|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,604.50
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.57 |
| Max. Negotiated Rate |
$2,344.05 |
| Rate for Payer: Aetna Commercial |
$2,213.82
|
| Rate for Payer: Aetna Medicare |
$677.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.91
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$651.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,141.16
|
| Rate for Payer: BCN Commercial |
$2,025.00
|
| Rate for Payer: BCN Medicare Advantage |
$651.12
|
| Rate for Payer: Cash Price |
$2,083.60
|
| 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: Health Alliance Plan Medicare Advantage |
$651.12
|
| Rate for Payer: Healthscope Commercial |
$2,344.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,953.38
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.68
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,213.82
|
| Rate for Payer: Nomi Health Commercial |
$2,135.69
|
| Rate for Payer: PACE Senior Care Partners |
$618.57
|
| Rate for Payer: PACE SWMI |
$651.12
|
| Rate for Payer: PHP Commercial |
$2,213.82
|
| Rate for Payer: PHP Medicare Advantage |
$651.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.92
|
| Rate for Payer: Priority Health HMO/PPO |
$2,265.92
|
| Rate for Payer: Priority Health Medicare |
$657.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.02
|
| Rate for Payer: Railroad Medicare Medicare |
$651.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,291.96
|
| Rate for Payer: UHC Core |
$2,174.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$651.12
|
| Rate for Payer: UHC Exchange |
$651.12
|
| Rate for Payer: UHC Medicare Advantage |
$651.12
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$651.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,953.38
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,387.44
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,551.84 |
| Max. Negotiated Rate |
$2,148.70 |
| Rate for Payer: Aetna Commercial |
$2,029.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,948.87
|
| Rate for Payer: BCN Commercial |
$1,845.01
|
| Rate for Payer: Cash Price |
$1,909.95
|
| Rate for Payer: Cofinity Commercial |
$2,053.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,909.95
|
| Rate for Payer: Healthscope Commercial |
$2,148.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,790.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,029.32
|
| Rate for Payer: Nomi Health Commercial |
$1,957.70
|
| Rate for Payer: PHP Commercial |
$2,029.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,077.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,599.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,100.95
|
| Rate for Payer: UHC Core |
$1,993.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,790.58
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,387.44
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.02 |
| Max. Negotiated Rate |
$2,148.70 |
| Rate for Payer: Aetna Commercial |
$2,029.32
|
| Rate for Payer: Aetna Medicare |
$620.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.08
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$596.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.71
|
| Rate for Payer: BCN Commercial |
$1,856.23
|
| Rate for Payer: BCN Medicare Advantage |
$596.86
|
| Rate for Payer: Cash Price |
$1,909.95
|
| Rate for Payer: Cash Price |
$1,909.95
|
| Rate for Payer: Cofinity Commercial |
$2,053.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,909.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$596.86
|
| Rate for Payer: Healthscope Commercial |
$2,148.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,790.58
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.70
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,029.32
|
| Rate for Payer: Nomi Health Commercial |
$1,957.70
|
| Rate for Payer: PACE Senior Care Partners |
$567.02
|
| Rate for Payer: PACE SWMI |
$596.86
|
| Rate for Payer: PHP Commercial |
$2,029.32
|
| Rate for Payer: PHP Medicare Advantage |
$596.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,077.07
|
| Rate for Payer: Priority Health Medicare |
$602.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,599.58
|
| Rate for Payer: Railroad Medicare Medicare |
$596.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,100.95
|
| Rate for Payer: UHC Core |
$1,993.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$596.86
|
| Rate for Payer: UHC Exchange |
$596.86
|
| Rate for Payer: UHC Medicare Advantage |
$596.86
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$596.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,790.58
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: BCBS Trust/PPO |
$757.03
|
| Rate for Payer: BCN Commercial |
$716.69
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.26 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: Aetna Medicare |
$241.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.81
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS MAPPO |
$231.85
|
| Rate for Payer: BCBS Trust/PPO |
$762.41
|
| Rate for Payer: BCN Commercial |
$721.05
|
| Rate for Payer: BCN Medicare Advantage |
$231.85
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.85
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PACE Senior Care Partners |
$220.26
|
| Rate for Payer: PACE SWMI |
$231.85
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: PHP Medicare Advantage |
$231.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Medicare |
$234.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: Railroad Medicare Medicare |
$231.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.85
|
| Rate for Payer: UHC Exchange |
$231.85
|
| Rate for Payer: UHC Medicare Advantage |
$231.85
|
| Rate for Payer: VA VA |
$231.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.26 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: Aetna Medicare |
$241.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.81
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS MAPPO |
