|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$290.29
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.05 |
| Max. Negotiated Rate |
$261.26 |
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: BCBS Trust/PPO |
$224.34
|
| Rate for Payer: BCN Commercial |
$224.34
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.75
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.46
|
| Rate for Payer: UHC Core |
$242.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$290.29
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$261.26 |
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Medicare |
$75.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.72
|
| Rate for Payer: BCBS Complete |
$116.12
|
| Rate for Payer: BCBS MAPPO |
$72.57
|
| Rate for Payer: BCBS Trust/PPO |
$225.70
|
| Rate for Payer: BCN Commercial |
$225.70
|
| Rate for Payer: BCN Medicare Advantage |
$72.57
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.57
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.75
|
| Rate for Payer: PACE Senior Care Partners |
$68.94
|
| Rate for Payer: PACE SWMI |
$72.57
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: PHP Medicare Advantage |
$72.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.55
|
| Rate for Payer: Priority Health Medicare |
$72.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.05
|
| Rate for Payer: Railroad Medicare Medicare |
$72.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.46
|
| Rate for Payer: UHC Core |
$242.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.57
|
| Rate for Payer: UHC Medicare Advantage |
$74.75
|
| Rate for Payer: VA VA |
$72.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$290.29
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.05 |
| Max. Negotiated Rate |
$261.26 |
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: BCBS Trust/PPO |
$224.34
|
| Rate for Payer: BCN Commercial |
$224.34
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.75
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.46
|
| Rate for Payer: UHC Core |
$242.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$290.29
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$261.26 |
| Rate for Payer: Aetna Commercial |
$246.75
|
| Rate for Payer: Aetna Medicare |
$75.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.72
|
| Rate for Payer: BCBS Complete |
$116.12
|
| Rate for Payer: BCBS MAPPO |
$72.57
|
| Rate for Payer: BCBS Trust/PPO |
$225.70
|
| Rate for Payer: BCN Commercial |
$225.70
|
| Rate for Payer: BCN Medicare Advantage |
$72.57
|
| Rate for Payer: Cash Price |
$232.23
|
| Rate for Payer: Cofinity Commercial |
$249.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.57
|
| Rate for Payer: Healthscope Commercial |
$261.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.75
|
| Rate for Payer: PACE Senior Care Partners |
$68.94
|
| Rate for Payer: PACE SWMI |
$72.57
|
| Rate for Payer: PHP Commercial |
$246.75
|
| Rate for Payer: PHP Medicare Advantage |
$72.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.55
|
| Rate for Payer: Priority Health Medicare |
$72.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.05
|
| Rate for Payer: Railroad Medicare Medicare |
$72.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.46
|
| Rate for Payer: UHC Core |
$242.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.57
|
| Rate for Payer: UHC Medicare Advantage |
$74.75
|
| Rate for Payer: VA VA |
$72.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.72
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.12
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$4.73
|
| Rate for Payer: BCN Commercial |
$4.73
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$5.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.90
|
| Rate for Payer: Healthscope Commercial |
$5.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.20
|
| Rate for Payer: PHP Commercial |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.39
|
| Rate for Payer: UHC Core |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.59
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.12
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.91
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS MAPPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.76
|
| Rate for Payer: BCN Commercial |
$4.76
|
| Rate for Payer: BCN Medicare Advantage |
$1.53
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$5.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$5.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.59
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Meridian Medicaid |
$3.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.20
|
| Rate for Payer: PACE Senior Care Partners |
$1.45
|
| Rate for Payer: PACE SWMI |
$1.53
|
| Rate for Payer: PHP Commercial |
$5.20
|
| Rate for Payer: PHP Medicare Advantage |
$1.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.32
|
| Rate for Payer: Priority Health Medicare |
$1.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.39
|
| Rate for Payer: UHC Core |
$5.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.53
|
| Rate for Payer: UHC Medicare Advantage |
$1.58
|
| Rate for Payer: VA VA |
$1.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.59
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$925.55
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$564.49 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Aetna Commercial |
$786.72
|
| Rate for Payer: BCBS Trust/PPO |
$715.27
|
| Rate for Payer: BCN Commercial |
$715.27
|
| Rate for Payer: Cash Price |
