|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$3.05
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$2.90
|
| Rate for Payer: Meridian Medicaid |
$3.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna Medicare |
$2.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.93
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS MAPPO |
$2.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Commercial |
$7.29
|
| Rate for Payer: BCN Medicare Advantage |
$2.34
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.04
|
| Rate for Payer: Mclaren Medicaid |
$2.42
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: PACE Senior Care Partners |
$2.23
|
| Rate for Payer: PACE SWMI |
$2.34
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: PHP Medicare Advantage |
$2.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.16
|
| Rate for Payer: Priority Health Medicare |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.34
|
| Rate for Payer: UHC Medicare Advantage |
$2.42
|
| Rate for Payer: VA VA |
$2.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.04
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.25
|
| Rate for Payer: BCN Commercial |
$7.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.04
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.24 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: BCBS Trust/PPO |
$71.26
|
| 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 Multiplan/Beech St/PHCS |
$78.38
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.24
|
| 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 GLUC TOLER 3 SPECIMENS
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.50 |
| 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 |
$9.97
|
| Rate for Payer: BCBS MAPPO |
$23.05
|
| Rate for Payer: BCBS Trust/PPO |
$71.69
|
| 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 |
$9.50
|
| Rate for Payer: Meridian Medicaid |
$9.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.38
|
| 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 |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Medicare |
$23.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.24
|
| 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 Medicare Advantage |
$23.74
|
| Rate for Payer: VA VA |
$23.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$55.64
|
| Rate for Payer: BCN Commercial |
$55.64
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.36
|
| Rate for Payer: UHC Core |
$60.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.00
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$18.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.26
|
| Rate for Payer: BCBS MAPPO |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$55.98
|
| Rate for Payer: BCN Commercial |
$55.98
|
| Rate for Payer: BCN Medicare Advantage |
$18.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.00
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.00
|
| Rate for Payer: Mclaren Medicaid |
$17.39
|
| Rate for Payer: Meridian Medicaid |
$18.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PACE Senior Care Partners |
$17.10
|
| Rate for Payer: PACE SWMI |
$18.00
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.64
|
| Rate for Payer: Priority Health Medicare |
$18.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.36
|
| Rate for Payer: UHC Core |
$60.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.00
|
| Rate for Payer: UHC Medicare Advantage |
$18.54
|
| Rate for Payer: VA VA |
$18.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.00
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$27.59
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS MAPPO |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Mclaren Medicaid |
$7.17
|
| Rate for Payer: Meridian Medicaid |
$7.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$8.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$9.19
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC GOLDENROD IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| 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 |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC GOLDENROD IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
OP
|
$600.43
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.60 |
| Max. Negotiated Rate |
$540.39 |
| Rate for Payer: Aetna Commercial |
$510.37
|
| Rate for Payer: Aetna Medicare |
$156.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.63
|
| Rate for Payer: BCBS Complete |
$240.17
|
| Rate for Payer: BCBS MAPPO |
$150.11
|
| Rate for Payer: BCBS Trust/PPO |
$466.83
|
| Rate for Payer: BCN Commercial |
$466.83
|
| Rate for Payer: BCN Medicare Advantage |
$150.11
|
| Rate for Payer: Cash Price |
$480.34
|
| Rate for Payer: Cofinity Commercial |
$516.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.11
|
| Rate for Payer: Healthscope Commercial |
$540.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.37
|
| Rate for Payer: PACE Senior Care Partners |
$142.60
|
| Rate for Payer: PACE SWMI |
$150.11
|
| Rate for Payer: PHP Commercial |
$510.37
|
| Rate for Payer: PHP Medicare Advantage |
$150.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.37
|
| Rate for Payer: Priority Health Medicare |
$150.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$366.20
|
| Rate for Payer: Railroad Medicare Medicare |
$150.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.38
|
| Rate for Payer: UHC Core |
$501.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.11
|
| Rate for Payer: UHC Medicare Advantage |
$154.61
|
| Rate for Payer: VA VA |
$150.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.32
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
IP
|
$600.43
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$366.20 |
| Max. Negotiated Rate |
$540.39 |
| Rate for Payer: Aetna Commercial |
$510.37
|
| Rate for Payer: BCBS Trust/PPO |
$464.01
|
| Rate for Payer: BCN Commercial |
$464.01
|
| Rate for Payer: Cash Price |
$480.34
|
| Rate for Payer: Cofinity Commercial |
$516.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.34
|
| Rate for Payer: Healthscope Commercial |
$540.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$450.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.37
|
| Rate for Payer: PHP Commercial |
$510.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$522.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$366.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.38
|
| Rate for Payer: UHC Core |
$501.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$450.32
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| 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 |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
OP
|
$748.01
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.65 |
| Max. Negotiated Rate |
$673.21 |
| Rate for Payer: Aetna Commercial |
$635.81
|
| Rate for Payer: Aetna Medicare |
$194.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.75
|