$231.85
|
| Rate for Payer: BCBS Trust/PPO |
$762.41
|
| Rate for Payer: BCN Commercial |
$721.05
|
| Rate for Payer: BCN Medicare Advantage |
$231.85
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.85
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PACE Senior Care Partners |
$220.26
|
| Rate for Payer: PACE SWMI |
$231.85
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: PHP Medicare Advantage |
$231.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Medicare |
$234.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: Railroad Medicare Medicare |
$231.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.85
|
| Rate for Payer: UHC Exchange |
$231.85
|
| Rate for Payer: UHC Medicare Advantage |
$231.85
|
| Rate for Payer: VA VA |
$231.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: BCBS Trust/PPO |
$757.03
|
| Rate for Payer: BCN Commercial |
$716.69
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.77 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: Aetna Medicare |
$184.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.06
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS MAPPO |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$584.18
|
| Rate for Payer: BCN Commercial |
$552.48
|
| Rate for Payer: BCN Medicare Advantage |
$177.65
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PACE Senior Care Partners |
$168.77
|
| Rate for Payer: PACE SWMI |
$177.65
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: PHP Medicare Advantage |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Medicare |
$179.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: Railroad Medicare Medicare |
$177.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.65
|
| Rate for Payer: UHC Exchange |
$177.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.65
|
| Rate for Payer: VA VA |
$177.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: BCBS Trust/PPO |
$580.05
|
| Rate for Payer: BCN Commercial |
$549.14
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.77 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: Aetna Medicare |
$184.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.06
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS MAPPO |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$584.18
|
| Rate for Payer: BCN Commercial |
$552.48
|
| Rate for Payer: BCN Medicare Advantage |
$177.65
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PACE Senior Care Partners |
$168.77
|
| Rate for Payer: PACE SWMI |
$177.65
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: PHP Medicare Advantage |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Medicare |
$179.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: Railroad Medicare Medicare |
$177.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.65
|
| Rate for Payer: UHC Exchange |
$177.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.65
|
| Rate for Payer: VA VA |
$177.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: BCBS Trust/PPO |
$580.05
|
| Rate for Payer: BCN Commercial |
$549.14
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
IP
|
$328.86
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.76 |
| Max. Negotiated Rate |
$295.97 |
| Rate for Payer: Aetna Commercial |
$279.53
|
| Rate for Payer: BCBS Trust/PPO |
$268.45
|
| Rate for Payer: BCN Commercial |
$254.14
|
| Rate for Payer: Cash Price |
$263.09
|
| Rate for Payer: Cofinity Commercial |
$282.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.09
|
| Rate for Payer: Healthscope Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.53
|
| Rate for Payer: Nomi Health Commercial |
$269.67
|
| Rate for Payer: PHP Commercial |
$279.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.76
|
| Rate for Payer: Priority Health HMO/PPO |
$286.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.40
|
| Rate for Payer: UHC Core |
$274.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.64
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
OP
|
$328.86
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.10 |
| Max. Negotiated Rate |
$295.97 |
| Rate for Payer: Aetna Commercial |
$279.53
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.77
|
| Rate for Payer: BCBS Complete |
$131.54
|
| Rate for Payer: BCBS MAPPO |
$82.22
|
| Rate for Payer: BCBS Trust/PPO |
$270.36
|
| Rate for Payer: BCN Commercial |
$255.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.22
|
| Rate for Payer: Cash Price |
$263.09
|
| Rate for Payer: Cofinity Commercial |
$282.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.22
|
| Rate for Payer: Healthscope Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.53
|
| Rate for Payer: Nomi Health Commercial |
$269.67
|
| Rate for Payer: PACE Senior Care Partners |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.22
|
| Rate for Payer: PHP Commercial |
$279.53
|
| Rate for Payer: PHP Medicare Advantage |
$82.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.76
|
| Rate for Payer: Priority Health HMO/PPO |
$286.11
|
| Rate for Payer: Priority Health Medicare |
$83.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.34
|
| Rate for Payer: Railroad Medicare Medicare |
$82.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.40
|
| Rate for Payer: UHC Core |
$274.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.22
|
| Rate for Payer: UHC Exchange |
$82.22
|
| Rate for Payer: UHC Medicare Advantage |
$82.22
|
| Rate for Payer: VA VA |
$82.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.64
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
IP
|
$197.01
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.06 |
| Max. Negotiated Rate |
$177.31 |
| Rate for Payer: Aetna Commercial |
$167.46
|
| Rate for Payer: BCBS Trust/PPO |
$160.82
|
| Rate for Payer: BCN Commercial |
$152.25
|
| Rate for Payer: Cash Price |
$157.61
|
| Rate for Payer: Cofinity Commercial |
$169.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.61
|
| Rate for Payer: Healthscope Commercial |
