|
HC IN SITU HYBRID EA ADDL PROBE STAIN PER SPECIMEN
|
Facility
|
OP
|
$259.90
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
31000120
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$233.91 |
| Rate for Payer: Aetna Commercial |
$220.92
|
| Rate for Payer: Aetna Medicare |
$67.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.22
|
| Rate for Payer: BCBS Complete |
$103.96
|
| Rate for Payer: BCBS MAPPO |
$64.98
|
| Rate for Payer: BCBS Trust/PPO |
$202.07
|
| Rate for Payer: BCCCP Commercial |
$137.47
|
| Rate for Payer: BCN Commercial |
$202.07
|
| Rate for Payer: BCN Medicare Advantage |
$64.98
|
| Rate for Payer: Cash Price |
$207.92
|
| Rate for Payer: Cash Price |
$207.92
|
| Rate for Payer: Cofinity Commercial |
$223.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$233.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.92
|
| Rate for Payer: PACE Senior Care Partners |
$61.73
|
| Rate for Payer: PACE SWMI |
$64.98
|
| Rate for Payer: PHP Commercial |
$220.92
|
| Rate for Payer: PHP Medicare Advantage |
$64.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.11
|
| Rate for Payer: Priority Health Medicare |
$64.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.51
|
| Rate for Payer: Railroad Medicare Medicare |
$64.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.71
|
| Rate for Payer: UHC Core |
$217.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.98
|
| Rate for Payer: UHC Medicare Advantage |
$66.92
|
| Rate for Payer: VA VA |
$64.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.92
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
OP
|
$642.60
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$578.34 |
| Rate for Payer: Aetna Commercial |
$546.21
|
| Rate for Payer: Aetna Medicare |
$167.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.81
|
| Rate for Payer: BCBS Complete |
$117.65
|
| Rate for Payer: BCBS MAPPO |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$499.62
|
| Rate for Payer: BCCCP Commercial |
$398.07
|
| Rate for Payer: BCN Commercial |
$499.62
|
| Rate for Payer: BCN Medicare Advantage |
$160.65
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$552.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.65
|
| Rate for Payer: Healthscope Commercial |
$578.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.95
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Medicaid |
$117.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$168.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.21
|
| Rate for Payer: PACE Senior Care Partners |
$152.62
|
| Rate for Payer: PACE SWMI |
$160.65
|
| Rate for Payer: PHP Commercial |
$546.21
|
| Rate for Payer: PHP Medicare Advantage |
$160.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.06
|
| Rate for Payer: Priority Health Medicare |
$160.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.92
|
| Rate for Payer: Railroad Medicare Medicare |
$160.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.49
|
| Rate for Payer: UHC Core |
$536.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.65
|
| Rate for Payer: UHC Medicare Advantage |
$165.47
|
| Rate for Payer: VA VA |
$160.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.95
|
|
|
HC IN SITU HYBRID MULTIPLX MRPH QUANT OR SEMI-QUANT
|
Facility
|
IP
|
$642.60
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
31000119
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$391.92 |
| Max. Negotiated Rate |
$578.34 |
| Rate for Payer: Aetna Commercial |
$546.21
|
| Rate for Payer: BCBS Trust/PPO |
$496.60
|
| Rate for Payer: BCN Commercial |
$496.60
|
| Rate for Payer: Cash Price |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$552.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.08
|
| Rate for Payer: Healthscope Commercial |
$578.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.21
|
| Rate for Payer: PHP Commercial |
$546.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.49
|
| Rate for Payer: UHC Core |
$536.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.95
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
IP
|
$731.89
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$446.38 |
| Max. Negotiated Rate |
$658.70 |
| Rate for Payer: Aetna Commercial |
$622.11
|
| Rate for Payer: BCBS Trust/PPO |
$565.60
|
| Rate for Payer: BCN Commercial |
$565.60
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cofinity Commercial |
$629.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.51
|
| Rate for Payer: Healthscope Commercial |
$658.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$622.11
|
| Rate for Payer: PHP Commercial |
$622.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$644.06
|
| Rate for Payer: UHC Core |
$611.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.92
|
|
|
HC INSTILL ANTICARCIN BLADDER
|
Facility
|
OP
|
$731.89
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
36100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.82 |
| Max. Negotiated Rate |
$658.70 |
| Rate for Payer: Aetna Commercial |
$622.11
|
| Rate for Payer: Aetna Medicare |
$190.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.72
|
| Rate for Payer: BCBS Complete |
$470.52
|
| Rate for Payer: BCBS MAPPO |
$182.97
|
| Rate for Payer: BCBS Trust/PPO |
$569.04
|
| Rate for Payer: BCN Commercial |
$569.04
|
| Rate for Payer: BCN Medicare Advantage |
$182.97
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cash Price |
$585.51
|
| Rate for Payer: Cofinity Commercial |
$629.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.97
|
| Rate for Payer: Healthscope Commercial |
$658.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.92
|
| Rate for Payer: Mclaren Medicaid |
$448.11
|
| Rate for Payer: Meridian Medicaid |
$470.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$192.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$622.11
|
| Rate for Payer: PACE Senior Care Partners |
$173.82
|
| Rate for Payer: PACE SWMI |
$182.97
|
| Rate for Payer: PHP Commercial |
$622.11
|
| Rate for Payer: PHP Medicare Advantage |
