|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$866.65 |
| Rate for Payer: Aetna Commercial |
$818.50
|
| Rate for Payer: Aetna Medicare |
$250.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$300.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$300.92
|
| Rate for Payer: BCBS Complete |
$178.24
|
| Rate for Payer: BCBS MAPPO |
$240.74
|
| Rate for Payer: BCBS Trust/PPO |
$791.63
|
| Rate for Payer: BCN Commercial |
$791.63
|
| Rate for Payer: BCN Medicare Advantage |
$240.74
|
| 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: Health Alliance Plan Medicare Advantage |
$240.74
|
| Rate for Payer: Healthscope Commercial |
$866.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.21
|
| Rate for Payer: Mclaren Medicaid |
$169.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.77
|
| Rate for Payer: Meridian Medicaid |
$178.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$264.81
|
| 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: PACE Senior Care Partners |
$228.70
|
| Rate for Payer: PACE SWMI |
$240.74
|
| Rate for Payer: PHP Commercial |
$818.50
|
| Rate for Payer: PHP Medicare Advantage |
$240.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$837.76
|
| Rate for Payer: Priority Health Medicare |
$243.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$670.21
|
| Rate for Payer: Railroad Medicare Medicare |
$240.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.39
|
| Rate for Payer: UHC Core |
$804.05
|
| Rate for Payer: UHC Exchange |
$240.74
|
| Rate for Payer: UHC Medicaid |
$169.77
|
| Rate for Payer: UHC Medicare Advantage |
$240.74
|
| Rate for Payer: UHCCP Medicaid |
$169.77
|
| Rate for Payer: VA VA |
$240.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.21
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,309.16
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$4,778.24 |
| Rate for Payer: Aetna Commercial |
$4,512.79
|
| Rate for Payer: Aetna Medicare |
$1,380.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,659.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,659.11
|
| Rate for Payer: BCBS Complete |
$982.73
|
| Rate for Payer: BCBS MAPPO |
$1,327.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,364.66
|
| Rate for Payer: BCN Commercial |
$4,364.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,327.29
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cofinity Commercial |
$4,565.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,247.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,327.29
|
| Rate for Payer: Healthscope Commercial |
$4,778.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,981.87
|
| Rate for Payer: Mclaren Medicaid |
$936.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,393.65
|
| Rate for Payer: Meridian Medicaid |
$982.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,526.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,460.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,512.79
|
| Rate for Payer: Nomi Health Commercial |
$4,353.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,981.87
|
| Rate for Payer: PACE Senior Care Partners |
$1,260.93
|
| Rate for Payer: PACE SWMI |
$1,327.29
|
| Rate for Payer: PHP Commercial |
$4,512.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,327.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$936.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,618.97
|
| Rate for Payer: Priority Health Medicare |
$1,340.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,695.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,327.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,672.06
|
| Rate for Payer: UHC Core |
$4,433.15
|
| Rate for Payer: UHC Exchange |
$1,327.29
|
| Rate for Payer: UHC Medicaid |
$936.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,327.29
|
| Rate for Payer: UHCCP Medicaid |
$936.00
|
| Rate for Payer: VA VA |
$1,327.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,981.87
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,309.16
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,695.18 |
| Max. Negotiated Rate |
$4,778.24 |
| Rate for Payer: Aetna Commercial |
$4,512.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,384.84
|
| Rate for Payer: BCN Commercial |
$4,384.84
|
| Rate for Payer: Cash Price |
$4,247.33
|
| Rate for Payer: Cofinity Commercial |
$4,565.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,247.33
|
| Rate for Payer: Healthscope Commercial |
$4,778.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,981.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,512.79
|
| Rate for Payer: Nomi Health Commercial |
$4,353.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,981.87
|
| Rate for Payer: PHP Commercial |
$4,512.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,618.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,695.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,672.06
