|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: BCBS Trust/PPO |
$24.86
|
| Rate for Payer: BCN Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: Nomi Health Commercial |
$24.97
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health HMO/PPO |
$26.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.80
|
| Rate for Payer: UHC Core |
$25.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.84
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: BCBS Trust/PPO |
$32.49
|
| Rate for Payer: BCN Commercial |
$30.76
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health HMO/PPO |
$34.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.02
|
| Rate for Payer: UHC Core |
$33.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.44
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: BCBS MAPPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$30.94
|
| Rate for Payer: BCN Medicare Advantage |
$9.95
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.95
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: PACE Senior Care Partners |
$9.45
|
| Rate for Payer: PACE SWMI |
$9.95
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health HMO/PPO |
$34.63
|
| Rate for Payer: Priority Health Medicare |
$10.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.67
|
| Rate for Payer: Railroad Medicare Medicare |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.02
|
| Rate for Payer: UHC Core |
$33.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.95
|
| Rate for Payer: UHC Exchange |
$9.95
|
| Rate for Payer: UHC Medicare Advantage |
$9.95
|
| Rate for Payer: VA VA |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna Medicare |
$14.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.73
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: BCBS MAPPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$46.64
|
| Rate for Payer: BCN Commercial |
$44.11
|
| Rate for Payer: BCN Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: Nomi Health Commercial |
$46.52
|
| Rate for Payer: PACE Senior Care Partners |
$13.47
|
| Rate for Payer: PACE SWMI |
$14.18
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: PHP Medicare Advantage |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health HMO/PPO |
$49.36
|
| Rate for Payer: Priority Health Medicare |
$14.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.92
|
| Rate for Payer: UHC Core |
$47.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.18
|
| Rate for Payer: UHC Exchange |
$14.18
|
| Rate for Payer: UHC Medicare Advantage |
$14.18
|
| Rate for Payer: VA VA |
$14.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.55
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: BCBS Trust/PPO |
$46.31
|
| Rate for Payer: BCN Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: Nomi Health Commercial |
$46.52
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health HMO/PPO |
$49.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.92
|
| Rate for Payer: UHC Core |
$47.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.55
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: BCBS Trust/PPO |
$83.75
|
| Rate for Payer: BCN Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: Nomi Health Commercial |
$84.13
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health HMO/PPO |
$89.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.29
|
| Rate for Payer: UHC Core |
$85.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.95
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$26.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.06
|
| Rate for Payer: BCBS Complete |
$41.04
|
| Rate for Payer: BCBS MAPPO |
$25.65
|
| Rate for Payer: BCBS Trust/PPO |
$84.35
|
| Rate for Payer: BCN Commercial |
$79.77
|
| Rate for Payer: BCN Medicare Advantage |
$25.65
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.65
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: Nomi Health Commercial |
$84.13
|
| Rate for Payer: PACE Senior Care Partners |
$24.37
|
| Rate for Payer: PACE SWMI |
$25.65
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: PHP Medicare Advantage |
$25.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health HMO/PPO |
$89.26
|
| Rate for Payer: Priority Health Medicare |
$25.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.74
|
| Rate for Payer: Railroad Medicare Medicare |
$25.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.29
|
| Rate for Payer: UHC Core |
$85.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.65
|
| Rate for Payer: UHC Exchange |
$25.65
|
| Rate for Payer: UHC Medicare Advantage |
$25.65
|
| Rate for Payer: VA VA |
$25.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.95
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$16.32
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: Nomi Health Commercial |
$16.39
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health HMO/PPO |
$17.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.59
|
| Rate for Payer: UHC Core |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.43
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: Nomi Health Commercial |
$16.39
