|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,924.74
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.33 |
| Max. Negotiated Rate |
$1,732.27 |
| Rate for Payer: Aetna Commercial |
$1,636.03
|
| Rate for Payer: Aetna Medicare |
$500.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.48
|
| Rate for Payer: BCBS Complete |
$356.27
|
| Rate for Payer: BCBS MAPPO |
$481.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.33
|
| Rate for Payer: BCN Commercial |
$1,582.33
|
| Rate for Payer: BCN Medicare Advantage |
$481.19
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cofinity Commercial |
$1,655.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.19
|
| Rate for Payer: Healthscope Commercial |
$1,732.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.56
|
| Rate for Payer: Mclaren Medicaid |
$339.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.24
|
| Rate for Payer: Meridian Medicaid |
$356.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$529.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.03
|
| Rate for Payer: Nomi Health Commercial |
$1,578.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,443.56
|
| Rate for Payer: PACE Senior Care Partners |
$457.13
|
| Rate for Payer: PACE SWMI |
$481.19
|
| Rate for Payer: PHP Commercial |
$1,636.03
|
| Rate for Payer: PHP Medicare Advantage |
$481.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,674.52
|
| Rate for Payer: Priority Health Medicare |
$486.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,339.62
|
| Rate for Payer: Railroad Medicare Medicare |
$481.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,693.77
|
| Rate for Payer: UHC Core |
$1,607.16
|
| Rate for Payer: UHC Exchange |
$481.19
|
| Rate for Payer: UHC Medicaid |
$339.33
|
| Rate for Payer: UHC Medicare Advantage |
$481.19
|
| Rate for Payer: UHCCP Medicaid |
$339.33
|
| Rate for Payer: VA VA |
$481.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.56
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,924.74
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,339.62 |
| Max. Negotiated Rate |
$1,732.27 |
| Rate for Payer: Aetna Commercial |
$1,636.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,589.64
|
| Rate for Payer: BCN Commercial |
$1,589.64
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cofinity Commercial |
$1,655.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.79
|
| Rate for Payer: Healthscope Commercial |
$1,732.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.03
|
| Rate for Payer: Nomi Health Commercial |
$1,578.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,443.56
|
| Rate for Payer: PHP Commercial |
$1,636.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,674.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,339.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,693.77
|
| Rate for Payer: UHC Core |
$1,607.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.56
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,161.60
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$733.69 |
| Max. Negotiated Rate |
$3,745.44 |
| Rate for Payer: Aetna Commercial |
$3,537.36
|
| Rate for Payer: Aetna Medicare |
$1,082.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,300.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,300.50
|
| Rate for Payer: BCBS Complete |
$770.31
|
| Rate for Payer: BCBS MAPPO |
$1,040.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,421.25
|
| Rate for Payer: BCN Commercial |
$3,421.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.40
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Commercial |
$3,578.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.40
|
| Rate for Payer: Healthscope Commercial |
$3,745.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,121.20
|
| Rate for Payer: Mclaren Medicaid |
$733.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.42
|
| Rate for Payer: Meridian Medicaid |
$770.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,196.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,144.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Nomi Health Commercial |
$3,412.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: PACE Senior Care Partners |
$988.38
|
| Rate for Payer: PACE SWMI |
$1,040.40
|
| Rate for Payer: PHP Commercial |
$3,537.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,620.59
|
| Rate for Payer: Priority Health Medicare |
$1,050.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,896.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,040.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,662.21
|
| Rate for Payer: UHC Core |
$3,474.94
|
| Rate for Payer: UHC Exchange |
$1,040.40
|
| Rate for Payer: UHC Medicaid |
$733.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.40
|
| Rate for Payer: UHCCP Medicaid |
$733.69
|
| Rate for Payer: VA VA |
$1,040.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,121.20
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,161.60
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,896.47 |
| Max. Negotiated Rate |
$3,745.44 |
| Rate for Payer: Aetna Commercial |
$3,537.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,437.07
|
| Rate for Payer: BCN Commercial |
$3,437.07
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Commercial |
$3,578.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Healthscope Commercial |
$3,745.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,121.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Nomi Health Commercial |
$3,412.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: PHP Commercial |
$3,537.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,620.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,896.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,662.21
