|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.06
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$92.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$28.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.05
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Mclaren Medicaid |
$91.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: Meridian Medicaid |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PACE Senior Care Partners |
$26.65
|
| Rate for Payer: PACE SWMI |
$28.05
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$28.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Medicare |
$28.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: Railroad Medicare Medicare |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Exchange |
$28.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.05
|
| Rate for Payer: UHCCP Medicaid |
$91.31
|
| Rate for Payer: VA VA |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC SS2PC SPECIAL STAIN (BILL ONLY)
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31200007
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: BCBS Trust/PPO |
$91.59
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
IP
|
$933.30
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$606.64 |
| Max. Negotiated Rate |
$839.97 |
| Rate for Payer: Aetna Commercial |
$793.30
|
| Rate for Payer: BCBS Trust/PPO |
$761.85
|
| Rate for Payer: BCN Commercial |
$721.25
|
| Rate for Payer: Cash Price |
$746.64
|
| Rate for Payer: Cofinity Commercial |
$802.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.64
|
| Rate for Payer: Healthscope Commercial |
$839.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.30
|
| Rate for Payer: Nomi Health Commercial |
$765.31
|
| Rate for Payer: PHP Commercial |
$793.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.64
|
| Rate for Payer: Priority Health HMO/PPO |
$811.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$625.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.30
|
| Rate for Payer: UHC Core |
$779.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.98
|
|
|
HC STABILIZERS HEART ESTECH
|
Facility
|
OP
|
$933.30
|
|
| Hospital Charge Code |
27000292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.66 |
| Max. Negotiated Rate |
$839.97 |
| Rate for Payer: Aetna Commercial |
$793.30
|
| Rate for Payer: Aetna Medicare |
$242.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$291.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$291.66
|
| Rate for Payer: BCBS Complete |
$373.32
|
| Rate for Payer: BCBS MAPPO |
$233.32
|
| Rate for Payer: BCBS Trust/PPO |
$767.27
|
| Rate for Payer: BCN Commercial |
$725.64
|
| Rate for Payer: BCN Medicare Advantage |
$233.32
|
| Rate for Payer: Cash Price |
$746.64
|
| Rate for Payer: Cofinity Commercial |
$802.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.32
|
| Rate for Payer: Healthscope Commercial |
$839.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.30
|
| Rate for Payer: Nomi Health Commercial |
$765.31
|
| Rate for Payer: PACE Senior Care Partners |
$221.66
|
| Rate for Payer: PACE SWMI |
$233.32
|
| Rate for Payer: PHP Commercial |
$793.30
|
| Rate for Payer: PHP Medicare Advantage |
$233.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.64
|
| Rate for Payer: Priority Health HMO/PPO |
$811.97
|
| Rate for Payer: Priority Health Medicare |
$235.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$625.31
|
| Rate for Payer: Railroad Medicare Medicare |
$233.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.30
|
| Rate for Payer: UHC Core |
$779.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.32
|
| Rate for Payer: UHC Exchange |
$233.32
|
| Rate for Payer: UHC Medicare Advantage |
$233.32
|
| Rate for Payer: VA VA |
$233.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.98
|
|
|
HC STACLOT LA.
|
Facility
|
IP
|
$148.92
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: BCBS Trust/PPO |
$121.56
|
| Rate for Payer: BCN Commercial |
$115.09
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO |
$129.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.05
|
| Rate for Payer: UHC Core |
$124.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.69
|
|
|
HC STACLOT LA.
