|
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
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
IP
|
$92.57
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.46 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Aetna Commercial |
$78.68
|
| Rate for Payer: BCBS Trust/PPO |
$71.54
|
| Rate for Payer: BCN Commercial |
$71.54
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cofinity Commercial |
$79.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.06
|
| Rate for Payer: Healthscope Commercial |
$83.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.68
|
| Rate for Payer: PHP Commercial |
$78.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.46
|
| Rate for Payer: UHC Core |
$77.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.43
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
OP
|
$92.57
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$83.31 |
| Rate for Payer: Aetna Commercial |
$78.68
|
| Rate for Payer: Aetna Medicare |
$24.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.93
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$23.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.97
|
| Rate for Payer: BCN Commercial |
$71.97
|
| Rate for Payer: BCN Medicare Advantage |
$23.14
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cash Price |
$74.06
|
| Rate for Payer: Cofinity Commercial |
$79.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.14
|
| Rate for Payer: Healthscope Commercial |
$83.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.43
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.68
|
| Rate for Payer: PACE Senior Care Partners |
$21.99
|
| Rate for Payer: PACE SWMI |
$23.14
|
| Rate for Payer: PHP Commercial |
$78.68
|
| Rate for Payer: PHP Medicare Advantage |
$23.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.54
|
| Rate for Payer: Priority Health Medicare |
$23.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: Railroad Medicare Medicare |
$23.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.46
|
| Rate for Payer: UHC Core |
$77.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.14
|
| Rate for Payer: UHC Medicare Advantage |
$23.84
|
| Rate for Payer: VA VA |
$23.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.43
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
OP
|
$112.22
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$95.39
|
| Rate for Payer: Aetna Medicare |
$29.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.07
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$28.06
|
| Rate for Payer: BCBS Trust/PPO |
$87.25
|
| Rate for Payer: BCN Commercial |
$87.25
|
| Rate for Payer: BCN Medicare Advantage |
$28.06
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$96.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.06
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.16
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.39
|
| Rate for Payer: PACE Senior Care Partners |
$26.65
|
| Rate for Payer: PACE SWMI |
$28.06
|
| Rate for Payer: PHP Commercial |
$95.39
|
| Rate for Payer: PHP Medicare Advantage |
$28.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.63
|
| Rate for Payer: Priority Health Medicare |
$28.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.44
|
| Rate for Payer: Railroad Medicare Medicare |
$28.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.75
|
| Rate for Payer: UHC Core |
$93.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.06
|
| Rate for Payer: UHC Medicare Advantage |
$28.90
|
| Rate for Payer: VA VA |
$28.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.16
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
IP
|
$112.22
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.44 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$95.39
|
| Rate for Payer: BCBS Trust/PPO |
$86.72
|
| Rate for Payer: BCN Commercial |
$86.72
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$96.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.78
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.39
|
| Rate for Payer: PHP Commercial |
$95.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.75
|
| Rate for Payer: UHC Core |
$93.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.16
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$1,091.56
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.74 |
| Max. Negotiated Rate |
$982.40 |
| Rate for Payer: Aetna Commercial |
$927.83
|
| Rate for Payer: BCBS Trust/PPO |
$843.56
|
| Rate for Payer: BCN Commercial |
$843.56
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cofinity Commercial |
$938.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.25
|
| Rate for Payer: Healthscope Commercial |
$982.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$927.83
|
| Rate for Payer: PHP Commercial |
$927.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$949.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$665.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.57
|
| Rate for Payer: UHC Core |
$911.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.67
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,091.56
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.25 |
| Max. Negotiated Rate |
$982.40 |
| Rate for Payer: Aetna Commercial |
$927.83
|
| Rate for Payer: Aetna Medicare |
$283.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.11
|
| Rate for Payer: BCBS Complete |
$432.60
|
| Rate for Payer: BCBS MAPPO |
