|
HC D & C POSTPARTUM
|
Facility
|
OP
|
$7,789.74
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,850.06 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna Medicare |
$2,025.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,434.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,434.29
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$1,947.44
|
| Rate for Payer: BCBS Trust/PPO |
$6,056.52
|
| Rate for Payer: BCN Commercial |
$6,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,947.44
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,231.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,947.44
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,842.30
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,044.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,239.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PACE Senior Care Partners |
$1,850.06
|
| Rate for Payer: PACE SWMI |
$1,947.44
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,947.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,777.07
|
| Rate for Payer: Priority Health Medicare |
$1,947.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,750.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,947.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,854.97
|
| Rate for Payer: UHC Core |
$6,504.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,947.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,005.86
|
| Rate for Payer: VA VA |
$1,947.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,842.30
|
|
|
HC D & C POSTPARTUM
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,750.96 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,019.91
|
| Rate for Payer: BCN Commercial |
$6,019.91
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,231.79
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,842.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,777.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,750.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,854.97
|
| Rate for Payer: UHC Core |
$6,504.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,842.30
|
|
|
HC DDAVP CMPT1
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$9.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.79
|
| Rate for Payer: BCBS Complete |
$17.78
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$29.34
|
| Rate for Payer: BCN Commercial |
$29.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Mclaren Medicaid |
$16.93
|
| Rate for Payer: Meridian Medicaid |
$17.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Senior Care Partners |
$8.96
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC DDAVP CMPT1
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$29.17
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC DDAVP CMPT2
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$9.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.79
|
| Rate for Payer: BCBS Complete |
$17.78
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$29.34
|
| Rate for Payer: BCN Commercial |
$29.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Mclaren Medicaid |
$16.93
|
| Rate for Payer: Meridian Medicaid |
$17.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Senior Care Partners |
$8.96
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC DDAVP CMPT2
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$29.17
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$9.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.79
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$29.34
|
| Rate for Payer: BCN Commercial |
$29.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Senior Care Partners |
$8.96
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$29.17
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: BCBS Trust/PPO |
$94.44
|
| Rate for Payer: BCN Commercial |
$94.44
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.19
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$95.01
|
| Rate for Payer: BCN Commercial |
$95.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.55
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Mclaren Medicaid |
$7.51
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.87
|
| Rate for Payer: PACE Senior Care Partners |
$29.02
|
| Rate for Payer: PACE SWMI |
$30.55
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$30.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.31
|
| Rate for Payer: Priority Health Medicare |
$30.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.53
|
| Rate for Payer: Railroad Medicare Medicare |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.55
|
| Rate for Payer: UHC Medicare Advantage |
$31.47
|
| Rate for Payer: VA VA |
$30.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$2,165.56
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,320.78 |
| Max. Negotiated Rate |
$1,949.00 |
| Rate for Payer: Aetna Commercial |
$1,840.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.54
|
| Rate for Payer: BCN Commercial |
$1,673.54
|
| Rate for Payer: Cash Price |
$1,732.45
|
| Rate for Payer: Cofinity Commercial |
$1,862.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,732.45
|
| Rate for Payer: Healthscope Commercial |
$1,949.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,624.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,840.73
|
| Rate for Payer: PHP Commercial |
$1,840.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,515.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,884.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,320.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,905.69
|
| Rate for Payer: UHC Core |
$1,808.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,624.17
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$2,165.56
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.32 |
| Max. Negotiated Rate |
$1,949.00 |
| Rate for Payer: Aetna Commercial |
$1,840.73
|
| Rate for Payer: Aetna Medicare |
$563.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.74
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS MAPPO |
$541.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,683.72
|
| Rate for Payer: BCN Commercial |
$1,683.72
|
| Rate for Payer: BCN Medicare Advantage |
$541.39
|
| Rate for Payer: Cash Price |
$1,732.45
|
| Rate for Payer: Cash Price |
$1,732.45
|
| Rate for Payer: Cofinity Commercial |
$1,862.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,732.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.39
|
| Rate for Payer: Healthscope Commercial |
$1,949.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,624.17
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$568.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,840.73
|
| Rate for Payer: PACE Senior Care Partners |