|
Facility
|
OP
|
$148.92
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
30500085
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna Medicare |
$38.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.54
|
| Rate for Payer: BCBS Complete |
$13.65
|
| Rate for Payer: BCBS MAPPO |
$37.23
|
| Rate for Payer: BCBS Trust/PPO |
$122.43
|
| Rate for Payer: BCN Commercial |
$115.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.23
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.23
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.69
|
| Rate for Payer: Mclaren Medicaid |
$13.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.09
|
| Rate for Payer: Meridian Medicaid |
$13.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PACE Senior Care Partners |
$35.37
|
| Rate for Payer: PACE SWMI |
$37.23
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: PHP Medicare Advantage |
$37.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO |
$129.56
|
| Rate for Payer: Priority Health Medicare |
$37.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.78
|
| Rate for Payer: Railroad Medicare Medicare |
$37.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.05
|
| Rate for Payer: UHC Core |
$124.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.23
|
| Rate for Payer: UHC Exchange |
$37.23
|
| Rate for Payer: UHC Medicare Advantage |
$37.23
|
| Rate for Payer: UHCCP Medicaid |
$13.00
|
| Rate for Payer: VA VA |
$37.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.69
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
IP
|
$2,417.64
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,571.47 |
| Max. Negotiated Rate |
$2,175.88 |
| Rate for Payer: Aetna Commercial |
$2,054.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.52
|
| Rate for Payer: BCN Commercial |
$1,868.35
|
| Rate for Payer: Cash Price |
$1,934.11
|
| Rate for Payer: Cofinity Commercial |
$2,079.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.11
|
| Rate for Payer: Healthscope Commercial |
$2,175.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,813.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.99
|
| Rate for Payer: Nomi Health Commercial |
$1,982.46
|
| Rate for Payer: PHP Commercial |
$2,054.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.47
|
| Rate for Payer: Priority Health HMO/PPO |
$2,103.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,619.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,127.52
|
| Rate for Payer: UHC Core |
$2,018.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,813.23
|
|
|
HC STANDBY OPEN HEART/TAVR
|
Facility
|
OP
|
$2,417.64
|
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$574.19 |
| Max. Negotiated Rate |
$2,175.88 |
| Rate for Payer: Aetna Commercial |
$2,054.99
|
| Rate for Payer: Aetna Medicare |
$628.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$755.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$755.51
|
| Rate for Payer: BCBS Complete |
$967.06
|
| Rate for Payer: BCBS MAPPO |
$604.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,987.54
|
| Rate for Payer: BCN Commercial |
$1,879.72
|
| Rate for Payer: BCN Medicare Advantage |
$604.41
|
| Rate for Payer: Cash Price |
$1,934.11
|
| Rate for Payer: Cofinity Commercial |
$2,079.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.41
|
| Rate for Payer: Healthscope Commercial |
$2,175.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,813.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$634.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$695.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,054.99
|
| Rate for Payer: Nomi Health Commercial |
$1,982.46
|
| Rate for Payer: PACE Senior Care Partners |
$574.19
|
| Rate for Payer: PACE SWMI |
$604.41
|
| Rate for Payer: PHP Commercial |
$2,054.99
|
| Rate for Payer: PHP Medicare Advantage |
$604.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.47
|
| Rate for Payer: Priority Health HMO/PPO |
$2,103.35
|
| Rate for Payer: Priority Health Medicare |
$610.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,619.82
|
| Rate for Payer: Railroad Medicare Medicare |
$604.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,127.52
|
| Rate for Payer: UHC Core |
$2,018.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.41
|
| Rate for Payer: UHC Exchange |
$604.41
|
| Rate for Payer: UHC Medicare Advantage |
$604.41
|
| Rate for Payer: VA VA |
$604.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,813.23
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna Medicare |
$14.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.53
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$14.02
|
| Rate for Payer: BCBS Trust/PPO |
$46.12
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$14.02
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.08
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.73
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.68
|
| Rate for Payer: Nomi Health Commercial |
$46.00
|
| Rate for Payer: PACE Senior Care Partners |
$13.32
|
| Rate for Payer: PACE SWMI |
$14.02
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: PHP Medicare Advantage |
$14.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.46
|
| Rate for Payer: Priority Health HMO/PPO |
$48.81
|
| Rate for Payer: Priority Health Medicare |
$14.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.59
|
| Rate for Payer: Railroad Medicare Medicare |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.37
|
| Rate for Payer: UHC Core |
$46.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.02
|
| Rate for Payer: UHC Exchange |
$14.02
|
| Rate for Payer: UHC Medicare Advantage |
$14.02
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$14.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.08
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
30600263
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: BCBS Trust/PPO |
$45.79
|
| Rate for Payer: BCN Commercial |
$43.35
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.68
|
| Rate for Payer: Nomi Health Commercial |
$46.00
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.46
|
| Rate for Payer: Priority Health HMO/PPO |
$48.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.37
