|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.95
|
| Rate for Payer: BCN Commercial |
$42.95
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.76
|
| Rate for Payer: UHC Core |
$43.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.00
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.60
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$10.08
|
| Rate for Payer: BCBS Trust/PPO |
$33.16
|
| Rate for Payer: BCN Commercial |
$33.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.08
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Mclaren Medicaid |
$7.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.59
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PACE Senior Care Partners |
$9.58
|
| Rate for Payer: PACE SWMI |
$10.08
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$10.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.49
|
| Rate for Payer: UHC Core |
$33.68
|
| Rate for Payer: UHC Exchange |
$10.08
|
| Rate for Payer: UHC Medicaid |
$7.11
|
| Rate for Payer: UHC Medicare Advantage |
$10.08
|
| Rate for Payer: UHCCP Medicaid |
$7.11
|
| Rate for Payer: VA VA |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.31
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.49
|
| Rate for Payer: UHC Core |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC APPLIANCE BELT
|
Facility
|
IP
|
$25.41
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$20.99
|
| Rate for Payer: BCN Commercial |
$20.99
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$22.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.60
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.06
|
| Rate for Payer: PHP Commercial |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.36
|
| Rate for Payer: UHC Core |
$21.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.06
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$25.41
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare |
$6.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.94
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.89
|
| Rate for Payer: BCN Commercial |
$20.89
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.06
|
| Rate for Payer: Mclaren Medicaid |
$4.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.67
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.60
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.60
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.11
|
| Rate for Payer: Priority Health Medicare |
$6.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.36
|
| Rate for Payer: UHC Core |
$21.22
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicaid |
$4.48
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$4.48
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.06
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$36.21
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: BCBS Trust/PPO |
$29.91
|
| Rate for Payer: BCN Commercial |
$29.91
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$31.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$32.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.78
|
| Rate for Payer: Nomi Health Commercial |
$29.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.16
|
| Rate for Payer: PHP Commercial |
$30.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.86
|
| Rate for Payer: UHC Core |
$30.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.16
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$36.21
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare |
$9.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.32
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS MAPPO |
$9.05
|
| Rate for Payer: BCBS Trust/PPO |
$29.77
|
| Rate for Payer: BCN Commercial |
$29.77
|
| Rate for Payer: BCN Medicare Advantage |
$9.05
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$31.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.05
|
| Rate for Payer: Healthscope Commercial |
$32.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.16
|
| Rate for Payer: Mclaren Medicaid |
$6.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$6.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.78
|
| Rate for Payer: Nomi Health Commercial |
$29.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.16
|
| Rate for Payer: PACE Senior Care Partners |
$8.60
|
| Rate for Payer: PACE SWMI |
$9.05
|
| Rate for Payer: PHP Commercial |
$30.78
|
| Rate for Payer: PHP Medicare Advantage |
$9.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.50
|
| Rate for Payer: Priority Health Medicare |
$9.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.20
|
| Rate for Payer: Railroad Medicare Medicare |
$9.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.86
|
| Rate for Payer: UHC Core |
$30.24
|
| Rate for Payer: UHC Exchange |
$9.05
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$9.05
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: VA VA |
$9.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.16
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$152.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$137.51 |
| Rate for Payer: Aetna Commercial |
$129.87
|
| Rate for Payer: Aetna Medicare |
$39.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.75
|
| Rate for Payer: BCBS Complete |
$28.28
|
| Rate for Payer: BCBS MAPPO |
$38.20
|
| Rate for Payer: BCBS Trust/PPO |
$125.61
|
| Rate for Payer: BCN Commercial |
$125.61
|
| Rate for Payer: BCN Medicare Advantage |
$38.20
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Commercial |
$131.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.20
|
| Rate for Payer: Healthscope Commercial |
$137.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.59
|
| Rate for Payer: Mclaren Medicaid |
$26.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.11
|
| Rate for Payer: Meridian Medicaid |
$28.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Nomi Health Commercial |
$125.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: PACE Senior Care Partners |
$36.29
|
| Rate for Payer: PACE SWMI |
$38.20
|
| Rate for Payer: PHP Commercial |
$129.87
|
| Rate for Payer: PHP Medicare Advantage |
$38.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.93
|
| Rate for Payer: Priority Health Medicare |