$514.32
|
| Rate for Payer: PACE SWMI |
$541.39
|
| Rate for Payer: PHP Commercial |
$1,840.73
|
| Rate for Payer: PHP Medicare Advantage |
$541.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,515.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,884.04
|
| Rate for Payer: Priority Health Medicare |
$541.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,320.78
|
| Rate for Payer: Railroad Medicare Medicare |
$541.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,905.69
|
| Rate for Payer: UHC Core |
$1,808.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$541.39
|
| Rate for Payer: UHC Medicare Advantage |
$557.63
|
| Rate for Payer: VA VA |
$541.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,624.17
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
OP
|
$524.69
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$472.22 |
| Rate for Payer: Aetna Commercial |
$445.99
|
| Rate for Payer: Aetna Medicare |
$136.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.97
|
| Rate for Payer: BCBS Complete |
$432.60
|
| Rate for Payer: BCBS MAPPO |
$131.17
|
| Rate for Payer: BCBS Trust/PPO |
$407.95
|
| Rate for Payer: BCN Commercial |
$407.95
|
| Rate for Payer: BCN Medicare Advantage |
$131.17
|
| Rate for Payer: Cash Price |
$419.75
|
| Rate for Payer: Cash Price |
$419.75
|
| Rate for Payer: Cofinity Commercial |
$451.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.17
|
| Rate for Payer: Healthscope Commercial |
$472.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.52
|
| Rate for Payer: Mclaren Medicaid |
$412.00
|
| Rate for Payer: Meridian Medicaid |
$432.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.99
|
| Rate for Payer: PACE Senior Care Partners |
$124.61
|
| Rate for Payer: PACE SWMI |
$131.17
|
| Rate for Payer: PHP Commercial |
$445.99
|
| Rate for Payer: PHP Medicare Advantage |
$131.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.48
|
| Rate for Payer: Priority Health Medicare |
$131.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.01
|
| Rate for Payer: Railroad Medicare Medicare |
$131.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.73
|
| Rate for Payer: UHC Core |
$438.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.17
|
| Rate for Payer: UHC Medicare Advantage |
$135.11
|
| Rate for Payer: VA VA |
$131.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.52
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
IP
|
$524.69
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.01 |
| Max. Negotiated Rate |
$472.22 |
| Rate for Payer: Aetna Commercial |
$445.99
|
| Rate for Payer: BCBS Trust/PPO |
$405.48
|
| Rate for Payer: BCN Commercial |
$405.48
|
| Rate for Payer: Cash Price |
$419.75
|
| Rate for Payer: Cofinity Commercial |
$451.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.75
|
| Rate for Payer: Healthscope Commercial |
$472.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.99
|
| Rate for Payer: PHP Commercial |
$445.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.73
|
| Rate for Payer: UHC Core |
$438.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.52
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$802.63 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,017.00
|
| Rate for Payer: BCN Commercial |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.80
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$987.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,158.08
|
| Rate for Payer: UHC Core |
$1,098.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$987.00
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.55 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: Aetna Medicare |
$342.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.25
|
| Rate for Payer: BCBS Complete |
$378.97
|
| Rate for Payer: BCBS MAPPO |
$329.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.19
|
| Rate for Payer: BCN Commercial |
$1,023.19
|
| Rate for Payer: BCN Medicare Advantage |
$329.00
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$987.00
|
| Rate for Payer: Mclaren Medicaid |
$360.93
|
| Rate for Payer: Meridian Medicaid |
$378.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PACE Senior Care Partners |
$312.55
|
| Rate for Payer: PACE SWMI |
$329.00
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: PHP Medicare Advantage |
$329.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.92
|
| Rate for Payer: Priority Health Medicare |
$329.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.63
|
| Rate for Payer: Railroad Medicare Medicare |
$329.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,158.08
|
| Rate for Payer: UHC Core |
$1,098.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.00
|
| Rate for Payer: UHC Medicare Advantage |
$338.87
|
| Rate for Payer: VA VA |
$329.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$987.00
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,624.71
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.87 |
| Max. Negotiated Rate |
$1,462.24 |
| Rate for Payer: Aetna Commercial |
$1,381.00
|
| Rate for Payer: Aetna Medicare |
$422.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$507.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$507.72
|
| Rate for Payer: BCBS Complete |
$649.88
|
| Rate for Payer: BCBS MAPPO |
$406.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.21
|
| Rate for Payer: BCN Commercial |
$1,263.21
|
| Rate for Payer: BCN Medicare Advantage |
$406.18
|
| Rate for Payer: Cash Price |
$1,299.77
|
| Rate for Payer: Cofinity Commercial |
$1,397.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.18
|
| Rate for Payer: Healthscope Commercial |
$1,462.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,218.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$426.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$467.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,381.00
|
| Rate for Payer: PACE Senior Care Partners |
$385.87
|
| Rate for Payer: PACE SWMI |
$406.18
|
| Rate for Payer: PHP Commercial |
$1,381.00
|
| Rate for Payer: PHP Medicare Advantage |
$406.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.50
|
| Rate for Payer: Priority Health Medicare |
$406.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$990.91
|
| Rate for Payer: Railroad Medicare Medicare |
$406.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,429.74
|
| Rate for Payer: UHC Core |
$1,356.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.18
|
| Rate for Payer: UHC Medicare Advantage |
$418.36
|
| Rate for Payer: VA VA |
$406.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,218.53
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,624.71
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.91 |
| Max. Negotiated Rate |