|
| Rate for Payer: UHC Core |
$4,433.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,981.87
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$853.94
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$150.55 |
| Max. Negotiated Rate |
$768.55 |
| Rate for Payer: Aetna Commercial |
$725.85
|
| Rate for Payer: Aetna Medicare |
$222.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$266.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$266.86
|
| Rate for Payer: BCBS Complete |
$158.06
|
| Rate for Payer: BCBS MAPPO |
$213.49
|
| Rate for Payer: BCBS Trust/PPO |
$702.02
|
| Rate for Payer: BCN Commercial |
$702.02
|
| Rate for Payer: BCN Medicare Advantage |
$213.49
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cofinity Commercial |
$734.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.49
|
| Rate for Payer: Healthscope Commercial |
$768.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.46
|
| Rate for Payer: Mclaren Medicaid |
$150.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.16
|
| Rate for Payer: Meridian Medicaid |
$158.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$234.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.85
|
| Rate for Payer: Nomi Health Commercial |
$700.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.46
|
| Rate for Payer: PACE Senior Care Partners |
$202.81
|
| Rate for Payer: PACE SWMI |
$213.49
|
| Rate for Payer: PHP Commercial |
$725.85
|
| Rate for Payer: PHP Medicare Advantage |
$213.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$742.93
|
| Rate for Payer: Priority Health Medicare |
$215.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.34
|
| Rate for Payer: Railroad Medicare Medicare |
$213.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.47
|
| Rate for Payer: UHC Core |
$713.04
|
| Rate for Payer: UHC Exchange |
$213.49
|
| Rate for Payer: UHC Medicaid |
$150.55
|
| Rate for Payer: UHC Medicare Advantage |
$213.49
|
| Rate for Payer: UHCCP Medicaid |
$150.55
|
| Rate for Payer: VA VA |
$213.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.46
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$853.94
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$594.34 |
| Max. Negotiated Rate |
$768.55 |
| Rate for Payer: Aetna Commercial |
$725.85
|
| Rate for Payer: BCBS Trust/PPO |
$705.27
|
| Rate for Payer: BCN Commercial |
$705.27
|
| Rate for Payer: Cash Price |
$683.15
|
| Rate for Payer: Cofinity Commercial |
$734.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.15
|
| Rate for Payer: Healthscope Commercial |
$768.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.85
|
| Rate for Payer: Nomi Health Commercial |
$700.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.46
|
| Rate for Payer: PHP Commercial |
$725.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$742.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.47
|
| Rate for Payer: UHC Core |
$713.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.46
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$249.83
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: Aetna Medicare |
$64.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.07
|
| Rate for Payer: BCBS Complete |
$46.24
|
| Rate for Payer: BCBS MAPPO |
$62.46
|
| Rate for Payer: BCBS Trust/PPO |
$205.39
|
| Rate for Payer: BCN Commercial |
$205.39
|
| Rate for Payer: BCN Medicare Advantage |
$62.46
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.46
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.37
|
| Rate for Payer: Mclaren Medicaid |
$44.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.58
|
| Rate for Payer: Meridian Medicaid |
$46.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$204.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PACE Senior Care Partners |
$59.33
|
| Rate for Payer: PACE SWMI |
$62.46
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: PHP Medicare Advantage |
$62.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.35
|
| Rate for Payer: Priority Health Medicare |
$63.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$62.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.85
|
| Rate for Payer: UHC Core |
$208.61
|
| Rate for Payer: UHC Exchange |
$62.46
|
| Rate for Payer: UHC Medicaid |
$44.05
|
| Rate for Payer: UHC Medicare Advantage |
$62.46
|
| Rate for Payer: UHCCP Medicaid |
$44.05
|
| Rate for Payer: VA VA |
$62.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.37
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$249.83
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$212.36
|
| Rate for Payer: BCBS Trust/PPO |
$206.33
|
| Rate for Payer: BCN Commercial |
$206.33
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Commercial |
$214.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Healthscope Commercial |