|
| Rate for Payer: UHC Core |
$3,474.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,121.20
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$519.25
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$467.32 |
| Rate for Payer: Aetna Commercial |
$441.36
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.27
|
| Rate for Payer: BCBS Complete |
$96.11
|
| Rate for Payer: BCBS MAPPO |
$129.81
|
| Rate for Payer: BCBS Trust/PPO |
$426.88
|
| Rate for Payer: BCN Commercial |
$426.88
|
| Rate for Payer: BCN Medicare Advantage |
$129.81
|
| Rate for Payer: Cash Price |
$415.40
|
| Rate for Payer: Cofinity Commercial |
$446.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.81
|
| Rate for Payer: Healthscope Commercial |
$467.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.44
|
| Rate for Payer: Mclaren Medicaid |
$91.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.30
|
| Rate for Payer: Meridian Medicaid |
$96.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.36
|
| Rate for Payer: Nomi Health Commercial |
$425.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.44
|
| Rate for Payer: PACE Senior Care Partners |
$123.32
|
| Rate for Payer: PACE SWMI |
$129.81
|
| Rate for Payer: PHP Commercial |
$441.36
|
| Rate for Payer: PHP Medicare Advantage |
$129.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$451.75
|
| Rate for Payer: Priority Health Medicare |
$131.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$361.40
|
| Rate for Payer: Railroad Medicare Medicare |
$129.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.94
|
| Rate for Payer: UHC Core |
$433.57
|
| Rate for Payer: UHC Exchange |
$129.81
|
| Rate for Payer: UHC Medicaid |
$91.54
|
| Rate for Payer: UHC Medicare Advantage |
$129.81
|
| Rate for Payer: UHCCP Medicaid |
$91.54
|
| Rate for Payer: VA VA |
$129.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.44
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$519.25
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.40 |
| Max. Negotiated Rate |
$467.32 |
| Rate for Payer: Aetna Commercial |
$441.36
|
| Rate for Payer: BCBS Trust/PPO |
$428.85
|
| Rate for Payer: BCN Commercial |
$428.85
|
| Rate for Payer: Cash Price |
$415.40
|
| Rate for Payer: Cofinity Commercial |
$446.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.40
|
| Rate for Payer: Healthscope Commercial |
$467.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.36
|
| Rate for Payer: Nomi Health Commercial |
$425.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.44
|
| Rate for Payer: PHP Commercial |
$441.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$451.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$361.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.94
|
| Rate for Payer: UHC Core |
$433.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.44
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$657.98
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$592.18 |
| Rate for Payer: Aetna Commercial |
$559.28
|
| Rate for Payer: Aetna Medicare |
$171.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.62
|
| Rate for Payer: BCBS Complete |
$121.79
|
| Rate for Payer: BCBS MAPPO |
$164.50
|
| Rate for Payer: BCBS Trust/PPO |
$540.93
|
| Rate for Payer: BCN Commercial |
$540.93
|
| Rate for Payer: BCN Medicare Advantage |
$164.50
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cofinity Commercial |
$565.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.50
|
| Rate for Payer: Healthscope Commercial |
$592.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.49
|
| Rate for Payer: Mclaren Medicaid |
$116.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.72
|
| Rate for Payer: Meridian Medicaid |
$121.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.28
|
| Rate for Payer: Nomi Health Commercial |
$539.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.49
|
| Rate for Payer: PACE Senior Care Partners |
$156.27
|
| Rate for Payer: PACE SWMI |
$164.50
|
| Rate for Payer: PHP Commercial |
$559.28
|
| Rate for Payer: PHP Medicare Advantage |
$164.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$572.44
|
| Rate for Payer: Priority Health Medicare |
$166.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.95
|
| Rate for Payer: Railroad Medicare Medicare |
$164.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.02
|
| Rate for Payer: UHC Core |
$549.41
|
| Rate for Payer: UHC Exchange |
$164.50
|
| Rate for Payer: UHC Medicaid |
$116.00
|
| Rate for Payer: UHC Medicare Advantage |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$116.00
|
| Rate for Payer: VA VA |
$164.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.49
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$657.98
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.95 |
| Max. Negotiated Rate |
$592.18 |
| Rate for Payer: Aetna Commercial |
$559.28
|
| Rate for Payer: BCBS Trust/PPO |
$543.43
|
| Rate for Payer: BCN Commercial |
$543.43
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cofinity Commercial |
$565.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.38
|
| Rate for Payer: Healthscope Commercial |
$592.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.28
|
| Rate for Payer: Nomi Health Commercial |
$539.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.49
|
| Rate for Payer: PHP Commercial |
$559.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$572.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.02
|
| Rate for Payer: UHC Core |
$549.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.49
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$38.31
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$32.56
|
| Rate for Payer: BCBS Trust/PPO |
$31.64
|
| Rate for Payer: BCN Commercial |