$740.44
|
| Rate for Payer: Cofinity Commercial |
$795.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.44
|
| Rate for Payer: Healthscope Commercial |
$833.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.72
|
| Rate for Payer: PHP Commercial |
$786.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.48
|
| Rate for Payer: UHC Core |
$772.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.16
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$925.55
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Aetna Commercial |
$786.72
|
| Rate for Payer: Aetna Medicare |
$240.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.23
|
| Rate for Payer: BCBS Complete |
$224.91
|
| Rate for Payer: BCBS MAPPO |
$231.39
|
| Rate for Payer: BCBS Trust/PPO |
$719.62
|
| Rate for Payer: BCN Commercial |
$719.62
|
| Rate for Payer: BCN Medicare Advantage |
$231.39
|
| Rate for Payer: Cash Price |
$740.44
|
| Rate for Payer: Cash Price |
$740.44
|
| Rate for Payer: Cofinity Commercial |
$795.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.39
|
| Rate for Payer: Healthscope Commercial |
$833.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.16
|
| Rate for Payer: Mclaren Medicaid |
$214.20
|
| Rate for Payer: Meridian Medicaid |
$224.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.72
|
| Rate for Payer: PACE Senior Care Partners |
$219.82
|
| Rate for Payer: PACE SWMI |
$231.39
|
| Rate for Payer: PHP Commercial |
$786.72
|
| Rate for Payer: PHP Medicare Advantage |
$231.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.23
|
| Rate for Payer: Priority Health Medicare |
$231.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.49
|
| Rate for Payer: Railroad Medicare Medicare |
$231.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.48
|
| Rate for Payer: UHC Core |
$772.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.39
|
| Rate for Payer: UHC Medicare Advantage |
$238.33
|
| Rate for Payer: VA VA |
$231.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.16
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$820.78
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$500.59 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Commercial |
$697.66
|
| Rate for Payer: BCBS Trust/PPO |
$634.30
|
| Rate for Payer: BCN Commercial |
$634.30
|
| Rate for Payer: Cash Price |
$656.62
|
| Rate for Payer: Cofinity Commercial |
$705.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.62
|
| Rate for Payer: Healthscope Commercial |
$738.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$697.66
|
| Rate for Payer: PHP Commercial |
$697.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$714.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.29
|
| Rate for Payer: UHC Core |
$685.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.58
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$820.78
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$194.94 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Commercial |
$697.66
|
| Rate for Payer: Aetna Medicare |
$213.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.49
|
| Rate for Payer: BCBS Complete |
$448.28
|
| Rate for Payer: BCBS MAPPO |
$205.20
|
| Rate for Payer: BCBS Trust/PPO |
$638.16
|
| Rate for Payer: BCN Commercial |
$638.16
|
| Rate for Payer: BCN Medicare Advantage |
$205.20
|
| Rate for Payer: Cash Price |
$656.62
|
| Rate for Payer: Cash Price |
$656.62
|
| Rate for Payer: Cofinity Commercial |
$705.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$738.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.58
|
| Rate for Payer: Mclaren Medicaid |
$426.93
|
| Rate for Payer: Meridian Medicaid |
$448.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$215.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$697.66
|
| Rate for Payer: PACE Senior Care Partners |
$194.94
|
| Rate for Payer: PACE SWMI |
$205.20
|
| Rate for Payer: PHP Commercial |
$697.66
|
| Rate for Payer: PHP Medicare Advantage |
$205.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$714.08
|
| Rate for Payer: Priority Health Medicare |
$205.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.59
|
| Rate for Payer: Railroad Medicare Medicare |
$205.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.29
|
| Rate for Payer: UHC Core |
$685.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.20
|
| Rate for Payer: UHC Medicare Advantage |
$211.35
|
| Rate for Payer: VA VA |
$205.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.58
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$240.13
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$146.46 |
| Max. Negotiated Rate |
$216.12 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: BCBS Trust/PPO |
$185.57
|
| Rate for Payer: BCN Commercial |
$185.57
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.10
|
| Rate for Payer: Healthscope Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: PHP Commercial |
$204.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.31
|
| Rate for Payer: UHC Core |
$200.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.10
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$240.13
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$57.03 |
| Max. Negotiated Rate |
$216.12 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna Medicare |
$62.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.04
|
| Rate for Payer: BCBS Complete |
$146.91
|
| Rate for Payer: BCBS MAPPO |
$60.03
|
| Rate for Payer: BCBS Trust/PPO |
$186.70
|
| Rate for Payer: BCN Commercial |
$186.70
|
| Rate for Payer: BCN Medicare Advantage |