$38.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.34
|
| Rate for Payer: Railroad Medicare Medicare |
$38.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.46
|
| Rate for Payer: UHC Core |
$127.58
|
| Rate for Payer: UHC Exchange |
$38.20
|
| Rate for Payer: UHC Medicaid |
$26.94
|
| Rate for Payer: UHC Medicare Advantage |
$38.20
|
| Rate for Payer: UHCCP Medicaid |
$26.94
|
| Rate for Payer: VA VA |
$38.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.59
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$152.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$137.51 |
| Rate for Payer: Aetna Commercial |
$129.87
|
| Rate for Payer: BCBS Trust/PPO |
$126.19
|
| Rate for Payer: BCN Commercial |
$126.19
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Commercial |
$131.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Healthscope Commercial |
$137.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Nomi Health Commercial |
$125.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: PHP Commercial |
$129.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.46
|
| Rate for Payer: UHC Core |
$127.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.59
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,986.46
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,382.58 |
| Max. Negotiated Rate |
$1,787.81 |
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.62
|
| Rate for Payer: BCN Commercial |
$1,640.62
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Commercial |
$1,708.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Healthscope Commercial |
$1,787.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,688.49
|
| Rate for Payer: Nomi Health Commercial |
$1,628.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: PHP Commercial |
$1,688.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,728.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,382.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,748.08
|
| Rate for Payer: UHC Core |
$1,658.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.85
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,986.46
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.21 |
| Max. Negotiated Rate |
$1,787.81 |
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: Aetna Medicare |
$516.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.77
|
| Rate for Payer: BCBS Complete |
$367.69
|
| Rate for Payer: BCBS MAPPO |
$496.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,633.07
|
| Rate for Payer: BCN Commercial |
$1,633.07
|
| Rate for Payer: BCN Medicare Advantage |
$496.62
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Commercial |
$1,708.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.62
|
| Rate for Payer: Healthscope Commercial |
$1,787.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.85
|
| Rate for Payer: Mclaren Medicaid |
$350.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.45
|
| Rate for Payer: Meridian Medicaid |
$367.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$546.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,688.49
|
| Rate for Payer: Nomi Health Commercial |
$1,628.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: PACE Senior Care Partners |
$471.78
|
| Rate for Payer: PACE SWMI |
$496.62
|
| Rate for Payer: PHP Commercial |
$1,688.49
|
| Rate for Payer: PHP Medicare Advantage |
$496.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,728.22
|
| Rate for Payer: Priority Health Medicare |
$501.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,382.58
|
| Rate for Payer: Railroad Medicare Medicare |
$496.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,748.08
|
| Rate for Payer: UHC Core |
$1,658.69
|
| Rate for Payer: UHC Exchange |
$496.62
|
| Rate for Payer: UHC Medicaid |
$350.21
|
| Rate for Payer: UHC Medicare Advantage |
$496.62
|
| Rate for Payer: UHCCP Medicaid |
$350.21
|
| Rate for Payer: VA VA |
$496.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.85
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,622.12
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,825.00 |
| Max. Negotiated Rate |
$2,359.91 |
| Rate for Payer: Aetna Commercial |
$2,228.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,165.61
|
| Rate for Payer: BCN Commercial |
$2,165.61
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Commercial |
$2,255.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Healthscope Commercial |
$2,359.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,966.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.80
|
| Rate for Payer: Nomi Health Commercial |
$2,150.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: PHP Commercial |
$2,228.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,281.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,825.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,307.47
|
| Rate for Payer: UHC Core |
$2,189.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,966.59
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,622.12
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$462.28 |
| Max. Negotiated Rate |
$2,359.91 |
| Rate for Payer: Aetna Commercial |
$2,228.80
|
| Rate for Payer: Aetna Medicare |
$681.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$819.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$819.41
|
| Rate for Payer: BCBS Complete |
$485.35
|
| Rate for Payer: BCBS MAPPO |
$655.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,155.64
|
| Rate for Payer: BCN Commercial |
$2,155.64
|
| Rate for Payer: BCN Medicare Advantage |
$655.53
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Commercial |
$2,255.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.53
|
| Rate for Payer: Healthscope Commercial |
$2,359.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,966.59
|
| Rate for Payer: Mclaren Medicaid |
$462.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.31
|
| Rate for Payer: Meridian Medicaid |
$485.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$753.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$721.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.80
|
| Rate for Payer: Nomi Health Commercial |
$2,150.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: PACE Senior Care Partners |
$622.75