$31.64
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cofinity Commercial |
$32.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.65
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Nomi Health Commercial |
$31.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: PHP Commercial |
$32.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.71
|
| Rate for Payer: UHC Core |
$31.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.73
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$38.31
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$32.56
|
| Rate for Payer: Aetna Medicare |
$9.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.97
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$9.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.49
|
| Rate for Payer: BCN Commercial |
$31.49
|
| Rate for Payer: BCN Medicare Advantage |
$9.58
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cofinity Commercial |
$32.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.73
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.06
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Nomi Health Commercial |
$31.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: PACE Senior Care Partners |
$9.10
|
| Rate for Payer: PACE SWMI |
$9.58
|
| Rate for Payer: PHP Commercial |
$32.56
|
| Rate for Payer: PHP Medicare Advantage |
$9.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.33
|
| Rate for Payer: Priority Health Medicare |
$9.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.66
|
| Rate for Payer: Railroad Medicare Medicare |
$9.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.71
|
| Rate for Payer: UHC Core |
$31.99
|
| Rate for Payer: UHC Exchange |
$9.58
|
| Rate for Payer: UHC Medicaid |
$6.75
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$9.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.73
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$492.82
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$443.54 |
| Rate for Payer: Aetna Commercial |
$418.90
|
| Rate for Payer: Aetna Medicare |
$128.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.01
|
| Rate for Payer: BCBS Complete |
$91.22
|
| Rate for Payer: BCBS MAPPO |
$123.20
|
| Rate for Payer: BCBS Trust/PPO |
$405.15
|
| Rate for Payer: BCN Commercial |
$405.15
|
| Rate for Payer: BCN Medicare Advantage |
$123.20
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cofinity Commercial |
$423.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.20
|
| Rate for Payer: Healthscope Commercial |
$443.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.62
|
| Rate for Payer: Mclaren Medicaid |
$86.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.37
|
| Rate for Payer: Meridian Medicaid |
$91.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.90
|
| Rate for Payer: Nomi Health Commercial |
$404.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.62
|
| Rate for Payer: PACE Senior Care Partners |
$117.04
|
| Rate for Payer: PACE SWMI |
$123.20
|
| Rate for Payer: PHP Commercial |
$418.90
|
| Rate for Payer: PHP Medicare Advantage |
$123.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$428.75
|
| Rate for Payer: Priority Health Medicare |
$124.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.00
|
| Rate for Payer: Railroad Medicare Medicare |
$123.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.68
|
| Rate for Payer: UHC Core |
$411.50
|
| Rate for Payer: UHC Exchange |
$123.20
|
| Rate for Payer: UHC Medicaid |
$86.88
|
| Rate for Payer: UHC Medicare Advantage |
$123.20
|
| Rate for Payer: UHCCP Medicaid |
$86.88
|
| Rate for Payer: VA VA |
$123.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.62
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$492.82
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$443.54 |
| Rate for Payer: Aetna Commercial |
$418.90
|
| Rate for Payer: BCBS Trust/PPO |
$407.02
|
| Rate for Payer: BCN Commercial |
$407.02
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cofinity Commercial |
$423.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.26
|
| Rate for Payer: Healthscope Commercial |
$443.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.90
|
| Rate for Payer: Nomi Health Commercial |
$404.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.62
|
| Rate for Payer: PHP Commercial |
$418.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$428.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.68
|
| Rate for Payer: UHC Core |
$411.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.62
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$146.25
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$131.62 |
| Rate for Payer: Aetna Commercial |
$124.31
|
| Rate for Payer: BCBS Trust/PPO |
$120.79
|
| Rate for Payer: BCN Commercial |
$120.79
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cofinity Commercial |
$125.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.00
|
| Rate for Payer: Healthscope Commercial |
$131.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.31
|
| Rate for Payer: Nomi Health Commercial |
$119.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.69
|
| Rate for Payer: PHP Commercial |
$124.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$127.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.70
|
| Rate for Payer: UHC Core |
$122.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.69
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$146.25
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$131.62 |
| Rate for Payer: Aetna Commercial |
$124.31
|
| Rate for Payer: Aetna Medicare |
$38.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.70
|
| Rate for Payer: BCBS Complete |
$27.07
|
| Rate for Payer: BCBS MAPPO |
$36.56
|
| Rate for Payer: BCBS Trust/PPO |