$60.03
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.03
|
| Rate for Payer: Healthscope Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.10
|
| Rate for Payer: Mclaren Medicaid |
$139.92
|
| Rate for Payer: Meridian Medicaid |
$146.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: PACE Senior Care Partners |
$57.03
|
| Rate for Payer: PACE SWMI |
$60.03
|
| Rate for Payer: PHP Commercial |
$204.11
|
| Rate for Payer: PHP Medicare Advantage |
$60.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.91
|
| Rate for Payer: Priority Health Medicare |
$60.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.46
|
| Rate for Payer: Railroad Medicare Medicare |
$60.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.31
|
| Rate for Payer: UHC Core |
$200.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.03
|
| Rate for Payer: UHC Medicare Advantage |
$61.83
|
| Rate for Payer: VA VA |
$60.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.10
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$555.42
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.75 |
| Max. Negotiated Rate |
$499.88 |
| Rate for Payer: Aetna Commercial |
$472.11
|
| Rate for Payer: BCBS Trust/PPO |
$429.23
|
| Rate for Payer: BCN Commercial |
$429.23
|
| Rate for Payer: Cash Price |
$444.34
|
| Rate for Payer: Cofinity Commercial |
$477.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.34
|
| Rate for Payer: Healthscope Commercial |
$499.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.11
|
| Rate for Payer: PHP Commercial |
$472.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.77
|
| Rate for Payer: UHC Core |
$463.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.56
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$555.42
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$499.88 |
| Rate for Payer: Aetna Commercial |
$472.11
|
| Rate for Payer: Aetna Medicare |
$144.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.57
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$138.86
|
| Rate for Payer: BCBS Trust/PPO |
$431.84
|
| Rate for Payer: BCN Commercial |
$431.84
|
| Rate for Payer: BCN Medicare Advantage |
$138.86
|
| Rate for Payer: Cash Price |
$444.34
|
| Rate for Payer: Cash Price |
$444.34
|
| Rate for Payer: Cofinity Commercial |
$477.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.86
|
| Rate for Payer: Healthscope Commercial |
$499.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.56
|
| Rate for Payer: Mclaren Medicaid |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.11
|
| Rate for Payer: PACE Senior Care Partners |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.86
|
| Rate for Payer: PHP Commercial |
$472.11
|
| Rate for Payer: PHP Medicare Advantage |
$138.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.22
|
| Rate for Payer: Priority Health Medicare |
$138.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.75
|
| Rate for Payer: Railroad Medicare Medicare |
$138.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.77
|
| Rate for Payer: UHC Core |
$463.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.86
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.56
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$484.32
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.03 |
| Max. Negotiated Rate |
$435.89 |
| Rate for Payer: Aetna Commercial |
$411.67
|
| Rate for Payer: Aetna Medicare |
$125.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.35
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$121.08
|
| Rate for Payer: BCBS Trust/PPO |
$376.56
|
| Rate for Payer: BCN Commercial |
$376.56
|
| Rate for Payer: BCN Medicare Advantage |
$121.08
|
| Rate for Payer: Cash Price |
$387.46
|
| Rate for Payer: Cash Price |
$387.46
|
| Rate for Payer: Cofinity Commercial |
$416.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.08
|
| Rate for Payer: Healthscope Commercial |
$435.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.24
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$127.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.67
|
| Rate for Payer: PACE Senior Care Partners |
$115.03
|
| Rate for Payer: PACE SWMI |
$121.08
|
| Rate for Payer: PHP Commercial |
$411.67
|
| Rate for Payer: PHP Medicare Advantage |
$121.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.36
|
| Rate for Payer: Priority Health Medicare |
$121.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.39
|
| Rate for Payer: Railroad Medicare Medicare |
$121.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.20
|
| Rate for Payer: UHC Core |
$404.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.08
|
| Rate for Payer: UHC Medicare Advantage |
$124.71
|
| Rate for Payer: VA VA |
$121.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.24
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$484.32
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.39 |
| Max. Negotiated Rate |
$435.89 |
| Rate for Payer: Aetna Commercial |
$411.67
|
| Rate for Payer: BCBS Trust/PPO |
$374.28
|
| Rate for Payer: BCN Commercial |
$374.28
|
| Rate for Payer: Cash Price |
$387.46
|
| Rate for Payer: Cofinity Commercial |
$416.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.46
|
| Rate for Payer: Healthscope Commercial |
$435.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.67
|
| Rate for Payer: PHP Commercial |
$411.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.20
|
| Rate for Payer: UHC Core |
$404.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.24
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