$177.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.46
|
| Rate for Payer: Nomi Health Commercial |
$161.55
|
| Rate for Payer: PHP Commercial |
$167.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.06
|
| Rate for Payer: Priority Health HMO/PPO |
$171.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.37
|
| Rate for Payer: UHC Core |
$164.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.76
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
OP
|
$197.01
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.79 |
| Max. Negotiated Rate |
$177.31 |
| Rate for Payer: Aetna Commercial |
$167.46
|
| Rate for Payer: Aetna Medicare |
$51.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.57
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$49.25
|
| Rate for Payer: BCBS Trust/PPO |
$161.96
|
| Rate for Payer: BCN Commercial |
$153.18
|
| Rate for Payer: BCN Medicare Advantage |
$49.25
|
| Rate for Payer: Cash Price |
$157.61
|
| Rate for Payer: Cofinity Commercial |
$169.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.25
|
| Rate for Payer: Healthscope Commercial |
$177.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.46
|
| Rate for Payer: Nomi Health Commercial |
$161.55
|
| Rate for Payer: PACE Senior Care Partners |
$46.79
|
| Rate for Payer: PACE SWMI |
$49.25
|
| Rate for Payer: PHP Commercial |
$167.46
|
| Rate for Payer: PHP Medicare Advantage |
$49.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.06
|
| Rate for Payer: Priority Health HMO/PPO |
$171.40
|
| Rate for Payer: Priority Health Medicare |
$49.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.00
|
| Rate for Payer: Railroad Medicare Medicare |
$49.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.37
|
| Rate for Payer: UHC Core |
$164.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.25
|
| Rate for Payer: UHC Exchange |
$49.25
|
| Rate for Payer: UHC Medicare Advantage |
$49.25
|
| Rate for Payer: VA VA |
$49.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.76
|
|
|
HC APT DOWNEY TEST
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: BCBS Trust/PPO |
$75.27
|
| Rate for Payer: BCN Commercial |
$71.26
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO |
$80.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.14
|
| Rate for Payer: UHC Core |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
|
HC APT DOWNEY TEST
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.82
|
| Rate for Payer: BCBS Complete |
$6.07
|
| Rate for Payer: BCBS MAPPO |
$23.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.81
|
| Rate for Payer: BCN Commercial |
$71.69
|
| Rate for Payer: BCN Medicare Advantage |
$23.05
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Mclaren Medicaid |
$5.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.21
|
| Rate for Payer: Meridian Medicaid |
$6.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PACE Senior Care Partners |
$21.90
|
| Rate for Payer: PACE SWMI |
$23.05
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$23.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO |
$80.22
|
| Rate for Payer: Priority Health Medicare |
$23.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.78
|
| Rate for Payer: Railroad Medicare Medicare |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.14
|
| Rate for Payer: UHC Core |
$77.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.05
|
| Rate for Payer: UHC Exchange |
$23.05
|
| Rate for Payer: UHC Medicare Advantage |
$23.05
|
| Rate for Payer: UHCCP Medicaid |
$5.78
|
| Rate for Payer: VA VA |
$23.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
|
HC APTT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$4.56
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$4.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$4.35
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC APTT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC APTT MIXING STUDY
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: BCBS Trust/PPO |
$81.60
|
| Rate for Payer: BCN Commercial |
$77.25
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO |
$86.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC APTT MIXING STUDY
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$25.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.24
|
| Rate for Payer: BCBS Complete |
$4.91
|
| Rate for Payer: BCBS MAPPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$77.72
|
| Rate for Payer: BCN Medicare Advantage |
$24.99
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Mclaren Medicaid |
$4.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.24
|
| Rate for Payer: Meridian Medicaid |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: PACE Senior Care Partners |
$23.74
|
| Rate for Payer: PACE SWMI |
$24.99
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$24.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO |
$86.97
|
| Rate for Payer: Priority Health Medicare |
$25.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.97
|
| Rate for Payer: Railroad Medicare Medicare |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.99
|
| Rate for Payer: UHC Exchange |
$24.99
|
| Rate for Payer: UHC Medicare Advantage |
$24.99
|
| Rate for Payer: UHCCP Medicaid |
$4.68
|
| Rate for Payer: VA VA |
$24.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$72.81
|
| Rate for Payer: BCN Medicare Advantage |
$23.41
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.24
|
| Rate for Payer: PACE SWMI |
$23.41
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: Railroad Medicare Medicare |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.41
|
| Rate for Payer: UHC Exchange |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.44
|
| Rate for Payer: BCN Commercial |
$72.36
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC ARBOVIRUS CALIF CMPT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$9.54
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC ARBOVIRUS CALIF CMPT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