$120.23
|
| Rate for Payer: BCN Commercial |
$120.23
|
| Rate for Payer: BCN Medicare Advantage |
$36.56
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cofinity Commercial |
$125.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.56
|
| Rate for Payer: Healthscope Commercial |
$131.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.69
|
| Rate for Payer: Mclaren Medicaid |
$25.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.39
|
| Rate for Payer: Meridian Medicaid |
$27.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.31
|
| Rate for Payer: Nomi Health Commercial |
$119.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.69
|
| Rate for Payer: PACE Senior Care Partners |
$34.73
|
| Rate for Payer: PACE SWMI |
$36.56
|
| Rate for Payer: PHP Commercial |
$124.31
|
| Rate for Payer: PHP Medicare Advantage |
$36.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$127.24
|
| Rate for Payer: Priority Health Medicare |
$36.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.79
|
| Rate for Payer: Railroad Medicare Medicare |
$36.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.70
|
| Rate for Payer: UHC Core |
$122.12
|
| Rate for Payer: UHC Exchange |
$36.56
|
| Rate for Payer: UHC Medicaid |
$25.78
|
| Rate for Payer: UHC Medicare Advantage |
$36.56
|
| Rate for Payer: UHCCP Medicaid |
$25.78
|
| Rate for Payer: VA VA |
$36.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.69
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$839.72
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$584.45 |
| Max. Negotiated Rate |
$755.75 |
| Rate for Payer: Aetna Commercial |
$713.76
|
| Rate for Payer: BCBS Trust/PPO |
$693.52
|
| Rate for Payer: BCN Commercial |
$693.52
|
| Rate for Payer: Cash Price |
$671.78
|
| Rate for Payer: Cofinity Commercial |
$722.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.78
|
| Rate for Payer: Healthscope Commercial |
$755.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.76
|
| Rate for Payer: Nomi Health Commercial |
$688.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.79
|
| Rate for Payer: PHP Commercial |
$713.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$730.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$584.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.95
|
| Rate for Payer: UHC Core |
$701.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.79
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$839.72
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.04 |
| Max. Negotiated Rate |
$755.75 |
| Rate for Payer: Aetna Commercial |
$713.76
|
| Rate for Payer: Aetna Medicare |
$218.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.41
|
| Rate for Payer: BCBS Complete |
$155.43
|
| Rate for Payer: BCBS MAPPO |
$209.93
|
| Rate for Payer: BCBS Trust/PPO |
$690.33
|
| Rate for Payer: BCN Commercial |
$690.33
|
| Rate for Payer: BCN Medicare Advantage |
$209.93
|
| Rate for Payer: Cash Price |
$671.78
|
| Rate for Payer: Cofinity Commercial |
$722.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.93
|
| Rate for Payer: Healthscope Commercial |
$755.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.79
|
| Rate for Payer: Mclaren Medicaid |
$148.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.43
|
| Rate for Payer: Meridian Medicaid |
$155.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.76
|
| Rate for Payer: Nomi Health Commercial |
$688.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.79
|
| Rate for Payer: PACE Senior Care Partners |
$199.43
|
| Rate for Payer: PACE SWMI |
$209.93
|
| Rate for Payer: PHP Commercial |
$713.76
|
| Rate for Payer: PHP Medicare Advantage |
$209.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$730.56
|
| Rate for Payer: Priority Health Medicare |
$212.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$584.45
|
| Rate for Payer: Railroad Medicare Medicare |
$209.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.95
|
| Rate for Payer: UHC Core |
$701.17
|
| Rate for Payer: UHC Exchange |
$209.93
|
| Rate for Payer: UHC Medicaid |
$148.04
|
| Rate for Payer: UHC Medicare Advantage |
$209.93
|
| Rate for Payer: UHCCP Medicaid |
$148.04
|
| Rate for Payer: VA VA |
$209.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.79
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,679.41
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,168.87 |
| Max. Negotiated Rate |
$1,511.47 |
| Rate for Payer: Aetna Commercial |
$1,427.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.02
|
| Rate for Payer: BCN Commercial |
$1,387.02
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Commercial |
$1,444.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,511.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,259.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Nomi Health Commercial |
$1,377.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PHP Commercial |
$1,427.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,461.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,168.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.88
|
| Rate for Payer: UHC Core |
$1,402.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,259.56
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,679.41
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$296.08 |
| Max. Negotiated Rate |
$1,511.47 |
| Rate for Payer: Aetna Commercial |
$1,427.50
|
| Rate for Payer: Aetna Medicare |
$436.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$524.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$524.82
|
| Rate for Payer: BCBS Complete |
$310.86
|
| Rate for Payer: BCBS MAPPO |
$419.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.64
|
| Rate for Payer: BCN Commercial |
$1,380.64
|
| Rate for Payer: BCN Medicare Advantage |