IP
|
$83.88
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.16 |
| Max. Negotiated Rate |
$75.49 |
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: BCBS Trust/PPO |
$64.82
|
| Rate for Payer: BCN Commercial |
$64.82
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.30
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.81
|
| Rate for Payer: UHC Core |
$70.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.91
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
OP
|
$83.88
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$75.49 |
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: Aetna Medicare |
$21.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.21
|
| Rate for Payer: BCBS Complete |
$33.55
|
| Rate for Payer: BCBS MAPPO |
$20.97
|
| Rate for Payer: BCBS Trust/PPO |
$65.22
|
| Rate for Payer: BCN Commercial |
$65.22
|
| Rate for Payer: BCN Medicare Advantage |
$20.97
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.97
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.30
|
| Rate for Payer: PACE Senior Care Partners |
$19.92
|
| Rate for Payer: PACE SWMI |
$20.97
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: PHP Medicare Advantage |
$20.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.98
|
| Rate for Payer: Priority Health Medicare |
$20.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.16
|
| Rate for Payer: Railroad Medicare Medicare |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.81
|
| Rate for Payer: UHC Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.97
|
| Rate for Payer: UHC Medicare Advantage |
$21.60
|
| Rate for Payer: VA VA |
$20.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.91
|
|
|
HC DES ADD.BRANCH
|
Facility
|
OP
|
$16,677.03
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,960.79 |
| Max. Negotiated Rate |
$15,009.33 |
| Rate for Payer: Aetna Commercial |
$14,175.48
|
| Rate for Payer: Aetna Medicare |
$4,336.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,211.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,211.57
|
| Rate for Payer: BCBS Complete |
$6,670.81
|
| Rate for Payer: BCBS MAPPO |
$4,169.26
|
| Rate for Payer: BCBS Trust/PPO |
$12,966.39
|
| Rate for Payer: BCN Commercial |
$12,966.39
|
| Rate for Payer: BCN Medicare Advantage |
$4,169.26
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cofinity Commercial |
$14,342.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,341.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,169.26
|
| Rate for Payer: Healthscope Commercial |
$15,009.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,507.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,377.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,794.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,175.48
|
| Rate for Payer: PACE Senior Care Partners |
$3,960.79
|
| Rate for Payer: PACE SWMI |
$4,169.26
|
| Rate for Payer: PHP Commercial |
$14,175.48
|
| Rate for Payer: PHP Medicare Advantage |
$4,169.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,673.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,509.02
|
| Rate for Payer: Priority Health Medicare |
$4,169.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,171.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4,169.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,675.79
|
| Rate for Payer: UHC Core |
$13,925.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,169.26
|
| Rate for Payer: UHC Medicare Advantage |
$4,294.34
|
| Rate for Payer: VA VA |
$4,169.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,507.77
|
|
|
HC DES ADD.BRANCH
|
Facility
|
IP
|
$16,677.03
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,171.32 |
| Max. Negotiated Rate |
$15,009.33 |
| Rate for Payer: Aetna Commercial |
$14,175.48
|
| Rate for Payer: BCBS Trust/PPO |
$12,888.01
|
| Rate for Payer: BCN Commercial |
$12,888.01
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cofinity Commercial |
$14,342.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,341.62
|
| Rate for Payer: Healthscope Commercial |
$15,009.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,507.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,175.48
|
| Rate for Payer: PHP Commercial |
$14,175.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,673.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,509.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,171.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,675.79
|
| Rate for Payer: UHC Core |
$13,925.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,507.77
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
IP
|
$7,950.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,848.70 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna Commercial |
$6,757.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,143.76
|
| Rate for Payer: BCN Commercial |
$6,143.76
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cofinity Commercial |
$6,837.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,360.00
|
| Rate for Payer: Healthscope Commercial |
$7,155.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,962.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,757.50
|
| Rate for Payer: PHP Commercial |
$6,757.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,565.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,916.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,848.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,996.00
|
| Rate for Payer: UHC Core |
$6,638.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,962.50