|
| Rate for Payer: PACE SWMI |
$655.53
|
| Rate for Payer: PHP Commercial |
$2,228.80
|
| Rate for Payer: PHP Medicare Advantage |
$655.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,281.24
|
| Rate for Payer: Priority Health Medicare |
$662.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,825.00
|
| Rate for Payer: Railroad Medicare Medicare |
$655.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,307.47
|
| Rate for Payer: UHC Core |
$2,189.47
|
| Rate for Payer: UHC Exchange |
$655.53
|
| Rate for Payer: UHC Medicaid |
$462.28
|
| Rate for Payer: UHC Medicare Advantage |
$655.53
|
| Rate for Payer: UHCCP Medicaid |
$462.28
|
| Rate for Payer: VA VA |
$655.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,966.59
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,656.59
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,848.99 |
| Max. Negotiated Rate |
$2,390.93 |
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,194.08
|
| Rate for Payer: BCN Commercial |
$2,194.08
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Commercial |
$2,284.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Healthscope Commercial |
$2,390.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,992.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,178.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PHP Commercial |
$2,258.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,311.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,848.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,337.80
|
| Rate for Payer: UHC Core |
$2,218.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,992.44
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,656.59
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.36 |
| Max. Negotiated Rate |
$2,390.93 |
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: Aetna Medicare |
$690.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$830.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$830.18
|
| Rate for Payer: BCBS Complete |
$491.73
|
| Rate for Payer: BCBS MAPPO |
$664.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,183.98
|
| Rate for Payer: BCN Commercial |
$2,183.98
|
| Rate for Payer: BCN Medicare Advantage |
$664.15
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Commercial |
$2,284.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.15
|
| Rate for Payer: Healthscope Commercial |
$2,390.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,992.44
|
| Rate for Payer: Mclaren Medicaid |
$468.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.35
|
| Rate for Payer: Meridian Medicaid |
$491.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,178.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PACE Senior Care Partners |
$630.94
|
| Rate for Payer: PACE SWMI |
$664.15
|
| Rate for Payer: PHP Commercial |
$2,258.10
|
| Rate for Payer: PHP Medicare Advantage |
$664.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$468.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,311.23
|
| Rate for Payer: Priority Health Medicare |
$670.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,848.99
|
| Rate for Payer: Railroad Medicare Medicare |
$664.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,337.80
|
| Rate for Payer: UHC Core |
$2,218.25
|
| Rate for Payer: UHC Exchange |
$664.15
|
| Rate for Payer: UHC Medicaid |
$468.36
|
| Rate for Payer: UHC Medicare Advantage |
$664.15
|
| Rate for Payer: UHCCP Medicaid |
$468.36
|
| Rate for Payer: VA VA |
$664.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,992.44
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,435.19
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,694.89 |
| Max. Negotiated Rate |
$2,191.67 |
| Rate for Payer: Aetna Commercial |
$2,069.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,011.22
|
| Rate for Payer: BCN Commercial |
$2,011.22
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Commercial |
$2,094.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Healthscope Commercial |
$2,191.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,826.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$1,996.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: PHP Commercial |
$2,069.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,118.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,694.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,142.97
|
| Rate for Payer: UHC Core |
$2,033.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,826.39
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,435.19
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$2,191.67 |
| Rate for Payer: Aetna Commercial |
$2,069.91
|
| Rate for Payer: Aetna Medicare |
$633.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$761.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$761.00
|
| Rate for Payer: BCBS Complete |
$450.75
|
| Rate for Payer: BCBS MAPPO |
$608.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,001.97
|
| Rate for Payer: BCN Commercial |
$2,001.97
|
| Rate for Payer: BCN Medicare Advantage |
$608.80
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Commercial |
$2,094.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.80
|
| Rate for Payer: Healthscope Commercial |
$2,191.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,826.39
|
| Rate for Payer: Mclaren Medicaid |
$429.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$639.24
|
| Rate for Payer: Meridian Medicaid |
$450.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$700.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$669.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$1,996.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: PACE Senior Care Partners |
$578.36
|
| Rate for Payer: PACE SWMI |
$608.80
|
| Rate for Payer: PHP Commercial |
$2,069.91
|
| Rate for Payer: PHP Medicare Advantage |
$608.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,118.62
|
| Rate for Payer: Priority Health Medicare |
$614.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,694.89
|
| Rate for Payer: Railroad Medicare Medicare |
$608.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,142.97
|
| Rate for Payer: UHC Core |
$2,033.38
|
| Rate for Payer: UHC Exchange |
$608.80
|
| Rate for Payer: UHC Medicaid |