|
| Rate for Payer: PACE Senior Care Partners |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health HMO/PPO |
$17.39
|
| Rate for Payer: Priority Health Medicare |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.59
|
| Rate for Payer: UHC Core |
$16.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Exchange |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: VA VA |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.02
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$21.11
|
| Rate for Payer: BCN Commercial |
$19.97
|
| Rate for Payer: BCN Medicare Advantage |
$6.42
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.42
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.10
|
| Rate for Payer: PACE SWMI |
$6.42
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$22.34
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: Railroad Medicare Medicare |
$6.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.60
|
| Rate for Payer: UHC Core |
$21.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.42
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicare Advantage |
$6.42
|
| Rate for Payer: VA VA |
$6.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$22.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.60
|
| Rate for Payer: UHC Core |
$21.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.26 |
| Max. Negotiated Rate |
$497.43 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: BCBS Trust/PPO |
$451.17
|
| Rate for Payer: BCN Commercial |
$427.13
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$475.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Healthscope Commercial |
$497.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: Nomi Health Commercial |
$453.21
|
| Rate for Payer: PHP Commercial |
$469.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.26
|
| Rate for Payer: Priority Health HMO/PPO |
$480.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.38
|
| Rate for Payer: UHC Core |
$461.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.52
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.27 |
| Max. Negotiated Rate |
$497.43 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Medicare |
$143.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.72
|
| Rate for Payer: BCBS Complete |
$221.08
|
| Rate for Payer: BCBS MAPPO |
$138.18
|
| Rate for Payer: BCBS Trust/PPO |
$454.37
|
| Rate for Payer: BCN Commercial |
$429.72
|
| Rate for Payer: BCN Medicare Advantage |
$138.18
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$475.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$497.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: Nomi Health Commercial |
$453.21
|
| Rate for Payer: PACE Senior Care Partners |
$131.27
|
| Rate for Payer: PACE SWMI |
$138.18
|
| Rate for Payer: PHP Commercial |
$469.80
|
| Rate for Payer: PHP Medicare Advantage |
$138.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.26
|
| Rate for Payer: Priority Health HMO/PPO |
$480.85
|
| Rate for Payer: Priority Health Medicare |
$139.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.31
|
| Rate for Payer: Railroad Medicare Medicare |
$138.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.38
|
| Rate for Payer: UHC Core |
$461.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.18
|
| Rate for Payer: UHC Exchange |
$138.18
|
| Rate for Payer: UHC Medicare Advantage |
$138.18
|
| Rate for Payer: VA VA |
$138.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.52
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$31.60
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health HMO/PPO |
$33.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.06
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna Medicare |
$10.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.10
|
| Rate for Payer: BCBS Complete |
$15.48
|
| Rate for Payer: BCBS MAPPO |
$9.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.82
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: BCN Medicare Advantage |
$9.68
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: PACE Senior Care Partners |
$9.19
|
| Rate for Payer: PACE SWMI |
$9.68
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: PHP Medicare Advantage |
$9.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health HMO/PPO |
$33.68
|
| Rate for Payer: Priority Health Medicare |
$9.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: Railroad Medicare Medicare |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.06
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.68
|
| Rate for Payer: UHC Exchange |
$9.68
|
| Rate for Payer: UHC Medicare Advantage |
$9.68
|
| Rate for Payer: VA VA |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.69 |
| Max. Negotiated Rate |
$484.18 |
| Rate for Payer: Aetna Commercial |
$457.28
|
| Rate for Payer: BCBS Trust/PPO |
$439.15
|
| Rate for Payer: BCN Commercial |
$415.75
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Healthscope Commercial |
$484.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: Nomi Health Commercial |
$441.14
|
| Rate for Payer: PHP Commercial |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: Priority Health HMO/PPO |
