|
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 |
$47.69
|
| 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 |
$14.03
|
| Rate for Payer: BCBS Trust/PPO |
$46.12
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$14.03
|
| 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 |
$14.03
|
| 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 |
$47.69
|
| Rate for Payer: Nomi Health Commercial |
$46.00
|
| Rate for Payer: PACE Senior Care Partners |
$13.32
|
| Rate for Payer: PACE SWMI |
$14.03
|
| Rate for Payer: PHP Commercial |
$47.69
|
| Rate for Payer: PHP Medicare Advantage |
$14.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.47
|
| 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 |
$14.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.37
|
| Rate for Payer: UHC Core |
$46.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.03
|
| Rate for Payer: UHC Exchange |
$14.03
|
| Rate for Payer: UHC Medicare Advantage |
$14.03
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$14.03
|
| 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
|
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 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 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 |
$45.10 |
| 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 |
$45.10
|
| 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 |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.10
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| 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 |
$42.95
|
| 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 |
$42.95
|
| 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 |
$1,087.07
|
| 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 |
$1,087.07
|
|
|
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 |
$402.83
|
| 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 |
$1,087.07
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.47
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| 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 |
$383.62
|
| 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 |
$383.62
|
| Rate for Payer: VA VA |
$362.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.07
|
|
|
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
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
IP
|
$5,572.41
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,622.07 |
| Max. Negotiated Rate |
$5,015.17 |
| Rate for Payer: Aetna Commercial |
$4,736.55
|
| Rate for Payer: BCBS Trust/PPO |
$4,548.76
|
| Rate for Payer: BCN Commercial |
$4,306.36
|
| 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: Healthscope Commercial |
$5,015.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,736.55
|
| Rate for Payer: Nomi Health Commercial |
$4,569.38
|
| Rate for Payer: PHP Commercial |
$4,736.55
|
| 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 Narrow/Tiered Network |
$3,733.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,903.72
|
| Rate for Payer: UHC Core |
$4,652.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,179.31
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
IP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,210.04 |
| Max. Negotiated Rate |
$5,829.28 |
| Rate for Payer: Aetna Commercial |
$5,505.43
|
| Rate for Payer: BCBS Trust/PPO |
$5,287.16
|
| Rate for Payer: BCN Commercial |
$5,005.41
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$5,570.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Healthscope Commercial |
$5,829.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,857.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: PHP Commercial |
$5,505.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,210.04
|
| Rate for Payer: Priority Health HMO/PPO |
$5,634.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,339.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,699.74
|
| Rate for Payer: UHC Core |
$5,408.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,857.73
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,476.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.28 |
| Max. Negotiated Rate |
$5,829.28 |
| Rate for Payer: Aetna Commercial |
$5,505.43
|
| Rate for Payer: Aetna Medicare |
$1,684.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,024.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,024.06
|
| Rate for Payer: BCBS Complete |
$2,590.79
|
| Rate for Payer: BCBS MAPPO |
$1,619.24
|
| Rate for Payer: BCBS Trust/PPO |
$5,324.73
|
| Rate for Payer: BCN Commercial |
$5,035.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,619.24
|
| Rate for Payer: Cash Price |
$5,181.58
|
| Rate for Payer: Cofinity Commercial |
$5,570.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,181.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,619.24
|
| Rate for Payer: Healthscope Commercial |
$5,829.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,857.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,700.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,862.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,505.43
|
| Rate for Payer: Nomi Health Commercial |
$5,311.12
|
| Rate for Payer: PACE Senior Care Partners |
$1,538.28
|
| Rate for Payer: PACE SWMI |
$1,619.24
|
| Rate for Payer: PHP Commercial |
$5,505.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,619.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,210.04
|
| Rate for Payer: Priority Health HMO/PPO |
$5,634.97
|
| Rate for Payer: Priority Health Medicare |
$1,635.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,339.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,619.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,699.74
|
| Rate for Payer: UHC Core |
$5,408.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,619.24
|
| Rate for Payer: UHC Exchange |
$1,619.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,619.24
|
| Rate for Payer: VA VA |
$1,619.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,857.73
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
IP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,703.65 |
| Max. Negotiated Rate |
$7,897.36 |
| Rate for Payer: Aetna Commercial |
$7,458.61
|
| Rate for Payer: BCBS Trust/PPO |
$7,162.90
|
| Rate for Payer: BCN Commercial |
$6,781.20
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$7,546.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Healthscope Commercial |
$7,897.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,581.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: PHP Commercial |
$7,458.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,703.65
|
| Rate for Payer: Priority Health HMO/PPO |
$7,634.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,879.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,721.86
|
| Rate for Payer: UHC Core |
$7,326.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,581.13
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