|
| Rate for Payer: UHC Core |
$46.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.08
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
IP
|
$61.69
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.10 |
| Max. Negotiated Rate |
$55.52 |
| Rate for Payer: Aetna Commercial |
$52.44
|
| Rate for Payer: BCBS Trust/PPO |
$50.36
|
| Rate for Payer: BCN Commercial |
$47.67
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$53.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.35
|
| Rate for Payer: Healthscope Commercial |
$55.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: PHP Commercial |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: Priority Health HMO/PPO |
$53.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.29
|
| Rate for Payer: UHC Core |
$51.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.27
|
|
|
HC STAPHYLOCOCCUS AUREUS PCR METHICILLIN RESISTANT
|
Facility
|
OP
|
$61.69
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
30600264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$55.52 |
| Rate for Payer: Aetna Commercial |
$52.44
|
| Rate for Payer: Aetna Medicare |
$16.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.28
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$15.42
|
| Rate for Payer: BCBS Trust/PPO |
$50.72
|
| Rate for Payer: BCN Commercial |
$47.96
|
| Rate for Payer: BCN Medicare Advantage |
$15.42
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$53.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$55.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.27
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.19
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.44
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: PACE Senior Care Partners |
$14.65
|
| Rate for Payer: PACE SWMI |
$15.42
|
| Rate for Payer: PHP Commercial |
$52.44
|
| Rate for Payer: PHP Medicare Advantage |
$15.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.10
|
| Rate for Payer: Priority Health HMO/PPO |
$53.67
|
| Rate for Payer: Priority Health Medicare |
$15.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.33
|
| Rate for Payer: Railroad Medicare Medicare |
$15.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.29
|
| Rate for Payer: UHC Core |
$51.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.42
|
| Rate for Payer: UHC Exchange |
$15.42
|
| Rate for Payer: UHC Medicare Advantage |
$15.42
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$15.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.27
|
|
|
HC STATLOCK
|
Facility
|
OP
|
$143.69
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$129.32 |
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: Aetna Medicare |
$37.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.90
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$35.92
|
| Rate for Payer: BCBS Trust/PPO |
$118.13
|
| Rate for Payer: BCN Commercial |
$111.72
|
| Rate for Payer: BCN Medicare Advantage |
$35.92
|
| Rate for Payer: Cash Price |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$123.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.92
|
| Rate for Payer: Healthscope Commercial |
$129.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.14
|
| Rate for Payer: Nomi Health Commercial |
$117.83
|
| Rate for Payer: PACE Senior Care Partners |
$34.13
|
| Rate for Payer: PACE SWMI |
$35.92
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: PHP Medicare Advantage |
$35.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.40
|
| Rate for Payer: Priority Health HMO/PPO |
$125.01
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$35.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.45
|
| Rate for Payer: UHC Core |
$119.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.92
|
| Rate for Payer: UHC Exchange |
$35.92
|
| Rate for Payer: UHC Medicare Advantage |
$35.92
|
| Rate for Payer: VA VA |
$35.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.77
|
|
|
HC STATLOCK
|
Facility
|
IP
|
$143.69
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$129.32 |
| Rate for Payer: Aetna Commercial |
$122.14
|
| Rate for Payer: BCBS Trust/PPO |
$117.29
|
| Rate for Payer: BCN Commercial |
$111.04
|
| Rate for Payer: Cash Price |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$123.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.95
|
| Rate for Payer: Healthscope Commercial |
$129.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.14
|
| Rate for Payer: Nomi Health Commercial |
$117.83
|
| Rate for Payer: PHP Commercial |
$122.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.40
|
| Rate for Payer: Priority Health HMO/PPO |
$125.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.45
|
| Rate for Payer: UHC Core |
$119.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.77
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$44.19 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.84
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS MAPPO |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$28.51
|
| Rate for Payer: BCN Commercial |
$26.96
|
| Rate for Payer: BCN Medicare Advantage |
$8.67
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.67
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Mclaren Medicaid |
$42.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.10
|
| Rate for Payer: Meridian Medicaid |
$44.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: PACE Senior Care Partners |
$8.24
|
| Rate for Payer: PACE SWMI |
$8.67
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health HMO/PPO |
$30.17
|
| Rate for Payer: Priority Health Medicare |
$8.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: Railroad Medicare Medicare |
$8.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.67
|
| Rate for Payer: UHC Exchange |
$8.67
|
| Rate for Payer: UHC Medicare Advantage |
$8.67
|
| Rate for Payer: UHCCP Medicaid |
$42.08
|
| Rate for Payer: VA VA |
$8.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: BCBS Trust/PPO |
$28.31
|
| Rate for Payer: BCN Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.48
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health HMO/PPO |
$30.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,449.42
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.12 |