$224.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$204.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PHP Commercial |
$212.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.85
|
| Rate for Payer: UHC Core |
$208.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.37
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$598.12
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$538.31 |
| Rate for Payer: Aetna Commercial |
$508.40
|
| Rate for Payer: Aetna Medicare |
$155.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.91
|
| Rate for Payer: BCBS Complete |
$110.71
|
| Rate for Payer: BCBS MAPPO |
$149.53
|
| Rate for Payer: BCBS Trust/PPO |
$491.71
|
| Rate for Payer: BCN Commercial |
$491.71
|
| Rate for Payer: BCN Medicare Advantage |
$149.53
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cofinity Commercial |
$514.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.53
|
| Rate for Payer: Healthscope Commercial |
$538.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.59
|
| Rate for Payer: Mclaren Medicaid |
$105.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.01
|
| Rate for Payer: Meridian Medicaid |
$110.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$164.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.40
|
| Rate for Payer: Nomi Health Commercial |
$490.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.59
|
| Rate for Payer: PACE Senior Care Partners |
$142.05
|
| Rate for Payer: PACE SWMI |
$149.53
|
| Rate for Payer: PHP Commercial |
$508.40
|
| Rate for Payer: PHP Medicare Advantage |
$149.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$520.36
|
| Rate for Payer: Priority Health Medicare |
$151.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.29
|
| Rate for Payer: Railroad Medicare Medicare |
$149.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.35
|
| Rate for Payer: UHC Core |
$499.43
|
| Rate for Payer: UHC Exchange |
$149.53
|
| Rate for Payer: UHC Medicaid |
$105.45
|
| Rate for Payer: UHC Medicare Advantage |
$149.53
|
| Rate for Payer: UHCCP Medicaid |
$105.45
|
| Rate for Payer: VA VA |
$149.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.59
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$598.12
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.29 |
| Max. Negotiated Rate |
$538.31 |
| Rate for Payer: Aetna Commercial |
$508.40
|
| Rate for Payer: BCBS Trust/PPO |
$493.99
|
| Rate for Payer: BCN Commercial |
$493.99
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cofinity Commercial |
$514.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.50
|
| Rate for Payer: Healthscope Commercial |
$538.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.40
|
| Rate for Payer: Nomi Health Commercial |
$490.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.59
|
| Rate for Payer: PHP Commercial |
$508.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$520.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.35
|
| Rate for Payer: UHC Core |
$499.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.59
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$573.10
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.88 |
| Max. Negotiated Rate |
$515.79 |
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: BCBS Trust/PPO |
$473.32
|
| Rate for Payer: BCN Commercial |
$473.32
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cofinity Commercial |
$492.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.48
|
| Rate for Payer: Healthscope Commercial |
$515.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.13
|
| Rate for Payer: Nomi Health Commercial |
$469.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.82
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.33
|
| Rate for Payer: UHC Core |
$478.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$573.10
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.04 |
| Max. Negotiated Rate |
$515.79 |
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: Aetna Medicare |
$149.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.09
|
| Rate for Payer: BCBS Complete |
$106.08
|
| Rate for Payer: BCBS MAPPO |
$143.28
|
| Rate for Payer: BCBS Trust/PPO |
$471.15
|
| Rate for Payer: BCN Commercial |
$471.15
|
| Rate for Payer: BCN Medicare Advantage |
$143.28
|
| Rate for Payer: Cash Price |
$458.48
|
| Rate for Payer: Cofinity Commercial |
$492.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.28
|
| Rate for Payer: Healthscope Commercial |
$515.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Mclaren Medicaid |
$101.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.44
|
| Rate for Payer: Meridian Medicaid |
$106.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.13
|
| Rate for Payer: Nomi Health Commercial |
$469.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.82
|
| Rate for Payer: PACE Senior Care Partners |
