|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
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
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
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 SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,986.46
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
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 SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,986.46
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
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 SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,622.12
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
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 SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,622.12
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
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 SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,656.59
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
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 SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,656.59
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
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 SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,435.19
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
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 SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,435.19
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
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 SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
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 SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
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 SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
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 SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
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 SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
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
|
|
|
HC APPLY SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
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 SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
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 SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
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
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
OP
|
$335.44
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.14 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$285.12
|
| Rate for Payer: Aetna Medicare |
$87.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.83
|
| Rate for Payer: BCBS Complete |
$62.09
|
| Rate for Payer: BCBS MAPPO |
$83.86
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$275.77
|
| Rate for Payer: BCN Medicare Advantage |
$83.86
|
| Rate for Payer: Cash Price |
$268.35
|
| Rate for Payer: Cash Price |
$268.35
|
| Rate for Payer: Cofinity Commercial |
$288.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.86
|
| Rate for Payer: Healthscope Commercial |
$301.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.58
|
| Rate for Payer: Mclaren Medicaid |
$59.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.05
|
| Rate for Payer: Meridian Medicaid |
$62.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.12
|
| Rate for Payer: Nomi Health Commercial |
$275.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.58
|
| Rate for Payer: PACE Senior Care Partners |
$79.67
|
| Rate for Payer: PACE SWMI |
$83.86
|
| Rate for Payer: PHP Commercial |
$285.12
|
| Rate for Payer: PHP Medicare Advantage |
$83.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.83
|
| Rate for Payer: Priority Health Medicare |
$84.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.47
|
| Rate for Payer: Railroad Medicare Medicare |
$83.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.19
|
| Rate for Payer: UHC Core |
$280.09
|
| Rate for Payer: UHC Exchange |
$83.86
|
| Rate for Payer: UHC Medicaid |
$59.14
|
| Rate for Payer: UHC Medicare Advantage |
$83.86
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$83.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.58
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
IP
|
$335.44
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$285.12
|
| Rate for Payer: BCBS Trust/PPO |
$277.04
|
| Rate for Payer: BCN Commercial |
$277.04
|
| Rate for Payer: Cash Price |
$268.35
|
| Rate for Payer: Cofinity Commercial |
$288.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.35
|
| Rate for Payer: Healthscope Commercial |
$301.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.12
|
| Rate for Payer: Nomi Health Commercial |
$275.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.58
|
| Rate for Payer: PHP Commercial |
$285.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.19
|
| Rate for Payer: UHC Core |
$280.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.58
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
IP
|
$200.95
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.86 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.81
|
| Rate for Payer: BCBS Trust/PPO |
$165.96
|
| Rate for Payer: BCN Commercial |
$165.96
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cofinity Commercial |
$172.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.76
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.81
|
| Rate for Payer: Nomi Health Commercial |
$164.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.71
|
| Rate for Payer: PHP Commercial |
$170.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.84
|
| Rate for Payer: UHC Core |
$167.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
OP
|
$200.95
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.81
|
| Rate for Payer: Aetna Medicare |
$52.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.80
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS MAPPO |
$50.24
|
| Rate for Payer: BCBS Trust/PPO |
$165.20
|
| Rate for Payer: BCN Commercial |
$165.20
|
| Rate for Payer: BCN Medicare Advantage |
$50.24
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cofinity Commercial |
$172.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.24
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Mclaren Medicaid |
$35.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.75
|
| Rate for Payer: Meridian Medicaid |
$37.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.81
|
| Rate for Payer: Nomi Health Commercial |
$164.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.71
|
| Rate for Payer: PACE Senior Care Partners |
$47.73
|
| Rate for Payer: PACE SWMI |
$50.24
|
| Rate for Payer: PHP Commercial |
$170.81
|
| Rate for Payer: PHP Medicare Advantage |
$50.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.83
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.86
|
| Rate for Payer: Railroad Medicare Medicare |
$50.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.84
|
| Rate for Payer: UHC Core |
$167.79
|
| Rate for Payer: UHC Exchange |
$50.24
|
| Rate for Payer: UHC Medicaid |
$35.43
|
| Rate for Payer: UHC Medicare Advantage |
$50.24
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$50.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC APT DOWNEY TEST
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: BCBS Trust/PPO |
$77.68
|
| Rate for Payer: BCN Commercial |
$77.68
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.76
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.54
|
|
|
HC APT DOWNEY TEST
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$24.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.39
|
| Rate for Payer: BCBS Complete |
$17.41
|
| Rate for Payer: BCBS MAPPO |
$23.51
|
| Rate for Payer: BCBS Trust/PPO |
$77.32
|
| Rate for Payer: BCN Commercial |
$77.32
|
| Rate for Payer: BCN Medicare Advantage |
$23.51
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.54
|
| Rate for Payer: Mclaren Medicaid |
$16.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.69
|
| Rate for Payer: Meridian Medicaid |
$17.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PACE Senior Care Partners |
$22.34
|
| Rate for Payer: PACE SWMI |
$23.51
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$23.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.82
|
| Rate for Payer: Priority Health Medicare |
$23.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.46
|
| Rate for Payer: Railroad Medicare Medicare |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.76
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: UHC Exchange |
$23.51
|
| Rate for Payer: UHC Medicaid |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$23.51
|
| Rate for Payer: UHCCP Medicaid |
$16.58
|
| Rate for Payer: VA VA |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.54
|
|
|
HC APTT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: BCBS Trust/PPO |
$21.91
|
| Rate for Payer: BCN Commercial |
$21.91
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.35
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