| Max. Negotiated Rate |
$1,304.48 |
| Rate for Payer: Aetna Commercial |
$1,232.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.16
|
| Rate for Payer: BCN Commercial |
$1,120.11
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cofinity Commercial |
$1,246.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.54
|
| Rate for Payer: Healthscope Commercial |
$1,304.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.01
|
| Rate for Payer: Nomi Health Commercial |
$1,188.52
|
| Rate for Payer: PHP Commercial |
$1,232.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.12
|
| Rate for Payer: Priority Health HMO/PPO |
$1,261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$971.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.49
|
| Rate for Payer: UHC Core |
$1,210.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.06
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,449.42
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.24 |
| Max. Negotiated Rate |
$1,304.48 |
| Rate for Payer: Aetna Commercial |
$1,232.01
|
| Rate for Payer: Aetna Medicare |
$376.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.94
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$362.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.57
|
| Rate for Payer: BCN Commercial |
$1,126.92
|
| Rate for Payer: BCN Medicare Advantage |
$362.36
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cash Price |
$1,159.54
|
| Rate for Payer: Cofinity Commercial |
$1,246.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.36
|
| Rate for Payer: Healthscope Commercial |
$1,304.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.06
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.47
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.01
|
| Rate for Payer: Nomi Health Commercial |
$1,188.52
|
| Rate for Payer: PACE Senior Care Partners |
$344.24
|
| Rate for Payer: PACE SWMI |
$362.36
|
| Rate for Payer: PHP Commercial |
$1,232.01
|
| Rate for Payer: PHP Medicare Advantage |
$362.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.12
|
| Rate for Payer: Priority Health HMO/PPO |
$1,261.00
|
| Rate for Payer: Priority Health Medicare |
$365.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$971.11
|
| Rate for Payer: Railroad Medicare Medicare |
$362.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.49
|
| Rate for Payer: UHC Core |
$1,210.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.36
|
| Rate for Payer: UHC Exchange |
$362.36
|
| Rate for Payer: UHC Medicare Advantage |
$362.36
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$362.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.06
|
|
|
HC STENT
|
Facility
|
IP
|
$953.16
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.55 |
| Max. Negotiated Rate |
$857.84 |
| Rate for Payer: Aetna Commercial |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$778.06
|
| Rate for Payer: BCN Commercial |
$736.60
|
| Rate for Payer: Cash Price |
$762.53
|
| Rate for Payer: Cofinity Commercial |
$819.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.53
|
| Rate for Payer: Healthscope Commercial |
$857.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.19
|
| Rate for Payer: Nomi Health Commercial |
$781.59
|
| Rate for Payer: PHP Commercial |
$810.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.55
|
| Rate for Payer: Priority Health HMO/PPO |
$829.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$638.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.78
|
| Rate for Payer: UHC Core |
$795.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.87
|
|
|
HC STENT
|
Facility
|
OP
|
$953.16
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.38 |
| Max. Negotiated Rate |
$857.84 |
| Rate for Payer: Aetna Commercial |
$810.19
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$381.26
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$783.59
|
| Rate for Payer: BCN Commercial |
$741.08
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$762.53
|
| Rate for Payer: Cofinity Commercial |
$819.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$857.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$810.19
|
| Rate for Payer: Nomi Health Commercial |
$781.59
|
| Rate for Payer: PACE Senior Care Partners |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$810.19
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.55
|
| Rate for Payer: Priority Health HMO/PPO |
$829.25
|
| Rate for Payer: Priority Health Medicare |
$240.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$638.62
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.78
|
| Rate for Payer: UHC Core |
$795.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$238.29
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: VA VA |
$238.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.87
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$17,010.57
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,056.87 |
| Max. Negotiated Rate |
$15,309.51 |
| Rate for Payer: Aetna Commercial |
$14,458.98
|
| Rate for Payer: BCBS Trust/PPO |
$13,885.73
|
| Rate for Payer: BCN Commercial |
$13,145.77
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$14,629.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$15,309.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,757.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: PHP Commercial |
$14,458.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health HMO/PPO |
$14,799.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,397.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,969.30
|
| Rate for Payer: UHC Core |
$14,203.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,757.93
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$17,010.57
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,040.01 |
| Max. Negotiated Rate |
$15,309.51 |
| Rate for Payer: Aetna Commercial |
$14,458.98
|
| Rate for Payer: Aetna Medicare |
$4,422.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,315.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,315.80
|
| Rate for Payer: BCBS Complete |
$6,804.23
|
| Rate for Payer: BCBS MAPPO |
$4,252.64
|
| Rate for Payer: BCBS Trust/PPO |
$13,984.39
|
| Rate for Payer: BCN Commercial |