$182.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.74
|
| Rate for Payer: Priority Health Medicare |
$182.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.38
|
| Rate for Payer: Railroad Medicare Medicare |
$182.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$644.06
|
| Rate for Payer: UHC Core |
$611.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.97
|
| Rate for Payer: UHC Medicare Advantage |
$188.46
|
| Rate for Payer: VA VA |
$182.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.92
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
OP
|
$653.82
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$588.44 |
| Rate for Payer: Aetna Commercial |
$555.75
|
| Rate for Payer: Aetna Medicare |
$169.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.32
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$163.46
|
| Rate for Payer: BCBS Trust/PPO |
$508.35
|
| Rate for Payer: BCN Commercial |
$508.35
|
| Rate for Payer: BCN Medicare Advantage |
$163.46
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cofinity Commercial |
$562.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.46
|
| Rate for Payer: Healthscope Commercial |
$588.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.36
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$555.75
|
| Rate for Payer: PACE Senior Care Partners |
$155.28
|
| Rate for Payer: PACE SWMI |
$163.46
|
| Rate for Payer: PHP Commercial |
$555.75
|
| Rate for Payer: PHP Medicare Advantage |
$163.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$568.82
|
| Rate for Payer: Priority Health Medicare |
$163.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.76
|
| Rate for Payer: Railroad Medicare Medicare |
$163.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.36
|
| Rate for Payer: UHC Core |
$545.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.46
|
| Rate for Payer: UHC Medicare Advantage |
$168.36
|
| Rate for Payer: VA VA |
$163.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.36
|
|
|
HC INST THER AGENT RENAL PELVIS/URETER VIA TUB
|
Facility
|
IP
|
$653.82
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
36100571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$398.76 |
| Max. Negotiated Rate |
$588.44 |
| Rate for Payer: Aetna Commercial |
$555.75
|
| Rate for Payer: BCBS Trust/PPO |
$505.27
|
| Rate for Payer: BCN Commercial |
$505.27
|
| Rate for Payer: Cash Price |
$523.06
|
| Rate for Payer: Cofinity Commercial |
$562.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.06
|
| Rate for Payer: Healthscope Commercial |
$588.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$555.75
|
| Rate for Payer: PHP Commercial |
$555.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$568.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.36
|
| Rate for Payer: UHC Core |
$545.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.36
|
|
|
HC INSULIN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$25.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.62
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS MAPPO |
$24.50
|
| Rate for Payer: BCBS Trust/PPO |
$76.20
|
| Rate for Payer: BCN Commercial |
$76.20
|
| Rate for Payer: BCN Medicare Advantage |
$24.50
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.50
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Mclaren Medicaid |
$8.44
|
| Rate for Payer: Meridian Medicaid |
$8.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Senior Care Partners |
$23.28
|
| Rate for Payer: PACE SWMI |
$24.50
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: PHP Medicare Advantage |
$24.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Medicare |
$24.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.77
|
| Rate for Payer: Railroad Medicare Medicare |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.24
|
| Rate for Payer: UHC Core |
$81.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.24
|
| Rate for Payer: VA VA |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
HC INSULIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.77 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: BCBS Trust/PPO |
$75.73
|
| Rate for Payer: BCN Commercial |
$75.73
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.24
|
| Rate for Payer: UHC Core |
$81.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: BCBS Trust/PPO |
$52.55
|
| Rate for Payer: BCN Commercial |
$52.55
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.25
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: BCBS MAPPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$52.87
|
| Rate for Payer: BCN Commercial |
$52.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Mclaren Medicaid |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$16.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Senior Care Partners |
$16.15
|
| Rate for Payer: PACE SWMI |
$17.00
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Medicare |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$17.51
|
| Rate for Payer: VA VA |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$12.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.30
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$38.07
|
| Rate for Payer: BCN Commercial |
$38.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.24
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Senior Care Partners |
$11.63
|
| Rate for Payer: PACE SWMI |
$12.24
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$12.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.60
|
| Rate for Payer: Priority Health Medicare |
$12.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$40.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.61
|
| Rate for Payer: VA VA |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$37.84
|
| Rate for Payer: BCN Commercial |
$37.84
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$40.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$186.06
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna Medicare |
$48.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.14