$272.89
|
| Rate for Payer: BCBS Trust/PPO |
$848.69
|
| Rate for Payer: BCN Commercial |
$848.69
|
| Rate for Payer: BCN Medicare Advantage |
$272.89
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cash Price |
$873.25
|
| Rate for Payer: Cofinity Commercial |
$938.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.89
|
| Rate for Payer: Healthscope Commercial |
$982.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.67
|
| Rate for Payer: Mclaren Medicaid |
$412.00
|
| Rate for Payer: Meridian Medicaid |
$432.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$286.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$927.83
|
| Rate for Payer: PACE Senior Care Partners |
$259.25
|
| Rate for Payer: PACE SWMI |
$272.89
|
| Rate for Payer: PHP Commercial |
$927.83
|
| Rate for Payer: PHP Medicare Advantage |
$272.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$949.66
|
| Rate for Payer: Priority Health Medicare |
$272.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$665.74
|
| Rate for Payer: Railroad Medicare Medicare |
$272.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.57
|
| Rate for Payer: UHC Core |
$911.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.89
|
| Rate for Payer: UHC Medicare Advantage |
$281.08
|
| Rate for Payer: VA VA |
$272.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.67
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,128.32 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Aetna Commercial |
$1,572.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,429.68
|
| Rate for Payer: BCN Commercial |
$1,429.68
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,591.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,480.00
|
| Rate for Payer: Healthscope Commercial |
$1,665.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,387.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,572.50
|
| Rate for Payer: PHP Commercial |
$1,572.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,609.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,128.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,628.00
|
| Rate for Payer: UHC Core |
$1,544.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,387.50
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.38 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Aetna Commercial |
$1,572.50
|
| Rate for Payer: Aetna Medicare |
$481.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$578.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$578.12
|
| Rate for Payer: BCBS Complete |
$484.61
|
| Rate for Payer: BCBS MAPPO |
$462.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.38
|
| Rate for Payer: BCN Commercial |
$1,438.38
|
| Rate for Payer: BCN Medicare Advantage |
$462.50
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cash Price |
$1,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,591.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,480.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.50
|
| Rate for Payer: Healthscope Commercial |
$1,665.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,387.50
|
| Rate for Payer: Mclaren Medicaid |
$461.54
|
| Rate for Payer: Meridian Medicaid |
$484.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$485.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$531.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,572.50
|
| Rate for Payer: PACE Senior Care Partners |
$439.38
|
| Rate for Payer: PACE SWMI |
$462.50
|
| Rate for Payer: PHP Commercial |
$1,572.50
|
| Rate for Payer: PHP Medicare Advantage |
$462.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,609.50
|
| Rate for Payer: Priority Health Medicare |
$462.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,128.32
|
| Rate for Payer: Railroad Medicare Medicare |
$462.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,628.00
|
| Rate for Payer: UHC Core |
$1,544.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.50
|
| Rate for Payer: UHC Medicare Advantage |
$476.38
|
| Rate for Payer: VA VA |
$462.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,387.50
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,439.60 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$3,400.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,091.20
|
| Rate for Payer: BCN Commercial |
$3,091.20
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,440.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,200.00
|
| Rate for Payer: Healthscope Commercial |
$3,600.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: PHP Commercial |
$3,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,480.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,439.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,520.00
|
| Rate for Payer: UHC Core |
$3,340.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,000.00
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$950.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$3,400.00
|
| Rate for Payer: Aetna Medicare |
$1,040.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,250.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,250.00
|
| Rate for Payer: BCBS Complete |
$1,957.20
|
| Rate for Payer: BCBS MAPPO |
$1,000.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,110.00
|
| Rate for Payer: BCN Commercial |
$3,110.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,440.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.00
|
| Rate for Payer: Healthscope Commercial |