$13,225.72
|
| Rate for Payer: BCN Medicare Advantage |
$4,252.64
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$14,629.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,252.64
|
| Rate for Payer: Healthscope Commercial |
$15,309.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,757.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,465.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,890.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: PACE Senior Care Partners |
$4,040.01
|
| Rate for Payer: PACE SWMI |
$4,252.64
|
| Rate for Payer: PHP Commercial |
$14,458.98
|
| Rate for Payer: PHP Medicare Advantage |
$4,252.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health HMO/PPO |
$14,799.20
|
| Rate for Payer: Priority Health Medicare |
$4,295.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,397.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4,252.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,969.30
|
| Rate for Payer: UHC Core |
$14,203.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,252.64
|
| Rate for Payer: UHC Exchange |
$4,252.64
|
| Rate for Payer: UHC Medicare Advantage |
$4,252.64
|
| Rate for Payer: VA VA |
$4,252.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,757.93
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$11,875.31
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,820.39 |
| Max. Negotiated Rate |
$10,687.78 |
| Rate for Payer: Aetna Commercial |
$10,094.01
|
| Rate for Payer: Aetna Medicare |
$3,087.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,711.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,711.03
|
| Rate for Payer: BCBS Complete |
$4,750.12
|
| Rate for Payer: BCBS MAPPO |
$2,968.83
|
| Rate for Payer: BCBS Trust/PPO |
$9,762.69
|
| Rate for Payer: BCN Commercial |
$9,233.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,968.83
|
| Rate for Payer: Cash Price |
$9,500.25
|
| Rate for Payer: Cofinity Commercial |
$10,212.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,500.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,968.83
|
| Rate for Payer: Healthscope Commercial |
$10,687.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,906.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,117.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,414.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,094.01
|
| Rate for Payer: Nomi Health Commercial |
$9,737.75
|
| Rate for Payer: PACE Senior Care Partners |
$2,820.39
|
| Rate for Payer: PACE SWMI |
$2,968.83
|
| Rate for Payer: PHP Commercial |
$10,094.01
|
| Rate for Payer: PHP Medicare Advantage |
$2,968.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,718.95
|
| Rate for Payer: Priority Health HMO/PPO |
$10,331.52
|
| Rate for Payer: Priority Health Medicare |
$2,998.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,956.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,968.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,450.27
|
| Rate for Payer: UHC Core |
$9,915.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,968.83
|
| Rate for Payer: UHC Exchange |
$2,968.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,968.83
|
| Rate for Payer: VA VA |
$2,968.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,906.48
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
IP
|
$11,875.31
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,718.95 |
| Max. Negotiated Rate |
$10,687.78 |
| Rate for Payer: Aetna Commercial |
$10,094.01
|
| Rate for Payer: BCBS Trust/PPO |
$9,693.82
|
| Rate for Payer: BCN Commercial |
$9,177.24
|
| Rate for Payer: Cash Price |
$9,500.25
|
| Rate for Payer: Cofinity Commercial |
$10,212.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,500.25
|
| Rate for Payer: Healthscope Commercial |
$10,687.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,906.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,094.01
|
| Rate for Payer: Nomi Health Commercial |
$9,737.75
|
| Rate for Payer: PHP Commercial |
$10,094.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,718.95
|
| Rate for Payer: Priority Health HMO/PPO |
$10,331.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,956.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,450.27
|
| Rate for Payer: UHC Core |
$9,915.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,906.48
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
OP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,323.45 |
| Max. Negotiated Rate |
$5,015.17 |
| Rate for Payer: Aetna Commercial |
$4,736.55
|
| Rate for Payer: Aetna Medicare |
$1,448.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,741.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,741.38
|
| Rate for Payer: BCBS Complete |
$2,228.96
|
| Rate for Payer: BCBS MAPPO |
$1,393.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,581.08
|
| Rate for Payer: BCN Commercial |
$4,332.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,393.10
|
| Rate for Payer: Cash Price |
$4,457.93
|
| Rate for Payer: Cofinity Commercial |
$4,792.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,457.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,393.10
|
| Rate for Payer: Healthscope Commercial |
$5,015.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,179.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,462.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,602.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,323.45
|
| Rate for Payer: PACE SWMI |
$1,393.10
|
| Rate for Payer: PHP Commercial |
$4,736.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,393.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,622.07
|
| Rate for Payer: Priority Health HMO/PPO |
$4,848.00
|
| Rate for Payer: Priority Health Medicare |
$1,407.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,733.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,393.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,903.72
|
| Rate for Payer: UHC Core |
$4,652.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,393.10
|
| Rate for Payer: UHC Exchange |
$1,393.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,393.10
|
| Rate for Payer: VA VA |
$1,393.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,179.31
|
|
