|
HC D & C
|
Facility
|
OP
|
$2,041.41
|
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.83 |
| Max. Negotiated Rate |
$1,837.27 |
| Rate for Payer: Aetna Commercial |
$1,735.20
|
| Rate for Payer: Aetna Medicare |
$530.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$637.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$637.94
|
| Rate for Payer: BCBS Complete |
$816.56
|
| Rate for Payer: BCBS MAPPO |
$510.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,678.24
|
| Rate for Payer: BCN Commercial |
$1,587.20
|
| Rate for Payer: BCN Medicare Advantage |
$510.35
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,755.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.35
|
| Rate for Payer: Healthscope Commercial |
$1,837.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,531.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$586.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: Nomi Health Commercial |
$1,673.96
|
| Rate for Payer: PACE Senior Care Partners |
$484.83
|
| Rate for Payer: PACE SWMI |
$510.35
|
| Rate for Payer: PHP Commercial |
$1,735.20
|
| Rate for Payer: PHP Medicare Advantage |
$510.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: Priority Health HMO/PPO |
$1,776.03
|
| Rate for Payer: Priority Health Medicare |
$515.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,367.74
|
| Rate for Payer: Railroad Medicare Medicare |
$510.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,796.44
|
| Rate for Payer: UHC Core |
$1,704.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.35
|
| Rate for Payer: UHC Exchange |
$510.35
|
| Rate for Payer: UHC Medicare Advantage |
$510.35
|
| Rate for Payer: VA VA |
$510.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,531.06
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
OP
|
$1,051.40
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$249.71 |
| Max. Negotiated Rate |
$946.26 |
| Rate for Payer: Aetna Commercial |
$893.69
|
| Rate for Payer: Aetna Medicare |
$273.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$328.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$328.56
|
| Rate for Payer: BCBS Complete |
$420.56
|
| Rate for Payer: BCBS MAPPO |
$262.85
|
| Rate for Payer: BCBS Trust/PPO |
$864.36
|
| Rate for Payer: BCN Commercial |
$817.46
|
| Rate for Payer: BCN Medicare Advantage |
$262.85
|
| Rate for Payer: Cash Price |
$841.12
|
| Rate for Payer: Cofinity Commercial |
$904.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.85
|
| Rate for Payer: Healthscope Commercial |
$946.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$788.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$893.69
|
| Rate for Payer: Nomi Health Commercial |
$862.15
|
| Rate for Payer: PACE Senior Care Partners |
$249.71
|
| Rate for Payer: PACE SWMI |
$262.85
|
| Rate for Payer: PHP Commercial |
$893.69
|
| Rate for Payer: PHP Medicare Advantage |
$262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.41
|
| Rate for Payer: Priority Health HMO/PPO |
$914.72
|
| Rate for Payer: Priority Health Medicare |
$265.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$704.44
|
| Rate for Payer: Railroad Medicare Medicare |
$262.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.23
|
| Rate for Payer: UHC Core |
$877.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.85
|
| Rate for Payer: UHC Exchange |
$262.85
|
| Rate for Payer: UHC Medicare Advantage |
$262.85
|
| Rate for Payer: VA VA |
$262.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$788.55
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
IP
|
$1,051.40
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.41 |
| Max. Negotiated Rate |
$946.26 |
| Rate for Payer: Aetna Commercial |
$893.69
|
| Rate for Payer: BCBS Trust/PPO |
$858.26
|
| Rate for Payer: BCN Commercial |
$812.52
|
| Rate for Payer: Cash Price |
$841.12
|
| Rate for Payer: Cofinity Commercial |
$904.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.12
|
| Rate for Payer: Healthscope Commercial |
$946.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$788.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$893.69
|
| Rate for Payer: Nomi Health Commercial |
$862.15
|
| Rate for Payer: PHP Commercial |
$893.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.41
|
| Rate for Payer: Priority Health HMO/PPO |
$914.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$704.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.23
|
| Rate for Payer: UHC Core |
$877.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$788.55
|
|
|
HC D & C POSTPARTUM
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,887.06 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna Medicare |
$2,065.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,482.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,482.98
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$1,986.38
|
| Rate for Payer: BCBS Trust/PPO |
$6,532.02
|
| Rate for Payer: BCN Commercial |
$6,177.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,986.38
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,986.38
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.15
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,085.70
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,284.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PACE Senior Care Partners |
$1,887.06
|
| Rate for Payer: PACE SWMI |
$1,986.38
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,986.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO |
$6,912.61
|
| Rate for Payer: Priority Health Medicare |
$2,006.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,323.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,986.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,992.07
|
| Rate for Payer: UHC Core |
$6,634.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,986.38
|
| Rate for Payer: UHC Exchange |
$1,986.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,986.38
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$1,986.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.15
|
|
|
HC D & C POSTPARTUM
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,164.59 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: BCBS Trust/PPO |
$6,485.94
|
| Rate for Payer: BCN Commercial |
$6,140.31
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO |
$6,912.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,323.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,992.07
|
| Rate for Payer: UHC Core |
$6,634.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.15
|
|
|
HC DDAVP CMPT1
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.03
|
| Rate for Payer: BCBS Complete |
$17.42
|
| Rate for Payer: BCBS MAPPO |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.64
|
| Rate for Payer: BCN Commercial |
$29.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.62
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Mclaren Medicaid |
$16.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.10
|
| Rate for Payer: Meridian Medicaid |
$17.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PACE Senior Care Partners |
$9.14
|
| Rate for Payer: PACE SWMI |
$9.62
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Medicare Advantage |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.62
|
| Rate for Payer: UHC Exchange |
$9.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$16.59
|
| Rate for Payer: VA VA |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC DDAVP CMPT1