| Rate for Payer: BCBS Complete |
$299.20
|
| Rate for Payer: BCBS MAPPO |
$187.00
|
| Rate for Payer: BCBS Trust/PPO |
$581.58
|
| Rate for Payer: BCN Commercial |
$581.58
|
| Rate for Payer: BCN Medicare Advantage |
$187.00
|
| Rate for Payer: Cash Price |
$598.41
|
| Rate for Payer: Cofinity Commercial |
$643.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.00
|
| Rate for Payer: Healthscope Commercial |
$673.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$196.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$635.81
|
| Rate for Payer: PACE Senior Care Partners |
$177.65
|
| Rate for Payer: PACE SWMI |
$187.00
|
| Rate for Payer: PHP Commercial |
$635.81
|
| Rate for Payer: PHP Medicare Advantage |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$650.77
|
| Rate for Payer: Priority Health Medicare |
$187.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$456.21
|
| Rate for Payer: Railroad Medicare Medicare |
$187.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.25
|
| Rate for Payer: UHC Core |
$624.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.00
|
| Rate for Payer: UHC Medicare Advantage |
$192.61
|
| Rate for Payer: VA VA |
$187.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.01
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
IP
|
$748.01
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$456.21 |
| Max. Negotiated Rate |
$673.21 |
| Rate for Payer: Aetna Commercial |
$635.81
|
| Rate for Payer: BCBS Trust/PPO |
$578.06
|
| Rate for Payer: BCN Commercial |
$578.06
|
| Rate for Payer: Cash Price |
$598.41
|
| Rate for Payer: Cofinity Commercial |
$643.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.41
|
| Rate for Payer: Healthscope Commercial |
$673.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$635.81
|
| Rate for Payer: PHP Commercial |
$635.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$650.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$456.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.25
|
| Rate for Payer: UHC Core |
$624.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.01
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$757.35
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.91 |
| Max. Negotiated Rate |
$681.62 |
| Rate for Payer: Aetna Commercial |
$643.75
|
| Rate for Payer: BCBS Trust/PPO |
$585.28
|
| Rate for Payer: BCN Commercial |
$585.28
|
| Rate for Payer: Cash Price |
$605.88
|
| Rate for Payer: Cofinity Commercial |
$651.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.88
|
| Rate for Payer: Healthscope Commercial |
$681.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$643.75
|
| Rate for Payer: PHP Commercial |
$643.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$658.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.47
|
| Rate for Payer: UHC Core |
$632.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.01
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$757.35
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.87 |
| Max. Negotiated Rate |
$681.62 |
| Rate for Payer: Aetna Commercial |
$643.75
|
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.67
|
| Rate for Payer: BCBS Complete |
$302.94
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCBS Trust/PPO |
$588.84
|
| Rate for Payer: BCN Commercial |
$588.84
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Cash Price |
$605.88
|
| Rate for Payer: Cofinity Commercial |
$651.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$681.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$643.75
|
| Rate for Payer: PACE Senior Care Partners |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Commercial |
$643.75
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$658.89
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.91
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.47
|
| Rate for Payer: UHC Core |
$632.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Medicare Advantage |
$195.02
|
| Rate for Payer: VA VA |
$189.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.01
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$467.51
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.13 |
| Max. Negotiated Rate |
$420.76 |
| Rate for Payer: Aetna Commercial |
$397.38
|
| Rate for Payer: BCBS Trust/PPO |
$361.29
|
| Rate for Payer: BCN Commercial |
$361.29
|
| Rate for Payer: Cash Price |
$374.01
|
| Rate for Payer: Cofinity Commercial |
$402.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.01
|
| Rate for Payer: Healthscope Commercial |
$420.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.38
|
| Rate for Payer: PHP Commercial |
$397.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.41
|
| Rate for Payer: UHC Core |
$390.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.63
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$467.51
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.03 |
| Max. Negotiated Rate |
$420.76 |
| Rate for Payer: Aetna Commercial |
$397.38
|
| Rate for Payer: Aetna Medicare |
$121.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.10
|
| Rate for Payer: BCBS Complete |
$187.00
|
| Rate for Payer: BCBS MAPPO |
$116.88
|
| Rate for Payer: BCBS Trust/PPO |
$363.49
|
| Rate for Payer: BCN Commercial |
$363.49
|
| Rate for Payer: BCN Medicare Advantage |
$116.88
|
| Rate for Payer: Cash Price |
$374.01
|
| Rate for Payer: Cofinity Commercial |
$402.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.88
|
| Rate for Payer: Healthscope Commercial |
$420.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.38
|
| Rate for Payer: PACE Senior Care Partners |
$111.03
|
| Rate for Payer: PACE SWMI |
$116.88
|
| Rate for Payer: PHP Commercial |
$397.38
|
| Rate for Payer: PHP Medicare Advantage |
$116.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.73
|
| Rate for Payer: Priority Health Medicare |
$116.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.13
|
| Rate for Payer: Railroad Medicare Medicare |
$116.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.41
|
| Rate for Payer: UHC Core |
$390.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.88
|
| Rate for Payer: UHC Medicare Advantage |
$120.38
|
| Rate for Payer: VA VA |
$116.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.63
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$272.53
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.22 |
| Max. Negotiated Rate |
$245.28 |
| Rate for Payer: Aetna Commercial |
$231.65
|
| Rate for Payer: BCBS Trust/PPO |
$210.61
|
| Rate for Payer: BCN Commercial |
$210.61
|
| Rate for Payer: Cash Price |
$218.02
|
| Rate for Payer: Cofinity Commercial |
$234.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.02
|
| Rate for Payer: Healthscope Commercial |
$245.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.65
|
| Rate for Payer: PHP Commercial |
$231.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.83
|
| Rate for Payer: UHC Core |
$227.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.40
|
|