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS MAPPO |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$144.66
|
| Rate for Payer: BCN Commercial |
$144.66
|
| Rate for Payer: BCN Medicare Advantage |
$46.52
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.52
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PACE Senior Care Partners |
$44.19
|
| Rate for Payer: PACE SWMI |
$46.52
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: PHP Medicare Advantage |
$46.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.87
|
| Rate for Payer: Priority Health Medicare |
$46.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.48
|
| Rate for Payer: Railroad Medicare Medicare |
$46.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.73
|
| Rate for Payer: UHC Core |
$155.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.52
|
| Rate for Payer: UHC Medicare Advantage |
$47.91
|
| Rate for Payer: VA VA |
$46.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$186.06
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$113.48 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: BCBS Trust/PPO |
$143.79
|
| Rate for Payer: BCN Commercial |
$143.79
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.73
|
| Rate for Payer: UHC Core |
$155.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,162.39
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.94 |
| Max. Negotiated Rate |
$1,046.15 |
| Rate for Payer: Aetna Commercial |
$988.03
|
| Rate for Payer: BCBS Trust/PPO |
$898.29
|
| Rate for Payer: BCN Commercial |
$898.29
|
| Rate for Payer: Cash Price |
$929.91
|
| Rate for Payer: Cofinity Commercial |
$999.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.91
|
| Rate for Payer: Healthscope Commercial |
$1,046.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$988.03
|
| Rate for Payer: PHP Commercial |
$988.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,011.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$708.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.90
|
| Rate for Payer: UHC Core |
$970.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.79
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,162.39
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.07 |
| Max. Negotiated Rate |
$1,046.15 |
| Rate for Payer: Aetna Commercial |
$988.03
|
| Rate for Payer: Aetna Medicare |
$302.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$363.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$363.25
|
| Rate for Payer: BCBS Complete |
$464.96
|
| Rate for Payer: BCBS MAPPO |
$290.60
|
| Rate for Payer: BCBS Trust/PPO |
$903.76
|
| Rate for Payer: BCN Commercial |
$903.76
|
| Rate for Payer: BCN Medicare Advantage |
$290.60
|
| Rate for Payer: Cash Price |
$929.91
|
| Rate for Payer: Cofinity Commercial |
$999.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.60
|
| Rate for Payer: Healthscope Commercial |
$1,046.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$305.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$988.03
|
| Rate for Payer: PACE Senior Care Partners |
$276.07
|
| Rate for Payer: PACE SWMI |
$290.60
|
| Rate for Payer: PHP Commercial |
$988.03
|
| Rate for Payer: PHP Medicare Advantage |
$290.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,011.28
|
| Rate for Payer: Priority Health Medicare |
$290.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$708.94
|
| Rate for Payer: Railroad Medicare Medicare |
$290.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.90
|
| Rate for Payer: UHC Core |
$970.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.60
|
| Rate for Payer: UHC Medicare Advantage |
$299.32
|
| Rate for Payer: VA VA |
$290.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.79
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: BCBS Trust/PPO |
$99.69
|
| Rate for Payer: BCN Commercial |
$99.69
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.52
|
| Rate for Payer: UHC Core |
$107.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.75
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna Medicare |
$33.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.31
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$32.25
|
| Rate for Payer: BCBS Trust/PPO |
$100.30
|
| Rate for Payer: BCN Commercial |
$100.30
|
| Rate for Payer: BCN Medicare Advantage |
$32.25
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$110.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.25
|
| Rate for Payer: Healthscope Commercial |
$116.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.75
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PACE Senior Care Partners |
$30.64
|
| Rate for Payer: PACE SWMI |
$32.25
|
| Rate for Payer: PHP Commercial |
$109.65
|
| Rate for Payer: PHP Medicare Advantage |
$32.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.23
|
| Rate for Payer: Priority Health Medicare |
$32.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.68
|
| Rate for Payer: Railroad Medicare Medicare |
$32.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.52
|
| Rate for Payer: UHC Core |
$107.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.25
|
| Rate for Payer: UHC Medicare Advantage |
$33.22
|
| Rate for Payer: VA VA |
$32.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.75
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,800.09
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$4,080.08
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.51
|
| Rate for Payer: BCN Commercial |
$3,709.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$3,840.07
|
| Rate for Payer: Cash Price |
$3,840.07
|
| Rate for Payer: Cash Price |
$3,840.07
|
| Rate for Payer: Cofinity Commercial |
$4,128.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,840.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$4,320.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,600.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,080.08
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$4,080.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,176.08