$1,462.24 |
| Rate for Payer: Aetna Commercial |
$1,381.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.58
|
| Rate for Payer: BCN Commercial |
$1,255.58
|
| Rate for Payer: Cash Price |
$1,299.77
|
| Rate for Payer: Cofinity Commercial |
$1,397.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.77
|
| Rate for Payer: Healthscope Commercial |
$1,462.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,218.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,381.00
|
| Rate for Payer: PHP Commercial |
$1,381.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$990.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,429.74
|
| Rate for Payer: UHC Core |
$1,356.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,218.53
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.44 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: BCBS Trust/PPO |
$284.39
|
| Rate for Payer: BCN Commercial |
$284.39
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.40
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.84
|
| Rate for Payer: UHC Core |
$307.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.00
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna Medicare |
$95.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.00
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: BCBS MAPPO |
$92.00
|
| Rate for Payer: BCBS Trust/PPO |
$286.12
|
| Rate for Payer: BCN Commercial |
$286.12
|
| Rate for Payer: BCN Medicare Advantage |
$92.00
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PACE Senior Care Partners |
$87.40
|
| Rate for Payer: PACE SWMI |
$92.00
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: PHP Medicare Advantage |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.16
|
| Rate for Payer: Priority Health Medicare |
$92.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.44
|
| Rate for Payer: Railroad Medicare Medicare |
$92.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.84
|
| Rate for Payer: UHC Core |
$307.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.00
|
| Rate for Payer: UHC Medicare Advantage |
$94.76
|
| Rate for Payer: VA VA |
$92.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.00
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
OP
|
$375.36
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.15 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna Medicare |
$97.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.30
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$93.84
|
| Rate for Payer: BCBS Trust/PPO |
$291.84
|
| Rate for Payer: BCN Commercial |
$291.84
|
| Rate for Payer: BCN Medicare Advantage |
$93.84
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.06
|
| Rate for Payer: PACE Senior Care Partners |
$89.15
|
| Rate for Payer: PACE SWMI |
$93.84
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: PHP Medicare Advantage |
$93.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.56
|
| Rate for Payer: Priority Health Medicare |
$93.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.93
|
| Rate for Payer: Railroad Medicare Medicare |
$93.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.32
|
| Rate for Payer: UHC Core |
$313.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.84
|
| Rate for Payer: UHC Medicare Advantage |
$96.66
|
| Rate for Payer: VA VA |
$93.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.93 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: BCBS Trust/PPO |
$290.08
|
| Rate for Payer: BCN Commercial |
$290.08
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.06
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.32
|
| Rate for Payer: UHC Core |
$313.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.05 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: BCBS Trust/PPO |
$394.13
|
| Rate for Payer: BCN Commercial |
$394.13
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$443.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.80
|
| Rate for Payer: UHC Core |
$425.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.12 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.38
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$396.52
|
| Rate for Payer: BCN Commercial |
$396.52
|
| Rate for Payer: BCN Medicare Advantage |
$127.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.50
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.50
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.50
|
| Rate for Payer: PACE Senior Care Partners |
$121.12
|
| Rate for Payer: PACE SWMI |
$127.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$127.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$443.70
|
| Rate for Payer: Priority Health Medicare |
$127.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.05
|
| Rate for Payer: Railroad Medicare Medicare |
$127.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.80
|
| Rate for Payer: UHC Core |
$425.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.50
|
| Rate for Payer: UHC Medicare Advantage |
$131.32
|
| Rate for Payer: VA VA |
$127.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$834.46
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.18 |
| Max. Negotiated Rate |
$751.01 |
| Rate for Payer: Aetna Commercial |
$709.29
|
| Rate for Payer: Aetna Medicare |
$216.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$260.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$260.77
|
| Rate for Payer: BCBS Complete |
$333.78
|
| Rate for Payer: BCBS MAPPO |
$208.62
|
| Rate for Payer: BCBS Trust/PPO |
$648.79
|
| Rate for Payer: BCN Commercial |
$648.79
|
| Rate for Payer: BCN Medicare Advantage |
$208.62
|
| Rate for Payer: Cash Price |
$667.57
|
| Rate for Payer: Cofinity Commercial |
$717.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$667.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.62
|
| Rate for Payer: Healthscope Commercial |
$751.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$625.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$219.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$709.29
|
| Rate for Payer: PACE Senior Care Partners |
$198.18
|
| Rate for Payer: PACE SWMI |
$208.62
|
| Rate for Payer: PHP Commercial |
$709.29
|
| Rate for Payer: PHP Medicare Advantage |
$208.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$725.98
|
| Rate for Payer: Priority Health Medicare |
$208.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$508.94
|
| Rate for Payer: Railroad Medicare Medicare |
$208.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$734.32
|
| Rate for Payer: UHC Core |
$696.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.62
|
| Rate for Payer: UHC Medicare Advantage |
$214.87
|
| Rate for Payer: VA VA |
$208.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$625.84
|
|