$468.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.42
|
| Rate for Payer: UHC Core |
$449.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.48
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.77 |
| Max. Negotiated Rate |
$484.18 |
| Rate for Payer: Aetna Commercial |
$457.28
|
| Rate for Payer: Aetna Medicare |
$139.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.12
|
| Rate for Payer: BCBS Complete |
$215.19
|
| Rate for Payer: BCBS MAPPO |
$134.50
|
| Rate for Payer: BCBS Trust/PPO |
$442.27
|
| Rate for Payer: BCN Commercial |
$418.28
|
| Rate for Payer: BCN Medicare Advantage |
$134.50
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.50
|
| Rate for Payer: Healthscope Commercial |
$484.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: Nomi Health Commercial |
$441.14
|
| Rate for Payer: PACE Senior Care Partners |
$127.77
|
| Rate for Payer: PACE SWMI |
$134.50
|
| Rate for Payer: PHP Commercial |
$457.28
|
| Rate for Payer: PHP Medicare Advantage |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: Priority Health HMO/PPO |
$468.04
|
| Rate for Payer: Priority Health Medicare |
$135.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.45
|
| Rate for Payer: Railroad Medicare Medicare |
$134.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.42
|
| Rate for Payer: UHC Core |
$449.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.50
|
| Rate for Payer: UHC Exchange |
$134.50
|
| Rate for Payer: UHC Medicare Advantage |
$134.50
|
| Rate for Payer: VA VA |
$134.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.48
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$11,873.09
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,717.51 |
| Max. Negotiated Rate |
$10,685.78 |
| Rate for Payer: Aetna Commercial |
$10,092.13
|
| Rate for Payer: BCBS Trust/PPO |
$9,692.00
|
| Rate for Payer: BCN Commercial |
$9,175.52
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cofinity Commercial |
$10,210.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,498.47
|
| Rate for Payer: Healthscope Commercial |
$10,685.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,904.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,092.13
|
| Rate for Payer: Nomi Health Commercial |
$9,735.93
|
| Rate for Payer: PHP Commercial |
$10,092.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,717.51
|
| Rate for Payer: Priority Health HMO/PPO |
$10,329.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,954.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,448.32
|
| Rate for Payer: UHC Core |
$9,914.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,904.82
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$11,873.09
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,819.86 |
| Max. Negotiated Rate |
$10,685.78 |
| Rate for Payer: Aetna Commercial |
$10,092.13
|
| Rate for Payer: Aetna Medicare |
$3,087.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,710.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,710.34
|
| Rate for Payer: BCBS Complete |
$7,784.62
|
| Rate for Payer: BCBS MAPPO |
$2,968.27
|
| Rate for Payer: BCBS Trust/PPO |
$9,760.87
|
| Rate for Payer: BCN Commercial |
$9,231.33
|
| Rate for Payer: BCN Medicare Advantage |
$2,968.27
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cofinity Commercial |
$10,210.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,498.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,968.27
|
| Rate for Payer: Healthscope Commercial |
$10,685.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,904.82
|
| Rate for Payer: Mclaren Medicaid |
$7,413.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,116.69
|
| Rate for Payer: Meridian Medicaid |
$7,784.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,413.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,092.13
|
| Rate for Payer: Nomi Health Commercial |
$9,735.93
|
| Rate for Payer: PACE Senior Care Partners |
$2,819.86
|
| Rate for Payer: PACE SWMI |
$2,968.27
|
| Rate for Payer: PHP Commercial |
$10,092.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,968.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,413.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,717.51
|
| Rate for Payer: Priority Health HMO/PPO |
$10,329.59
|
| Rate for Payer: Priority Health Medicare |
$2,997.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,954.97
|
| Rate for Payer: Railroad Medicare Medicare |
$2,968.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,448.32
|
| Rate for Payer: UHC Core |
$9,914.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,968.27
|
| Rate for Payer: UHC Exchange |
$2,968.27
|
| Rate for Payer: UHC Medicare Advantage |
$2,968.27
|
| Rate for Payer: UHCCP Medicaid |
$7,413.44
|
| Rate for Payer: VA VA |
$2,968.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,904.82
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
IP
|
$13,060.39
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,489.25 |
| Max. Negotiated Rate |
$11,754.35 |
| Rate for Payer: Aetna Commercial |
$11,101.33
|
| Rate for Payer: BCBS Trust/PPO |