$3,600.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,000.00
|
| Rate for Payer: Mclaren Medicaid |
$1,864.00
|
| Rate for Payer: Meridian Medicaid |
$1,957.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,050.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: PACE Senior Care Partners |
$950.00
|
| Rate for Payer: PACE SWMI |
$1,000.00
|
| Rate for Payer: PHP Commercial |
$3,400.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,864.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,480.00
|
| Rate for Payer: Priority Health Medicare |
$1,000.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,439.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,000.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,520.00
|
| Rate for Payer: UHC Core |
$3,340.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,000.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,030.00
|
| Rate for Payer: VA VA |
$1,000.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,000.00
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$499.09
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.53 |
| Max. Negotiated Rate |
$449.18 |
| Rate for Payer: Aetna Commercial |
$424.23
|
| Rate for Payer: Aetna Medicare |
$129.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.97
|
| Rate for Payer: BCBS Complete |
$199.64
|
| Rate for Payer: BCBS MAPPO |
$124.77
|
| Rate for Payer: BCBS Trust/PPO |
$388.04
|
| Rate for Payer: BCN Commercial |
$388.04
|
| Rate for Payer: BCN Medicare Advantage |
$124.77
|
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Cofinity Commercial |
$429.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.77
|
| Rate for Payer: Healthscope Commercial |
$449.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.23
|
| Rate for Payer: PACE Senior Care Partners |
$118.53
|
| Rate for Payer: PACE SWMI |
$124.77
|
| Rate for Payer: PHP Commercial |
$424.23
|
| Rate for Payer: PHP Medicare Advantage |
$124.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.21
|
| Rate for Payer: Priority Health Medicare |
$124.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.39
|
| Rate for Payer: Railroad Medicare Medicare |
$124.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.20
|
| Rate for Payer: UHC Core |
$416.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.77
|
| Rate for Payer: UHC Medicare Advantage |
$128.52
|
| Rate for Payer: VA VA |
$124.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.32
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$499.09
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$449.18 |
| Rate for Payer: Aetna Commercial |
$424.23
|
| Rate for Payer: BCBS Trust/PPO |
$385.70
|
| Rate for Payer: BCN Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Cofinity Commercial |
$429.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.27
|
| Rate for Payer: Healthscope Commercial |
$449.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.23
|
| Rate for Payer: PHP Commercial |
$424.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.20
|
| Rate for Payer: UHC Core |
$416.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.32
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$632.43
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.20 |
| Max. Negotiated Rate |
$569.19 |
| Rate for Payer: Aetna Commercial |
$537.57
|
| Rate for Payer: Aetna Medicare |
$164.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$197.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$197.63
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$158.11
|
| Rate for Payer: BCBS Trust/PPO |
$491.71
|
| Rate for Payer: BCN Commercial |
$491.71
|
| Rate for Payer: BCN Medicare Advantage |
$158.11
|
| Rate for Payer: Cash Price |
$505.94
|
| Rate for Payer: Cash Price |
$505.94
|
| Rate for Payer: Cofinity Commercial |
$543.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.11
|
| Rate for Payer: Healthscope Commercial |
$569.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.32
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$166.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.57
|
| Rate for Payer: PACE Senior Care Partners |
$150.20
|
| Rate for Payer: PACE SWMI |
$158.11
|
| Rate for Payer: PHP Commercial |
$537.57
|
| Rate for Payer: PHP Medicare Advantage |
$158.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.21
|
| Rate for Payer: Priority Health Medicare |
$158.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.72
|
| Rate for Payer: Railroad Medicare Medicare |
$158.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.54
|
| Rate for Payer: UHC Core |
$528.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.11
|
| Rate for Payer: UHC Medicare Advantage |
$162.85
|
| Rate for Payer: VA VA |
$158.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.32
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$632.43
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.72 |
| Max. Negotiated Rate |
$569.19 |
| Rate for Payer: Aetna Commercial |
$537.57
|
| Rate for Payer: BCBS Trust/PPO |
$488.74
|
| Rate for Payer: BCN Commercial |
$488.74
|
| Rate for Payer: Cash Price |
$505.94
|
| Rate for Payer: Cofinity Commercial |
$543.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.94
|
| Rate for Payer: Healthscope Commercial |
$569.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.57
|
| Rate for Payer: PHP Commercial |
$537.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.54