$419.85
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Commercial |
$1,444.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.85
|
| Rate for Payer: Healthscope Commercial |
$1,511.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,259.56
|
| Rate for Payer: Mclaren Medicaid |
$296.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$440.85
|
| Rate for Payer: Meridian Medicaid |
$310.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$482.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$461.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Nomi Health Commercial |
$1,377.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PACE Senior Care Partners |
$398.86
|
| Rate for Payer: PACE SWMI |
$419.85
|
| Rate for Payer: PHP Commercial |
$1,427.50
|
| Rate for Payer: PHP Medicare Advantage |
$419.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,461.09
|
| Rate for Payer: Priority Health Medicare |
$424.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,168.87
|
| Rate for Payer: Railroad Medicare Medicare |
$419.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.88
|
| Rate for Payer: UHC Core |
$1,402.31
|
| Rate for Payer: UHC Exchange |
$419.85
|
| Rate for Payer: UHC Medicaid |
$296.08
|
| Rate for Payer: UHC Medicare Advantage |
$419.85
|
| Rate for Payer: UHCCP Medicaid |
$296.08
|
| Rate for Payer: VA VA |
$419.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,259.56
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$78.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.38
|
| Rate for Payer: BCBS Complete |
$55.90
|
| Rate for Payer: BCBS MAPPO |
$75.50
|
| Rate for Payer: BCBS Trust/PPO |
$248.29
|
| Rate for Payer: BCN Commercial |
$248.29
|
| Rate for Payer: BCN Medicare Advantage |
$75.50
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.50
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: Mclaren Medicaid |
$53.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.28
|
| Rate for Payer: Meridian Medicaid |
$55.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PACE Senior Care Partners |
$71.73
|
| Rate for Payer: PACE SWMI |
$75.50
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: PHP Medicare Advantage |
$75.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.76
|
| Rate for Payer: Priority Health Medicare |
$76.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.21
|
| Rate for Payer: Railroad Medicare Medicare |
$75.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.78
|
| Rate for Payer: UHC Core |
$252.19
|
| Rate for Payer: UHC Exchange |
$75.50
|
| Rate for Payer: UHC Medicaid |
$53.25
|
| Rate for Payer: UHC Medicare Advantage |
$75.50
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
| Rate for Payer: VA VA |
$75.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: BCBS Trust/PPO |
$249.44
|
| Rate for Payer: BCN Commercial |
$249.44
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.78
|
| Rate for Payer: UHC Core |
$252.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$78.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.38
|
| Rate for Payer: BCBS Complete |
$55.90
|
| Rate for Payer: BCBS MAPPO |
$75.50
|
| Rate for Payer: BCBS Trust/PPO |
$248.29
|
| Rate for Payer: BCN Commercial |
$248.29
|
| Rate for Payer: BCN Medicare Advantage |
$75.50
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.50
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: Mclaren Medicaid |
$53.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.28
|
| Rate for Payer: Meridian Medicaid |
$55.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PACE Senior Care Partners |
$71.73
|
| Rate for Payer: PACE SWMI |
$75.50
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: PHP Medicare Advantage |
$75.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.76
|
| Rate for Payer: Priority Health Medicare |
$76.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.21
|
| Rate for Payer: Railroad Medicare Medicare |
$75.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.78
|
| Rate for Payer: UHC Core |
$252.19
|
| Rate for Payer: UHC Exchange |
$75.50
|
| Rate for Payer: UHC Medicaid |
$53.25
|
| Rate for Payer: UHC Medicare Advantage |
$75.50
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
| Rate for Payer: VA VA |
$75.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.21 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: BCBS Trust/PPO |
$249.44
|
| Rate for Payer: BCN Commercial |
$249.44
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Nomi Health Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.78
|
| Rate for Payer: UHC Core |
$252.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.51
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$5.23
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Mclaren Medicaid |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PACE Senior Care Partners |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$670.21 |
| Max. Negotiated Rate |
$866.65 |
| Rate for Payer: Aetna Commercial |
$818.50
|
| Rate for Payer: BCBS Trust/PPO |
$795.29
|
| Rate for Payer: BCN Commercial |
$795.29
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cofinity Commercial |
$828.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.35
|
| Rate for Payer: Healthscope Commercial |
$866.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.50
|
| Rate for Payer: Nomi Health Commercial |
$789.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.21
|
| Rate for Payer: PHP Commercial |
$818.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$837.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$670.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.39
|
| Rate for Payer: UHC Core |
$804.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.21
|
|
