commercial |
$72,958.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health HMO/PPO |
$74,674.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57,508.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75,533.04
|
| Rate for Payer: UHC Core |
$71,670.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64,374.75
|
|
|
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 |
$5,168.80 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,491.22
|
| Rate for Payer: BCN Commercial |
$6,145.31
|
| 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: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: Priority Health HMO/PPO |
$6,918.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,327.84
|
| 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
|
|