|
| Rate for Payer: UHC Core |
$528.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.32
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$36.82
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: BCBS Trust/PPO |
$28.45
|
| Rate for Payer: BCN Commercial |
$28.45
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.30
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.40
|
| Rate for Payer: UHC Core |
$30.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.62
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$36.82
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.51
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS MAPPO |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.63
|
| Rate for Payer: BCN Commercial |
$28.63
|
| Rate for Payer: BCN Medicare Advantage |
$9.20
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.20
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.30
|
| Rate for Payer: PACE Senior Care Partners |
$8.74
|
| Rate for Payer: PACE SWMI |
$9.20
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: PHP Medicare Advantage |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.03
|
| Rate for Payer: Priority Health Medicare |
$9.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.46
|
| Rate for Payer: Railroad Medicare Medicare |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.40
|
| Rate for Payer: UHC Core |
$30.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.20
|
| Rate for Payer: UHC Medicare Advantage |
$9.48
|
| Rate for Payer: VA VA |
$9.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.62
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$473.69
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.90 |
| Max. Negotiated Rate |
$426.32 |
| Rate for Payer: Aetna Commercial |
$402.64
|
| Rate for Payer: BCBS Trust/PPO |
$366.07
|
| Rate for Payer: BCN Commercial |
$366.07
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cofinity Commercial |
$407.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.95
|
| Rate for Payer: Healthscope Commercial |
$426.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.64
|
| Rate for Payer: PHP Commercial |
$402.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.85
|
| Rate for Payer: UHC Core |
$395.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.27
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$473.69
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$426.32 |
| Rate for Payer: Aetna Commercial |
$402.64
|
| Rate for Payer: Aetna Medicare |
$123.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.03
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$118.42
|
| Rate for Payer: BCBS Trust/PPO |
$368.29
|
| Rate for Payer: BCN Commercial |
$368.29
|
| Rate for Payer: BCN Medicare Advantage |
$118.42
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cofinity Commercial |
$407.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.42
|
| Rate for Payer: Healthscope Commercial |
$426.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.27
|
| Rate for Payer: Mclaren Medicaid |
$222.16
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.64
|
| Rate for Payer: PACE Senior Care Partners |
$112.50
|
| Rate for Payer: PACE SWMI |
$118.42
|
| Rate for Payer: PHP Commercial |
$402.64
|
| Rate for Payer: PHP Medicare Advantage |
$118.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.11
|
| Rate for Payer: Priority Health Medicare |
$118.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.90
|
| Rate for Payer: Railroad Medicare Medicare |
$118.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.85
|
| Rate for Payer: UHC Core |
$395.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.42
|
| Rate for Payer: UHC Medicare Advantage |
$121.98
|
| Rate for Payer: VA VA |
$118.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.27
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$140.57
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.73 |
| Max. Negotiated Rate |
$126.51 |
| Rate for Payer: Aetna Commercial |
$119.48
|
| Rate for Payer: BCBS Trust/PPO |
$108.63
|
| Rate for Payer: BCN Commercial |
$108.63
|
| Rate for Payer: Cash Price |
$112.46
|
| Rate for Payer: Cofinity Commercial |
$120.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.46
|
| Rate for Payer: Healthscope Commercial |
$126.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.48
|
| Rate for Payer: PHP Commercial |
$119.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.70
|
| Rate for Payer: UHC Core |
$117.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.43
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$140.57
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$126.51 |
| Rate for Payer: Aetna Commercial |
$119.48
|
| Rate for Payer: Aetna Medicare |
$36.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.93
|
| Rate for Payer: BCBS Complete |
$56.23
|
| Rate for Payer: BCBS MAPPO |
$35.14
|
| Rate for Payer: BCBS Trust/PPO |
$109.29
|
| Rate for Payer: BCN Commercial |
$109.29
|
| Rate for Payer: BCN Medicare Advantage |
$35.14
|
| Rate for Payer: Cash Price |
$112.46
|
| Rate for Payer: Cofinity Commercial |
$120.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.14
|
| Rate for Payer: Healthscope Commercial |
$126.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.48
|
| Rate for Payer: PACE Senior Care Partners |
$33.39
|
| Rate for Payer: PACE SWMI |
$35.14
|
| Rate for Payer: PHP Commercial |
$119.48
|
