|
HC APIXABAN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC APIXABAN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Mclaren Medicaid |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: Meridian Medicaid |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$13.48
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
OP
|
$131.72
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$118.55 |
| Rate for Payer: Aetna Commercial |
$111.96
|
| Rate for Payer: Aetna Medicare |
$34.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.16
|
| Rate for Payer: BCBS Complete |
$52.69
|
| Rate for Payer: BCBS MAPPO |
$32.93
|
| Rate for Payer: BCBS Trust/PPO |
$108.29
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: BCN Medicare Advantage |
$32.93
|
| Rate for Payer: Cash Price |
$105.38
|
| Rate for Payer: Cofinity Commercial |
$113.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.93
|
| Rate for Payer: Healthscope Commercial |
$118.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.96
|
| Rate for Payer: Nomi Health Commercial |
$108.01
|
| Rate for Payer: PACE Senior Care Partners |
$31.28
|
| Rate for Payer: PACE SWMI |
$32.93
|
| Rate for Payer: PHP Commercial |
$111.96
|
| Rate for Payer: PHP Medicare Advantage |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.62
|
| Rate for Payer: Priority Health HMO/PPO |
$114.60
|
| Rate for Payer: Priority Health Medicare |
$33.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.25
|
| Rate for Payer: Railroad Medicare Medicare |
$32.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.91
|
| Rate for Payer: UHC Core |
$109.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.93
|
| Rate for Payer: UHC Exchange |
$32.93
|
| Rate for Payer: UHC Medicare Advantage |
$32.93
|
| Rate for Payer: VA VA |
$32.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.79
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
IP
|
$131.72
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.62 |
| Max. Negotiated Rate |
$118.55 |
| Rate for Payer: Aetna Commercial |
$111.96
|
| Rate for Payer: BCBS Trust/PPO |
$107.52
|
| Rate for Payer: BCN Commercial |
$101.79
|
| Rate for Payer: Cash Price |
$105.38
|
| Rate for Payer: Cofinity Commercial |
$113.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.38
|
| Rate for Payer: Healthscope Commercial |
$118.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.96
|
| Rate for Payer: Nomi Health Commercial |
$108.01
|
| Rate for Payer: PHP Commercial |
$111.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.62
|
| Rate for Payer: Priority Health HMO/PPO |
$114.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.91
|
| Rate for Payer: UHC Core |
$109.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.79
|
|
|
HC APNEALINK PLUS
|
Facility
|
OP
|
$747.76
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$672.98 |
| Rate for Payer: Aetna Commercial |
$635.60
|
| Rate for Payer: Aetna Medicare |
$194.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.68
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$186.94
|
| Rate for Payer: BCBS Trust/PPO |
$614.73
|
| Rate for Payer: BCN Commercial |
$581.38
|
| Rate for Payer: BCN Medicare Advantage |
$186.94
|
| Rate for Payer: Cash Price |
$598.21
|
| Rate for Payer: Cash Price |
$598.21
|
| Rate for Payer: Cofinity Commercial |
$643.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.94
|
| Rate for Payer: Healthscope Commercial |
$672.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.82
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.29
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.60
|
| Rate for Payer: Nomi Health Commercial |
$613.16
|
| Rate for Payer: PACE Senior Care Partners |
$177.59
|
| Rate for Payer: PACE SWMI |
$186.94
|
| Rate for Payer: PHP Commercial |
$635.60
|
| Rate for Payer: PHP Medicare Advantage |
$186.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.04
|
| Rate for Payer: Priority Health HMO/PPO |
$650.55
|
| Rate for Payer: Priority Health Medicare |
$188.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.00
|
| Rate for Payer: Railroad Medicare Medicare |
$186.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.03
|
| Rate for Payer: UHC Core |
$624.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.94
|
| Rate for Payer: UHC Exchange |
$186.94
|
| Rate for Payer: UHC Medicare Advantage |
$186.94
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$186.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.82
|
|
|
HC APNEALINK PLUS
|
Facility
|
IP
|
$747.76
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$486.04 |
| Max. Negotiated Rate |
$672.98 |
| Rate for Payer: Aetna Commercial |
$635.60
|
| Rate for Payer: BCBS Trust/PPO |
$610.40
|
| Rate for Payer: BCN Commercial |
$577.87
|
| Rate for Payer: Cash Price |
$598.21
|
| Rate for Payer: Cofinity Commercial |
$643.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.21
|
| Rate for Payer: Healthscope Commercial |
$672.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.60
|
| Rate for Payer: Nomi Health Commercial |
$613.16
|
| Rate for Payer: PHP Commercial |
$635.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.04
|
| Rate for Payer: Priority Health HMO/PPO |
$650.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.03
|
| Rate for Payer: UHC Core |