$429.32
|
| Rate for Payer: UHC Medicare Advantage |
$608.80
|
| Rate for Payer: UHCCP Medicaid |
$429.32
|
| Rate for Payer: VA VA |
$608.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,826.39
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: BCBS Trust/PPO |
$781.25
|
| Rate for Payer: BCN Commercial |
$781.25
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$709.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$822.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$658.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.43
|
| Rate for Payer: UHC Core |
$789.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$709.46
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.77 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: Aetna Medicare |
$245.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.61
|
| Rate for Payer: BCBS Complete |
$175.09
|
| Rate for Payer: BCBS MAPPO |
$236.49
|
| Rate for Payer: BCBS Trust/PPO |
$777.66
|
| Rate for Payer: BCN Commercial |
$777.66
|
| Rate for Payer: BCN Medicare Advantage |
$236.49
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.49
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$709.46
|
| Rate for Payer: Mclaren Medicaid |
$166.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.31
|
| Rate for Payer: Meridian Medicaid |
$175.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$260.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PACE Senior Care Partners |
$224.66
|
| Rate for Payer: PACE SWMI |
$236.49
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: PHP Medicare Advantage |
$236.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$822.97
|
| Rate for Payer: Priority Health Medicare |
$238.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$658.37
|
| Rate for Payer: Railroad Medicare Medicare |
$236.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.43
|
| Rate for Payer: UHC Core |
$789.86
|
| Rate for Payer: UHC Exchange |
$236.49
|
| Rate for Payer: UHC Medicaid |
$166.77
|
| Rate for Payer: UHC Medicare Advantage |
$236.49
|
| Rate for Payer: UHCCP Medicaid |
$166.77
|
| Rate for Payer: VA VA |
$236.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$709.46
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$658.37 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: BCBS Trust/PPO |
$781.25
|
| Rate for Payer: BCN Commercial |
$781.25
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$709.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$822.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$658.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.43
|
| Rate for Payer: UHC Core |
$789.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$709.46
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.77 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: Aetna Medicare |
$245.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.61
|
| Rate for Payer: BCBS Complete |
$175.09
|
| Rate for Payer: BCBS MAPPO |
$236.49
|
| Rate for Payer: BCBS Trust/PPO |
$777.66
|
| Rate for Payer: BCN Commercial |
$777.66
|
| Rate for Payer: BCN Medicare Advantage |
$236.49
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.49
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$709.46
|
| Rate for Payer: Mclaren Medicaid |
$166.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.31
|
| Rate for Payer: Meridian Medicaid |
$175.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$260.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PACE Senior Care Partners |
$224.66
|
| Rate for Payer: PACE SWMI |
$236.49
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: PHP Medicare Advantage |
$236.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$822.97
|
| Rate for Payer: Priority Health Medicare |
$238.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$658.37
|
| Rate for Payer: Railroad Medicare Medicare |
$236.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.43
|
| Rate for Payer: UHC Core |
$789.86
|
| Rate for Payer: UHC Exchange |
$236.49
|
| Rate for Payer: UHC Medicaid |
$166.77
|
| Rate for Payer: UHC Medicare Advantage |
$236.49
|
| Rate for Payer: UHCCP Medicaid |
$166.77
|
| Rate for Payer: VA VA |
$236.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$709.46
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.46 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: BCBS Trust/PPO |
$598.61
|
| Rate for Payer: BCN Commercial |
$598.61
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$543.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$630.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$504.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.82
|
| Rate for Payer: UHC Core |
$605.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$543.60
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna Medicare |
$188.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.50
|
| Rate for Payer: BCBS Complete |
$134.16
|
| Rate for Payer: BCBS MAPPO |
$181.20
|
| Rate for Payer: BCBS Trust/PPO |
$595.86
|
| Rate for Payer: BCN Commercial |
$595.86
|
| Rate for Payer: BCN Medicare Advantage |
$181.20
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.20
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$543.60
|
| Rate for Payer: Mclaren Medicaid |
$127.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.26
|
| Rate for Payer: Meridian Medicaid |
$134.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$199.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PACE Senior Care Partners |
$172.14
|
| Rate for Payer: PACE SWMI |
$181.20
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: PHP Medicare Advantage |
$181.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$630.58
|
| Rate for Payer: Priority Health Medicare |
$183.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$504.46
|
| Rate for Payer: Railroad Medicare Medicare |
$181.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.82
|
| Rate for Payer: UHC Core |
$605.21
|
| Rate for Payer: UHC Exchange |
$181.20
|
| Rate for Payer: UHC Medicaid |
$127.78
|
| Rate for Payer: UHC Medicare Advantage |
$181.20
|
| Rate for Payer: UHCCP Medicaid |
$127.78
|
| Rate for Payer: VA VA |
$181.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$543.60
|
|