$136.11
|
| Rate for Payer: PACE SWMI |
$143.28
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: PHP Medicare Advantage |
$143.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.60
|
| Rate for Payer: Priority Health Medicare |
$144.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.88
|
| Rate for Payer: Railroad Medicare Medicare |
$143.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.33
|
| Rate for Payer: UHC Core |
$478.54
|
| Rate for Payer: UHC Exchange |
$143.28
|
| Rate for Payer: UHC Medicaid |
$101.04
|
| Rate for Payer: UHC Medicare Advantage |
$143.28
|
| Rate for Payer: UHCCP Medicaid |
$101.04
|
| Rate for Payer: VA VA |
$143.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
IP
|
$87.27
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.74 |
| Max. Negotiated Rate |
$78.54 |
| Rate for Payer: Aetna Commercial |
$74.18
|
| Rate for Payer: BCBS Trust/PPO |
$72.08
|
| Rate for Payer: BCN Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cofinity Commercial |
$75.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.18
|
| Rate for Payer: Nomi Health Commercial |
$71.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.45
|
| Rate for Payer: PHP Commercial |
$74.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.80
|
| Rate for Payer: UHC Core |
$72.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.45
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
OP
|
$87.27
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$78.54 |
| Rate for Payer: Aetna Commercial |
$74.18
|
| Rate for Payer: Aetna Medicare |
$22.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.27
|
| Rate for Payer: BCBS Complete |
$16.15
|
| Rate for Payer: BCBS MAPPO |
$21.82
|
| Rate for Payer: BCBS Trust/PPO |
$71.74
|
| Rate for Payer: BCN Commercial |
$71.74
|
| Rate for Payer: BCN Medicare Advantage |
$21.82
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: Cofinity Commercial |
$75.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.82
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.45
|
| Rate for Payer: Mclaren Medicaid |
$15.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.91
|
| Rate for Payer: Meridian Medicaid |
$16.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.18
|
| Rate for Payer: Nomi Health Commercial |
$71.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.45
|
| Rate for Payer: PACE Senior Care Partners |
$20.73
|
| Rate for Payer: PACE SWMI |
$21.82
|
| Rate for Payer: PHP Commercial |
$74.18
|
| Rate for Payer: PHP Medicare Advantage |
$21.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.92
|
| Rate for Payer: Priority Health Medicare |
$22.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.74
|
| Rate for Payer: Railroad Medicare Medicare |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.80
|
| Rate for Payer: UHC Core |
$72.87
|
| Rate for Payer: UHC Exchange |
$21.82
|
| Rate for Payer: UHC Medicaid |
$15.39
|
| Rate for Payer: UHC Medicare Advantage |
$21.82
|
| Rate for Payer: UHCCP Medicaid |
$15.39
|
| Rate for Payer: VA VA |
$21.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.45
|
|
|
HC DES ADD.BRANCH
|
Facility
|
IP
|
$17,350.78
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,076.14 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: BCBS Trust/PPO |
$14,330.01
|
| Rate for Payer: BCN Commercial |
$14,330.01
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,013.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Nomi Health Commercial |
$14,227.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15,095.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,076.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,268.69
|
| Rate for Payer: UHC Core |
$14,487.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,013.08
|
|
|
HC DES ADD.BRANCH
|
Facility
|
OP
|
$17,350.78
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,058.94 |
| Max. Negotiated Rate |
$15,615.70 |
| Rate for Payer: Aetna Commercial |
$14,748.16
|
| Rate for Payer: Aetna Medicare |
$4,511.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,422.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,422.12
|
| Rate for Payer: BCBS Complete |
$3,211.63
|
| Rate for Payer: BCBS MAPPO |
$4,337.69
|
| Rate for Payer: BCBS Trust/PPO |
$14,264.08
|
| Rate for Payer: BCN Commercial |
$14,264.08
|
| Rate for Payer: BCN Medicare Advantage |
$4,337.69
|
| Rate for Payer: Cash Price |
$13,880.62
|
| Rate for Payer: Cofinity Commercial |
$14,921.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,880.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,337.69
|
| Rate for Payer: Healthscope Commercial |
$15,615.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,013.08
|
| Rate for Payer: Mclaren Medicaid |
$3,058.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,554.58
|
| Rate for Payer: Meridian Medicaid |