$624.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.82
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: BCBS Trust/PPO |
$57.45
|
| Rate for Payer: BCN Commercial |
$54.39
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health HMO/PPO |
$61.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.93
|
| Rate for Payer: UHC Core |
$58.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$18.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.99
|
| Rate for Payer: BCBS Complete |
$16.01
|
| Rate for Payer: BCBS MAPPO |
$17.59
|
| Rate for Payer: BCBS Trust/PPO |
$57.86
|
| Rate for Payer: BCN Commercial |
$54.72
|
| Rate for Payer: BCN Medicare Advantage |
$17.59
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.78
|
| Rate for Payer: Mclaren Medicaid |
$15.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.47
|
| Rate for Payer: Meridian Medicaid |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$57.71
|
| Rate for Payer: PACE Senior Care Partners |
$16.72
|
| Rate for Payer: PACE SWMI |
$17.59
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$17.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health HMO/PPO |
$61.23
|
| Rate for Payer: Priority Health Medicare |
$17.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.15
|
| Rate for Payer: Railroad Medicare Medicare |
$17.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.93
|
| Rate for Payer: UHC Core |
$58.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.59
|
| Rate for Payer: UHC Exchange |
$17.59
|
| Rate for Payer: UHC Medicare Advantage |
$17.59
|
| Rate for Payer: UHCCP Medicaid |
$15.25
|
| Rate for Payer: VA VA |
$17.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.78
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.93
|
| Rate for Payer: BCBS Complete |
$16.01
|
| Rate for Payer: BCBS MAPPO |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$41.91
|
| Rate for Payer: BCN Commercial |
$39.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.74
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Mclaren Medicaid |
$15.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.38
|
| Rate for Payer: Meridian Medicaid |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.74
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$12.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO |
$44.35
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.16
|
| Rate for Payer: Railroad Medicare Medicare |
$12.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.86
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.74
|
| Rate for Payer: UHC Exchange |
$12.74
|
| Rate for Payer: UHC Medicare Advantage |
$12.74
|
| Rate for Payer: UHCCP Medicaid |
$15.25
|
| Rate for Payer: VA VA |
$12.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: BCBS Trust/PPO |
$41.61
|
| Rate for Payer: BCN Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO |
$44.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.86
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: BCBS Trust/PPO |
$32.28
|
| Rate for Payer: BCN Commercial |
$30.56
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO |
$34.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.80
|
| Rate for Payer: UHC Core |
$33.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$10.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.36
|
| Rate for Payer: BCBS Complete |
$16.01
|
| Rate for Payer: BCBS MAPPO |
$9.88
|
| Rate for Payer: BCBS Trust/PPO |
$32.51
|
| Rate for Payer: BCN Commercial |
$30.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.88
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.88
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Mclaren Medicaid |
$15.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.38
|
| Rate for Payer: Meridian Medicaid |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: PACE Senior Care Partners |
$9.39
|
| Rate for Payer: PACE SWMI |
$9.88
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: PHP Medicare Advantage |
$9.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO |
$34.40
|
| Rate for Payer: Priority Health Medicare |
$9.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.80
|
| Rate for Payer: UHC Core |
$33.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.88
|
| Rate for Payer: UHC Exchange |
$9.88
|
| Rate for Payer: UHC Medicare Advantage |
$9.88
|
| Rate for Payer: UHCCP Medicaid |
$15.25
|
| Rate for Payer: VA VA |
$9.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC APPLIANCE BELT
|
Facility
|
IP
|
$24.91
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$22.42 |
| Rate for Payer: Aetna Commercial |
$21.17
|
| Rate for Payer: BCBS Trust/PPO |
$20.33
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$22.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.17
|
| Rate for Payer: Nomi Health Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$21.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.19
|
| Rate for Payer: Priority Health HMO/PPO |
$21.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.92
|
| Rate for Payer: UHC Core |
$20.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.68
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$24.91
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$22.42 |
| Rate for Payer: Aetna Commercial |
$21.17
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$6.23