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,888.12 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna Commercial |
$6,757.50
|
| Rate for Payer: Aetna Medicare |
$2,067.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,484.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,484.38
|
| Rate for Payer: BCBS Complete |
$2,217.64
|
| Rate for Payer: BCBS MAPPO |
$1,987.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,181.12
|
| Rate for Payer: BCN Commercial |
$6,181.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,987.50
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cofinity Commercial |
$6,837.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,987.50
|
| Rate for Payer: Healthscope Commercial |
$7,155.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,962.50
|
| Rate for Payer: Mclaren Medicaid |
$2,112.04
|
| Rate for Payer: Meridian Medicaid |
$2,217.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,086.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,285.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,757.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,888.12
|
| Rate for Payer: PACE SWMI |
$1,987.50
|
| Rate for Payer: PHP Commercial |
$6,757.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,987.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,565.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,916.50
|
| Rate for Payer: Priority Health Medicare |
$1,987.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,848.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,987.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,996.00
|
| Rate for Payer: UHC Core |
$6,638.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,987.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,047.12
|
| Rate for Payer: VA VA |
$1,987.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,962.50
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
IP
|
$237.86
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.07 |
| Max. Negotiated Rate |
$214.07 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: BCBS Trust/PPO |
$183.82
|
| Rate for Payer: BCN Commercial |
$183.82
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cofinity Commercial |
$204.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.29
|
| Rate for Payer: Healthscope Commercial |
$214.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.18
|
| Rate for Payer: PHP Commercial |
$202.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.32
|
| Rate for Payer: UHC Core |
$198.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.40
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
OP
|
$237.86
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$214.07 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Medicare |
$61.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.33
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$59.46
|
| Rate for Payer: BCBS Trust/PPO |
$184.94
|
| Rate for Payer: BCN Commercial |
$184.94
|
| Rate for Payer: BCN Medicare Advantage |
$59.46
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cofinity Commercial |
$204.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$214.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.40
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.18
|
| Rate for Payer: PACE Senior Care Partners |
$56.49
|
| Rate for Payer: PACE SWMI |
$59.46
|
| Rate for Payer: PHP Commercial |
$202.18
|
| Rate for Payer: PHP Medicare Advantage |
$59.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.94
|
| Rate for Payer: Priority Health Medicare |
$59.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.07
|
| Rate for Payer: Railroad Medicare Medicare |
$59.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.32
|
| Rate for Payer: UHC Core |
$198.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.46
|
| Rate for Payer: UHC Medicare Advantage |
$61.25
|
| Rate for Payer: VA VA |
$59.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.40
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
OP
|
$384.54
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.33 |
| Max. Negotiated Rate |
$346.09 |
| Rate for Payer: Aetna Commercial |
$326.86
|
| Rate for Payer: Aetna Medicare |
$99.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.17
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$96.14
|
| Rate for Payer: BCBS Trust/PPO |
$298.98
|
| Rate for Payer: BCN Commercial |
$298.98
|
| Rate for Payer: BCN Medicare Advantage |
$96.14
|
| Rate for Payer: Cash Price |
$307.63
|
| Rate for Payer: Cash Price |
$307.63
|
| Rate for Payer: Cofinity Commercial |
$330.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.14
|
| Rate for Payer: Healthscope Commercial |
$346.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.40
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$326.86
|
| Rate for Payer: PACE Senior Care Partners |
$91.33
|
| Rate for Payer: PACE SWMI |
$96.14
|
| Rate for Payer: PHP Commercial |
$326.86
|
| Rate for Payer: PHP Medicare Advantage |
$96.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.55
|
| Rate for Payer: Priority Health Medicare |
$96.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.53
|
| Rate for Payer: Railroad Medicare Medicare |
$96.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.40
|
| Rate for Payer: UHC Core |
$321.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.14
|
| Rate for Payer: UHC Medicare Advantage |
$99.02
|
| Rate for Payer: VA VA |
$96.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.40
|
|