OP
|
$8,774.84
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,084.02 |
| Max. Negotiated Rate |
$7,897.36 |
| Rate for Payer: Aetna Commercial |
$7,458.61
|
| Rate for Payer: Aetna Medicare |
$2,281.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,742.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,742.14
|
| Rate for Payer: BCBS Complete |
$3,509.94
|
| Rate for Payer: BCBS MAPPO |
$2,193.71
|
| Rate for Payer: BCBS Trust/PPO |
$7,213.80
|
| Rate for Payer: BCN Commercial |
$6,822.44
|
| Rate for Payer: BCN Medicare Advantage |
$2,193.71
|
| Rate for Payer: Cash Price |
$7,019.87
|
| Rate for Payer: Cofinity Commercial |
$7,546.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,019.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,193.71
|
| Rate for Payer: Healthscope Commercial |
$7,897.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,581.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,303.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,522.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,458.61
|
| Rate for Payer: Nomi Health Commercial |
$7,195.37
|
| Rate for Payer: PACE Senior Care Partners |
$2,084.02
|
| Rate for Payer: PACE SWMI |
$2,193.71
|
| Rate for Payer: PHP Commercial |
$7,458.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,193.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,703.65
|
| Rate for Payer: Priority Health HMO/PPO |
$7,634.11
|
| Rate for Payer: Priority Health Medicare |
$2,215.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,879.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2,193.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,721.86
|
| Rate for Payer: UHC Core |
$7,326.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,193.71
|
| Rate for Payer: UHC Exchange |
$2,193.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,193.71
|
| Rate for Payer: VA VA |
$2,193.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,581.13
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,835.01 |
| Max. Negotiated Rate |
$2,540.78 |
| Rate for Payer: Aetna Commercial |
$2,399.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,304.49
|
| Rate for Payer: BCN Commercial |
$2,181.68
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$2,427.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Healthscope Commercial |
$2,540.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,117.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: Nomi Health Commercial |
$2,314.93
|
| Rate for Payer: PHP Commercial |
$2,399.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,456.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,891.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,484.32
|
| Rate for Payer: UHC Core |
$2,357.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,117.32
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
OP
|
$2,823.09
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$2,540.78 |
| Rate for Payer: Aetna Commercial |
$2,399.63
|
| Rate for Payer: Aetna Medicare |
$734.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$882.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$882.22
|
| Rate for Payer: BCBS Complete |
$1,129.24
|
| Rate for Payer: BCBS MAPPO |
$705.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,320.86
|
| Rate for Payer: BCN Commercial |
$2,194.95
|
| Rate for Payer: BCN Medicare Advantage |
$705.77
|
| Rate for Payer: Cash Price |
$2,258.47
|
| Rate for Payer: Cofinity Commercial |
$2,427.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.77
|
| Rate for Payer: Healthscope Commercial |
$2,540.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,117.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.63
|
| Rate for Payer: Nomi Health Commercial |
$2,314.93
|
| Rate for Payer: PACE Senior Care Partners |
$670.48
|
| Rate for Payer: PACE SWMI |
$705.77
|
| Rate for Payer: PHP Commercial |
$2,399.63
|
| Rate for Payer: PHP Medicare Advantage |
$705.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.01
|
| Rate for Payer: Priority Health HMO/PPO |
$2,456.09
|
| Rate for Payer: Priority Health Medicare |
$712.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,891.47
|
| Rate for Payer: Railroad Medicare Medicare |
$705.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,484.32
|
| Rate for Payer: UHC Core |
$2,357.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$705.77
|
| Rate for Payer: UHC Exchange |
$705.77
|
| Rate for Payer: UHC Medicare Advantage |
$705.77
|
| Rate for Payer: VA VA |
$705.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,117.32
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.81 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.67
|
| Rate for Payer: Aetna Medicare |
$2,923.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,514.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,514.22
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: BCBS MAPPO |
$2,811.38
|
| Rate for Payer: BCBS Trust/PPO |
$9,244.93
|
| Rate for Payer: BCN Commercial |
$8,743.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,811.38
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,811.38
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,951.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,233.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.67
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: PACE Senior Care Partners |
$2,670.81
|
| Rate for Payer: PACE SWMI |
$2,811.38
|
| Rate for Payer: PHP Commercial |
$9,558.67
|
| Rate for Payer: PHP Medicare Advantage |
$2,811.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.57
|
| Rate for Payer: Priority Health HMO/PPO |
$9,783.58
|
| Rate for Payer: Priority Health Medicare |
$2,839.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,534.48
|
| Rate for Payer: Railroad Medicare Medicare |
$2,811.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,896.04
|
| Rate for Payer: UHC Core |
$9,389.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,811.38
|
| Rate for Payer: UHC Exchange |
$2,811.38
|
| Rate for Payer: UHC Medicare Advantage |
$2,811.38
|
| Rate for Payer: VA VA |
$2,811.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
HC STENT NONCOATED W SYS LVL 112
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,309.57 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.67
|
| Rate for Payer: BCBS Trust/PPO |
$9,179.70
|
| Rate for Payer: BCN Commercial |
$8,690.52
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,558.67
|
| Rate for Payer: Nomi Health Commercial |
$9,221.31
|
| Rate for Payer: PHP Commercial |
$9,558.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,309.57
|
| Rate for Payer: Priority Health HMO/PPO |
$9,783.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,534.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,896.04
|
| Rate for Payer: UHC Core |
$9,389.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