|
| Rate for Payer: BCBS Trust/PPO |
$20.48
|
| Rate for Payer: BCN Commercial |
$19.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.23
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.23
|
| Rate for Payer: Healthscope Commercial |
$22.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.17
|
| Rate for Payer: Nomi Health Commercial |
$20.43
|
| Rate for Payer: PACE Senior Care Partners |
$5.92
|
| Rate for Payer: PACE SWMI |
$6.23
|
| Rate for Payer: PHP Commercial |
$21.17
|
| Rate for Payer: PHP Medicare Advantage |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.19
|
| Rate for Payer: Priority Health HMO/PPO |
$21.67
|
| Rate for Payer: Priority Health Medicare |
$6.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.92
|
| Rate for Payer: UHC Core |
$20.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.23
|
| Rate for Payer: UHC Exchange |
$6.23
|
| Rate for Payer: UHC Medicare Advantage |
$6.23
|
| Rate for Payer: VA VA |
$6.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.68
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$35.50
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.09
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS MAPPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$29.18
|
| Rate for Payer: BCN Commercial |
$27.60
|
| Rate for Payer: BCN Medicare Advantage |
$8.88
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.88
|
| Rate for Payer: Healthscope Commercial |
$31.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$29.11
|
| Rate for Payer: PACE Senior Care Partners |
$8.43
|
| Rate for Payer: PACE SWMI |
$8.88
|
| Rate for Payer: PHP Commercial |
$30.18
|
| Rate for Payer: PHP Medicare Advantage |
$8.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.07
|
| Rate for Payer: Priority Health HMO/PPO |
$30.89
|
| Rate for Payer: Priority Health Medicare |
$8.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.79
|
| Rate for Payer: Railroad Medicare Medicare |
$8.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.24
|
| Rate for Payer: UHC Core |
$29.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.88
|
| Rate for Payer: UHC Exchange |
$8.88
|
| Rate for Payer: UHC Medicare Advantage |
$8.88
|
| Rate for Payer: VA VA |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.62
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$35.50
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: BCBS Trust/PPO |
$28.98
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$31.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$29.11
|
| Rate for Payer: PHP Commercial |
$30.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.07
|
| Rate for Payer: Priority Health HMO/PPO |
$30.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.24
|
| Rate for Payer: UHC Core |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.62
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna Medicare |
$38.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.81
|
| Rate for Payer: BCBS Complete |
$35.03
|
| Rate for Payer: BCBS MAPPO |
$37.45
|
| Rate for Payer: BCBS Trust/PPO |
$123.14
|
| Rate for Payer: BCN Commercial |
$116.46
|
| Rate for Payer: BCN Medicare Advantage |
$37.45
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.45
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Mclaren Medicaid |
$33.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.32
|
| Rate for Payer: Meridian Medicaid |
$35.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE Senior Care Partners |
$35.58
|
| Rate for Payer: PACE SWMI |
$37.45
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: PHP Medicare Advantage |
$37.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health HMO/PPO |
$130.32
|
| Rate for Payer: Priority Health Medicare |
$37.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.36
|
| Rate for Payer: Railroad Medicare Medicare |
$37.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Core |
$125.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.45
|
| Rate for Payer: UHC Exchange |
$37.45
|
| Rate for Payer: UHC Medicare Advantage |
$37.45
|
| Rate for Payer: UHCCP Medicaid |
$33.36
|
| Rate for Payer: VA VA |
$37.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.36 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: BCBS Trust/PPO |
$122.27
|
| Rate for Payer: BCN Commercial |
$115.76
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health HMO/PPO |
$130.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Core |
$125.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,947.51
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$462.53 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: Aetna Medicare |
$506.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$608.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$608.60
|
| Rate for Payer: BCBS Complete |
$1,388.75
|
| Rate for Payer: BCBS MAPPO |
$486.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.05
|
| Rate for Payer: BCN Commercial |
$1,514.19
|
| Rate for Payer: BCN Medicare Advantage |
$486.88
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cofinity Commercial |
$1,674.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.88
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Mclaren Medicaid |
$1,322.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.22