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,927.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,224.08
|
| Rate for Payer: UHC Core |
$4,008.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,600.07
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$2,824.42
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$2,400.76
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.71
|
| Rate for Payer: BCN Commercial |
$2,182.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$2,259.54
|
| Rate for Payer: Cash Price |
$2,259.54
|
| Rate for Payer: Cash Price |
$2,259.54
|
| Rate for Payer: Cofinity Commercial |
$2,429.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,259.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$2,541.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,118.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,400.76
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$2,400.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,977.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,457.25
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,722.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,485.49
|
| Rate for Payer: UHC Core |
$2,358.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,118.32
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$526.32
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$473.69 |
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: Aetna Medicare |
$136.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.48
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$131.58
|
| Rate for Payer: BCBS Trust/PPO |
$409.21
|
| Rate for Payer: BCN Commercial |
$409.21
|
| Rate for Payer: BCN Medicare Advantage |
$131.58
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$452.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.58
|
| Rate for Payer: Healthscope Commercial |
$473.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.74
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.37
|
| Rate for Payer: PACE Senior Care Partners |
$125.00
|
| Rate for Payer: PACE SWMI |
$131.58
|
| Rate for Payer: PHP Commercial |
$447.37
|
| Rate for Payer: PHP Medicare Advantage |
$131.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.90
|
| Rate for Payer: Priority Health Medicare |
$131.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.00
|
| Rate for Payer: Railroad Medicare Medicare |
$131.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.16
|
| Rate for Payer: UHC Core |
$439.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.58
|
| Rate for Payer: UHC Medicare Advantage |
$135.53
|
| Rate for Payer: VA VA |
$131.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.74
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$526.32
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.00 |
| Max. Negotiated Rate |
$473.69 |
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: BCBS Trust/PPO |
$406.74
|
| Rate for Payer: BCN Commercial |
$406.74
|
| Rate for Payer: Cash Price |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$452.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.06
|
| Rate for Payer: Healthscope Commercial |
$473.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.37
|
| Rate for Payer: PHP Commercial |
$447.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.16
|
| Rate for Payer: UHC Core |
$439.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.74
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
OP
|
$1,851.36
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$439.70 |
| Max. Negotiated Rate |
$1,666.22 |
| Rate for Payer: Aetna Commercial |
$1,573.66
|
| Rate for Payer: Aetna Medicare |
$481.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$578.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$578.55
|
| Rate for Payer: BCBS Complete |
$740.54
|
| Rate for Payer: BCBS MAPPO |
$462.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.43
|
| Rate for Payer: BCN Commercial |
$1,439.43
|
| Rate for Payer: BCN Medicare Advantage |
$462.84
|
| Rate for Payer: Cash Price |
$1,481.09
|
| Rate for Payer: Cofinity Commercial |
$1,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.84
|
| Rate for Payer: Healthscope Commercial |
$1,666.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,388.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$485.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$532.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,573.66
|
| Rate for Payer: PACE Senior Care Partners |
$439.70
|
| Rate for Payer: PACE SWMI |
$462.84
|
| Rate for Payer: PHP Commercial |
$1,573.66
|
| Rate for Payer: PHP Medicare Advantage |
$462.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,610.68
|
| Rate for Payer: Priority Health Medicare |
$462.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.14
|
| Rate for Payer: Railroad Medicare Medicare |
$462.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,629.20
|
| Rate for Payer: UHC Core |
$1,545.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.84
|
| Rate for Payer: UHC Medicare Advantage |
$476.73
|
| Rate for Payer: VA VA |
$462.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,388.52
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
IP
|
$1,851.36
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,129.14 |
| Max. Negotiated Rate |
$1,666.22 |
| Rate for Payer: Aetna Commercial |
$1,573.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,430.73
|
| Rate for Payer: BCN Commercial |
$1,430.73
|
| Rate for Payer: Cash Price |
$1,481.09
|
| Rate for Payer: Cofinity Commercial |
$1,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.09
|
| Rate for Payer: Healthscope Commercial |
$1,666.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,388.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,573.66
|
| Rate for Payer: PHP Commercial |
$1,573.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,610.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,629.20
|
| Rate for Payer: UHC Core |
$1,545.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,388.52
|
|