$3,211.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,988.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,771.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,748.16
|
| Rate for Payer: Nomi Health Commercial |
$14,227.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,013.08
|
| Rate for Payer: PACE Senior Care Partners |
$4,120.81
|
| Rate for Payer: PACE SWMI |
$4,337.69
|
| Rate for Payer: PHP Commercial |
$14,748.16
|
| Rate for Payer: PHP Medicare Advantage |
$4,337.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,058.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15,095.18
|
| Rate for Payer: Priority Health Medicare |
$4,381.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,076.14
|
| Rate for Payer: Railroad Medicare Medicare |
$4,337.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,268.69
|
| Rate for Payer: UHC Core |
$14,487.90
|
| Rate for Payer: UHC Exchange |
$4,337.69
|
| Rate for Payer: UHC Medicaid |
$3,058.94
|
| Rate for Payer: UHC Medicare Advantage |
$4,337.69
|
| Rate for Payer: UHCCP Medicaid |
$3,058.94
|
| Rate for Payer: VA VA |
$4,337.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,013.08
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
IP
|
$8,271.18
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,756.74 |
| Max. Negotiated Rate |
$7,444.06 |
| Rate for Payer: Aetna Commercial |
$7,030.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,831.17
|
| Rate for Payer: BCN Commercial |
$6,831.17
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cofinity Commercial |
$7,113.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,616.94
|
| Rate for Payer: Healthscope Commercial |
$7,444.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,203.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,030.50
|
| Rate for Payer: Nomi Health Commercial |
$6,782.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,203.39
|
| Rate for Payer: PHP Commercial |
$7,030.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,195.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,756.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,278.64
|
| Rate for Payer: UHC Core |
$6,906.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,203.39
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
OP
|
$8,271.18
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,458.21 |
| Max. Negotiated Rate |
$7,444.06 |
| Rate for Payer: Aetna Commercial |
$7,030.50
|
| Rate for Payer: Aetna Medicare |
$2,150.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,584.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,584.74
|
| Rate for Payer: BCBS Complete |
$1,531.00
|
| Rate for Payer: BCBS MAPPO |
$2,067.80
|
| Rate for Payer: BCBS Trust/PPO |
$6,799.74
|
| Rate for Payer: BCN Commercial |
$6,799.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,067.80
|
| Rate for Payer: Cash Price |
$6,616.94
|
| Rate for Payer: Cofinity Commercial |
$7,113.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,616.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,067.80
|
| Rate for Payer: Healthscope Commercial |
$7,444.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,203.39
|
| Rate for Payer: Mclaren Medicaid |
$1,458.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,171.18
|
| Rate for Payer: Meridian Medicaid |
$1,531.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,377.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,274.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,030.50
|
| Rate for Payer: Nomi Health Commercial |
$6,782.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,203.39
|
| Rate for Payer: PACE Senior Care Partners |
$1,964.41
|
| Rate for Payer: PACE SWMI |
$2,067.80
|
| Rate for Payer: PHP Commercial |
$7,030.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,067.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,458.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,195.93
|
| Rate for Payer: Priority Health Medicare |
$2,088.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,756.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2,067.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,278.64
|
| Rate for Payer: UHC Core |
$6,906.44
|
| Rate for Payer: UHC Exchange |
$2,067.80
|
| Rate for Payer: UHC Medicaid |
$1,458.21
|
| Rate for Payer: UHC Medicare Advantage |
$2,067.80
|
| Rate for Payer: UHCCP Medicaid |
$1,458.21
|
| Rate for Payer: VA VA |
$2,067.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,203.39
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
OP
|
$247.47
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.63 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$210.35
|
| Rate for Payer: Aetna Medicare |
$64.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.33
|
| Rate for Payer: BCBS Complete |
$45.81
|
| Rate for Payer: BCBS MAPPO |
$61.87
|