$10,661.20
|
| Rate for Payer: BCN Commercial |
$10,093.07
|
| Rate for Payer: Cash Price |
$10,448.31
|
| Rate for Payer: Cofinity Commercial |
$11,231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,448.31
|
| Rate for Payer: Healthscope Commercial |
$11,754.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,795.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,101.33
|
| Rate for Payer: Nomi Health Commercial |
$10,709.52
|
| Rate for Payer: PHP Commercial |
$11,101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,489.25
|
| Rate for Payer: Priority Health HMO/PPO |
$11,362.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,750.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,493.14
|
| Rate for Payer: UHC Core |
$10,905.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,795.29
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
OP
|
$13,060.39
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$11,754.35 |
| Rate for Payer: Aetna Commercial |
$11,101.33
|
| Rate for Payer: Aetna Medicare |
$3,395.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,081.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,081.37
|
| Rate for Payer: BCBS Complete |
$7,784.62
|
| Rate for Payer: BCBS MAPPO |
$3,265.10
|
| Rate for Payer: BCBS Trust/PPO |
$10,736.95
|
| Rate for Payer: BCN Commercial |
$10,154.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,265.10
|
| Rate for Payer: Cash Price |
$10,448.31
|
| Rate for Payer: Cash Price |
$10,448.31
|
| Rate for Payer: Cofinity Commercial |
$11,231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,448.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,265.10
|
| Rate for Payer: Healthscope Commercial |
$11,754.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,795.29
|
| Rate for Payer: Mclaren Medicaid |
$7,413.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,428.35
|
| Rate for Payer: Meridian Medicaid |
$7,784.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,754.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,101.33
|
| Rate for Payer: Nomi Health Commercial |
$10,709.52
|
| Rate for Payer: PACE Senior Care Partners |
$3,101.84
|
| Rate for Payer: PACE SWMI |
$3,265.10
|
| Rate for Payer: PHP Commercial |
$11,101.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,265.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,413.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,489.25
|
| Rate for Payer: Priority Health HMO/PPO |
$11,362.54
|
| Rate for Payer: Priority Health Medicare |
$3,297.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,750.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3,265.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,493.14
|
| Rate for Payer: UHC Core |
$10,905.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,265.10
|
| Rate for Payer: UHC Exchange |
$3,265.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,265.10
|
| Rate for Payer: UHCCP Medicaid |
$7,413.44
|
| Rate for Payer: VA VA |
$3,265.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,795.29
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
IP
|
$438.60
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$285.09 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: BCBS Trust/PPO |
$358.03
|
| Rate for Payer: BCN Commercial |
$338.95
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$359.65
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health HMO/PPO |
$381.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.97
|
| Rate for Payer: UHC Core |
$366.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.95
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
OP
|
$438.60
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Aetna Medicare |
$114.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.06
|
| Rate for Payer: BCBS Complete |
$38.77
|
| Rate for Payer: BCBS MAPPO |
$109.65
|
| Rate for Payer: BCBS Trust/PPO |
$360.57
|
| Rate for Payer: BCN Commercial |
$341.01
|
| Rate for Payer: BCN Medicare Advantage |
$109.65
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.65
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.95
|
| Rate for Payer: Mclaren Medicaid |
$36.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.13
|
| Rate for Payer: Meridian Medicaid |
$38.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$359.65
|
| Rate for Payer: PACE Senior Care Partners |
$104.17
|
| Rate for Payer: PACE SWMI |
$109.65
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: PHP Medicare Advantage |
$109.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health HMO/PPO |
$381.58
|
| Rate for Payer: Priority Health Medicare |
$110.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.86
|
| Rate for Payer: Railroad Medicare Medicare |
$109.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.97
|
| Rate for Payer: UHC Core |
$366.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.65
|
| Rate for Payer: UHC Exchange |
$109.65
|
| Rate for Payer: UHC Medicare Advantage |
$109.65
|
| Rate for Payer: UHCCP Medicaid |
$36.92
|
| Rate for Payer: VA VA |
$109.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.95
|
|