|
| Rate for Payer: Meridian Medicaid |
$1,388.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$559.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$1,596.96
|
| Rate for Payer: PACE Senior Care Partners |
$462.53
|
| Rate for Payer: PACE SWMI |
$486.88
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: PHP Medicare Advantage |
$486.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,322.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,694.33
|
| Rate for Payer: Priority Health Medicare |
$491.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.83
|
| Rate for Payer: Railroad Medicare Medicare |
$486.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.81
|
| Rate for Payer: UHC Core |
$1,626.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.88
|
| Rate for Payer: UHC Exchange |
$486.88
|
| Rate for Payer: UHC Medicare Advantage |
$486.88
|
| Rate for Payer: UHCCP Medicaid |
$1,322.53
|
| Rate for Payer: VA VA |
$486.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,460.63
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,947.51
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,589.75
|
| Rate for Payer: BCN Commercial |
$1,505.04
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cofinity Commercial |
$1,674.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.01
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$1,596.96
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,694.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.81
|
| Rate for Payer: UHC Core |
$1,626.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,460.63
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,570.71
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.54 |
| Max. Negotiated Rate |
$2,779.41 |
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: Aetna Medicare |
$668.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$803.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$803.35
|
| Rate for Payer: BCBS Complete |
$2,779.41
|
| Rate for Payer: BCBS MAPPO |
$642.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.38
|
| Rate for Payer: BCN Commercial |
$1,998.73
|
| Rate for Payer: BCN Medicare Advantage |
$642.68
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cofinity Commercial |
$2,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,056.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.68
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Mclaren Medicaid |
$2,646.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.81
|
| Rate for Payer: Meridian Medicaid |
$2,779.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$739.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$2,107.98
|
| Rate for Payer: PACE Senior Care Partners |
$610.54
|
| Rate for Payer: PACE SWMI |
$642.68
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: PHP Medicare Advantage |
$642.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,646.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO |
$2,236.52
|
| Rate for Payer: Priority Health Medicare |
$649.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,722.38
|
| Rate for Payer: Railroad Medicare Medicare |
$642.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,262.22
|
| Rate for Payer: UHC Core |
$2,146.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.68
|
| Rate for Payer: UHC Exchange |
$642.68
|
| Rate for Payer: UHC Medicare Advantage |
$642.68
|
| Rate for Payer: UHCCP Medicaid |
$2,646.88
|
| Rate for Payer: VA VA |
$642.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,928.03
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,570.71
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,670.96 |
| Max. Negotiated Rate |
$2,313.64 |
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,098.47
|
| Rate for Payer: BCN Commercial |
$1,986.64
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cofinity Commercial |
$2,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,056.57
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$2,107.98
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO |
$2,236.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,722.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,262.22
|
| Rate for Payer: UHC Core |
$2,146.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,928.03
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,604.50
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,692.92 |
| Max. Negotiated Rate |
$2,344.05 |
| Rate for Payer: Aetna Commercial |
$2,213.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.05
|
| Rate for Payer: BCN Commercial |
$2,012.76
|
| Rate for Payer: Cash Price |
$2,083.60
|
| Rate for Payer: Cofinity Commercial |
$2,239.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,083.60
|
| Rate for Payer: Healthscope Commercial |
$2,344.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,953.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,213.82
|
| Rate for Payer: Nomi Health Commercial |
$2,135.69
|
| Rate for Payer: PHP Commercial |
$2,213.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.92
|
| Rate for Payer: Priority Health HMO/PPO |
$2,265.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,291.96
|
| Rate for Payer: UHC Core |
$2,174.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,953.38
|
|