| Rate for Payer: BCBS Trust/PPO |
$203.45
|
| Rate for Payer: BCN Commercial |
$203.45
|
| Rate for Payer: BCN Medicare Advantage |
$61.87
|
| Rate for Payer: Cash Price |
$197.98
|
| Rate for Payer: Cofinity Commercial |
$212.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.87
|
| Rate for Payer: Healthscope Commercial |
$222.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.60
|
| Rate for Payer: Mclaren Medicaid |
$43.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.96
|
| Rate for Payer: Meridian Medicaid |
$45.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.35
|
| Rate for Payer: Nomi Health Commercial |
$202.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.60
|
| Rate for Payer: PACE Senior Care Partners |
$58.77
|
| Rate for Payer: PACE SWMI |
$61.87
|
| Rate for Payer: PHP Commercial |
$210.35
|
| Rate for Payer: PHP Medicare Advantage |
$61.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.30
|
| Rate for Payer: Priority Health Medicare |
$62.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.24
|
| Rate for Payer: Railroad Medicare Medicare |
$61.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.77
|
| Rate for Payer: UHC Core |
$206.64
|
| Rate for Payer: UHC Exchange |
$61.87
|
| Rate for Payer: UHC Medicaid |
$43.63
|
| Rate for Payer: UHC Medicare Advantage |
$61.87
|
| Rate for Payer: UHCCP Medicaid |
$43.63
|
| Rate for Payer: VA VA |
$61.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.60
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
IP
|
$247.47
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.24 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$210.35
|
| Rate for Payer: BCBS Trust/PPO |
$204.39
|
| Rate for Payer: BCN Commercial |
$204.39
|
| Rate for Payer: Cash Price |
$197.98
|
| Rate for Payer: Cofinity Commercial |
$212.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.98
|
| Rate for Payer: Healthscope Commercial |
$222.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.35
|
| Rate for Payer: Nomi Health Commercial |
$202.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.60
|
| Rate for Payer: PHP Commercial |
$210.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$215.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.77
|
| Rate for Payer: UHC Core |
$206.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.60
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
OP
|
$400.07
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: Aetna Medicare |
$104.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.02
|
| Rate for Payer: BCBS Complete |
$74.05
|
| Rate for Payer: BCBS MAPPO |
$100.02
|
| Rate for Payer: BCBS Trust/PPO |
$328.90
|
| Rate for Payer: BCN Commercial |
$328.90
|
| Rate for Payer: BCN Medicare Advantage |
$100.02
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.02
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.05
|
| Rate for Payer: Mclaren Medicaid |
$70.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.02
|
| Rate for Payer: Meridian Medicaid |
$74.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.06
|
| Rate for Payer: Nomi Health Commercial |
$328.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.05
|
| Rate for Payer: PACE Senior Care Partners |
$95.02
|
| Rate for Payer: PACE SWMI |
$100.02
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: PHP Medicare Advantage |
$100.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.06
|
| Rate for Payer: Priority Health Medicare |
$101.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.45
|
| Rate for Payer: Railroad Medicare Medicare |
$100.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.06
|
| Rate for Payer: UHC Core |
$334.06
|
| Rate for Payer: UHC Exchange |
$100.02
|
| Rate for Payer: UHC Medicaid |
$70.53
|
| Rate for Payer: UHC Medicare Advantage |
$100.02
|
| Rate for Payer: UHCCP Medicaid |
$70.53
|
| Rate for Payer: VA VA |
$100.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.05
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
IP
|
$400.07
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.45 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: BCBS Trust/PPO |
$330.42
|
| Rate for Payer: BCN Commercial |
$330.42
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.06
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.06
|
| Rate for Payer: Nomi Health Commercial |
$328.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.05
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.06
|
| Rate for Payer: UHC Core |
$334.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.05
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
OP
|
$400.07
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: Aetna Medicare |
$104.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.02
|
| Rate for Payer: BCBS Complete |
$74.05
|
| Rate for Payer: BCBS MAPPO |
$100.02
|