| Rate for Payer: PHP Medicare Advantage |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.30
|
| Rate for Payer: Priority Health Medicare |
$35.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.73
|
| Rate for Payer: Railroad Medicare Medicare |
$35.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.70
|
| Rate for Payer: UHC Core |
$117.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.14
|
| Rate for Payer: UHC Medicare Advantage |
$36.20
|
| Rate for Payer: VA VA |
$35.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.43
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$807.11
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$492.26 |
| Max. Negotiated Rate |
$726.40 |
| Rate for Payer: Aetna Commercial |
$686.04
|
| Rate for Payer: BCBS Trust/PPO |
$623.73
|
| Rate for Payer: BCN Commercial |
$623.73
|
| Rate for Payer: Cash Price |
$645.69
|
| Rate for Payer: Cofinity Commercial |
$694.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.69
|
| Rate for Payer: Healthscope Commercial |
$726.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$686.04
|
| Rate for Payer: PHP Commercial |
$686.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.26
|
| Rate for Payer: UHC Core |
$673.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.33
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$807.11
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$726.40 |
| Rate for Payer: Aetna Commercial |
$686.04
|
| Rate for Payer: Aetna Medicare |
$209.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.22
|
| Rate for Payer: BCBS Complete |
$322.84
|
| Rate for Payer: BCBS MAPPO |
$201.78
|
| Rate for Payer: BCBS Trust/PPO |
$627.53
|
| Rate for Payer: BCN Commercial |
$627.53
|
| Rate for Payer: BCN Medicare Advantage |
$201.78
|
| Rate for Payer: Cash Price |
$645.69
|
| Rate for Payer: Cofinity Commercial |
$694.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.78
|
| Rate for Payer: Healthscope Commercial |
$726.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$211.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$686.04
|
| Rate for Payer: PACE Senior Care Partners |
$191.69
|
| Rate for Payer: PACE SWMI |
$201.78
|
| Rate for Payer: PHP Commercial |
$686.04
|
| Rate for Payer: PHP Medicare Advantage |
$201.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.19
|
| Rate for Payer: Priority Health Medicare |
$201.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.26
|
| Rate for Payer: Railroad Medicare Medicare |
$201.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.26
|
| Rate for Payer: UHC Core |
$673.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.78
|
| Rate for Payer: UHC Medicare Advantage |
$207.83
|
| Rate for Payer: VA VA |
$201.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.33
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,614.20
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$984.50 |
| Max. Negotiated Rate |
$1,452.78 |
| Rate for Payer: Aetna Commercial |
$1,372.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.45
|
| Rate for Payer: BCN Commercial |
$1,247.45
|
| Rate for Payer: Cash Price |
$1,291.36
|
| Rate for Payer: Cofinity Commercial |
$1,388.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,291.36
|
| Rate for Payer: Healthscope Commercial |
$1,452.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,210.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,372.07
|
| Rate for Payer: PHP Commercial |
$1,372.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,404.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,420.50
|
| Rate for Payer: UHC Core |
$1,347.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,210.65
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,614.20
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$383.37 |
| Max. Negotiated Rate |
$1,452.78 |
| Rate for Payer: Aetna Commercial |
$1,372.07
|
| Rate for Payer: Aetna Medicare |
$419.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$504.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$504.44
|
| Rate for Payer: BCBS Complete |
$645.68
|
| Rate for Payer: BCBS MAPPO |
$403.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.04
|
| Rate for Payer: BCN Commercial |
$1,255.04
|
| Rate for Payer: BCN Medicare Advantage |
$403.55
|
| Rate for Payer: Cash Price |
$1,291.36
|
| Rate for Payer: Cofinity Commercial |
$1,388.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,291.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.55
|
| Rate for Payer: Healthscope Commercial |
$1,452.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,210.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$423.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$464.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,372.07
|
| Rate for Payer: PACE Senior Care Partners |
$383.37
|
| Rate for Payer: PACE SWMI |
$403.55
|
| Rate for Payer: PHP Commercial |
$1,372.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,404.35
|
| Rate for Payer: Priority Health Medicare |
$403.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.50
|
| Rate for Payer: Railroad Medicare Medicare |
$403.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,420.50
|
| Rate for Payer: UHC Core |
$1,347.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.55
|
| Rate for Payer: UHC Medicare Advantage |
$415.66
|
| Rate for Payer: VA VA |
$403.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,210.65
|
|