| Rate for Payer: BCBS Trust/PPO |
$328.90
|
| Rate for Payer: BCN Commercial |
$328.90
|
| Rate for Payer: BCN Medicare Advantage |
$100.02
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.02
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.05
|
| Rate for Payer: Mclaren Medicaid |
$70.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.02
|
| Rate for Payer: Meridian Medicaid |
$74.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.06
|
| Rate for Payer: Nomi Health Commercial |
$328.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.05
|
| Rate for Payer: PACE Senior Care Partners |
$95.02
|
| Rate for Payer: PACE SWMI |
$100.02
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: PHP Medicare Advantage |
$100.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.06
|
| Rate for Payer: Priority Health Medicare |
$101.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.45
|
| Rate for Payer: Railroad Medicare Medicare |
$100.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.06
|
| Rate for Payer: UHC Core |
$334.06
|
| Rate for Payer: UHC Exchange |
$100.02
|
| Rate for Payer: UHC Medicaid |
$70.53
|
| Rate for Payer: UHC Medicare Advantage |
$100.02
|
| Rate for Payer: UHCCP Medicaid |
$70.53
|
| Rate for Payer: VA VA |
$100.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.05
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
IP
|
$400.07
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.45 |
| Max. Negotiated Rate |
$360.06 |
| Rate for Payer: Aetna Commercial |
$340.06
|
| Rate for Payer: BCBS Trust/PPO |
$330.42
|
| Rate for Payer: BCN Commercial |
$330.42
|
| Rate for Payer: Cash Price |
$320.06
|
| Rate for Payer: Cofinity Commercial |
$344.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.06
|
| Rate for Payer: Healthscope Commercial |
$360.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.06
|
| Rate for Payer: Nomi Health Commercial |
$328.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.05
|
| Rate for Payer: PHP Commercial |
$340.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.06
|
| Rate for Payer: UHC Core |
$334.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.05
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
OP
|
$614.44
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna Commercial |
$522.27
|
| Rate for Payer: Aetna Medicare |
$159.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.01
|
| Rate for Payer: BCBS Complete |
$113.73
|
| Rate for Payer: BCBS MAPPO |
$153.61
|
| Rate for Payer: BCBS Trust/PPO |
$505.13
|
| Rate for Payer: BCN Commercial |
$505.13
|
| Rate for Payer: BCN Medicare Advantage |
$153.61
|
| Rate for Payer: Cash Price |
$491.55
|
| Rate for Payer: Cofinity Commercial |
$528.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.61
|
| Rate for Payer: Healthscope Commercial |
$553.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.83
|
| Rate for Payer: Mclaren Medicaid |
$108.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.29
|
| Rate for Payer: Meridian Medicaid |
$113.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.27
|
| Rate for Payer: Nomi Health Commercial |
$503.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.83
|
| Rate for Payer: PACE Senior Care Partners |
$145.93
|
| Rate for Payer: PACE SWMI |
$153.61
|
| Rate for Payer: PHP Commercial |
$522.27
|
| Rate for Payer: PHP Medicare Advantage |
$153.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$534.56
|
| Rate for Payer: Priority Health Medicare |
$155.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.65
|
| Rate for Payer: Railroad Medicare Medicare |
$153.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.71
|
| Rate for Payer: UHC Core |
$513.06
|
| Rate for Payer: UHC Exchange |
$153.61
|
| Rate for Payer: UHC Medicaid |
$108.33
|
| Rate for Payer: UHC Medicare Advantage |
$153.61
|
| Rate for Payer: UHCCP Medicaid |
$108.33
|
| Rate for Payer: VA VA |
$153.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.83
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
IP
|
$614.44
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.65 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna Commercial |
$522.27
|
| Rate for Payer: BCBS Trust/PPO |
$507.47
|
| Rate for Payer: BCN Commercial |
$507.47
|
| Rate for Payer: Cash Price |
$491.55
|
| Rate for Payer: Cofinity Commercial |
$528.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.55
|
| Rate for Payer: Healthscope Commercial |
$553.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.27
|
| Rate for Payer: Nomi Health Commercial |
$503.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.83
|
| Rate for Payer: PHP Commercial |
$522.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$534.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.71
|
| Rate for Payer: UHC Core |
$513.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.83
|
|