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.42
|
| Rate for Payer: BCN Commercial |
$29.75
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC DDAVP CMPT2
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.03
|
| Rate for Payer: BCBS Complete |
$17.42
|
| Rate for Payer: BCBS MAPPO |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.64
|
| Rate for Payer: BCN Commercial |
$29.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.62
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Mclaren Medicaid |
$16.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.10
|
| Rate for Payer: Meridian Medicaid |
$17.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PACE Senior Care Partners |
$9.14
|
| Rate for Payer: PACE SWMI |
$9.62
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Medicare Advantage |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.62
|
| Rate for Payer: UHC Exchange |
$9.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$16.59
|
| Rate for Payer: VA VA |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC DDAVP CMPT2
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.42
|
| Rate for Payer: BCN Commercial |
$29.75
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.03
|
| Rate for Payer: BCBS Complete |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.64
|
| Rate for Payer: BCN Commercial |
$29.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.62
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Mclaren Medicaid |
$12.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.10
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PACE Senior Care Partners |
$9.14
|
| Rate for Payer: PACE SWMI |
$9.62
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Medicare Advantage |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.62
|
| Rate for Payer: UHC Exchange |
$9.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$12.94
|
| Rate for Payer: VA VA |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.42
|
| Rate for Payer: BCN Commercial |
$29.75
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
IP
|
$124.64
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$112.18 |
| Rate for Payer: Aetna Commercial |
$105.94
|
| Rate for Payer: BCBS Trust/PPO |
$101.74
|
| Rate for Payer: BCN Commercial |
$96.32
|
| Rate for Payer: Cash Price |
$99.71
|
| Rate for Payer: Cofinity Commercial |
$107.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.71
|
| Rate for Payer: Healthscope Commercial |
$112.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.94
|
| Rate for Payer: Nomi Health Commercial |
$102.20
|
| Rate for Payer: PHP Commercial |
$105.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.02
|
| Rate for Payer: Priority Health HMO/PPO |
$108.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.68
|
| Rate for Payer: UHC Core |
$104.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.48
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
OP
|
$124.64
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$112.18 |
| Rate for Payer: Aetna Commercial |
$105.94
|
| Rate for Payer: Aetna Medicare |
$32.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.95
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$31.16
|
| Rate for Payer: BCBS Trust/PPO |
$102.47
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: BCN Medicare Advantage |
$31.16
|
| Rate for Payer: Cash Price |
$99.71
|
| Rate for Payer: Cash Price |
$99.71
|
| Rate for Payer: Cofinity Commercial |
$107.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.16
|
| Rate for Payer: Healthscope Commercial |
$112.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.48
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.72
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.94
|
| Rate for Payer: Nomi Health Commercial |
$102.20
|
| Rate for Payer: PACE Senior Care Partners |
$29.60
|
| Rate for Payer: PACE SWMI |
$31.16
|
| Rate for Payer: PHP Commercial |
$105.94
|
| Rate for Payer: PHP Medicare Advantage |
$31.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.02
|
| Rate for Payer: Priority Health HMO/PPO |
$108.44
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.51
|
| Rate for Payer: Railroad Medicare Medicare |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.68
|
| Rate for Payer: UHC Core |
$104.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.16
|
| Rate for Payer: UHC Exchange |
$31.16
|
| Rate for Payer: UHC Medicare Advantage |
$31.16
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$31.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.48
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$2,208.87
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.61 |
| Max. Negotiated Rate |
$1,987.98 |
| Rate for Payer: Aetna Commercial |
$1,877.54
|
| Rate for Payer: Aetna Medicare |
$574.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$690.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$690.27
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$552.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.91
|
| Rate for Payer: BCN Commercial |
$1,717.40
|
| Rate for Payer: BCN Medicare Advantage |
$552.22
|
| Rate for Payer: Cash Price |
$1,767.10
|
| Rate for Payer: Cash Price |
$1,767.10
|
| Rate for Payer: Cofinity Commercial |
$1,899.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.22
|
| Rate for Payer: Healthscope Commercial |
$1,987.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.65
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.83
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$635.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.54
|
| Rate for Payer: Nomi Health Commercial |
$1,811.27
|
| Rate for Payer: PACE Senior Care Partners |
$524.61
|
| Rate for Payer: PACE SWMI |
$552.22
|
| Rate for Payer: PHP Commercial |
$1,877.54
|
| Rate for Payer: PHP Medicare Advantage |
$552.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,921.72
|
| Rate for Payer: Priority Health Medicare |
$557.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,479.94
|
| Rate for Payer: Railroad Medicare Medicare |
$552.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,943.81
|
| Rate for Payer: UHC Core |
$1,844.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.22
|
| Rate for Payer: UHC Exchange |
$552.22
|
| Rate for Payer: UHC Medicare Advantage |
$552.22
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$552.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.65
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$2,208.87
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.77 |
| Max. Negotiated Rate |
$1,987.98 |
| Rate for Payer: Aetna Commercial |
$1,877.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.10
|
| Rate for Payer: BCN Commercial |
$1,707.01
|
| Rate for Payer: Cash Price |
$1,767.10
|
| Rate for Payer: Cofinity Commercial |
$1,899.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.10
|
| Rate for Payer: Healthscope Commercial |
$1,987.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,656.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,877.54
|
| Rate for Payer: Nomi Health Commercial |
$1,811.27
|
| Rate for Payer: PHP Commercial |
$1,877.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,921.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,479.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,943.81
|
| Rate for Payer: UHC Core |
$1,844.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,656.65
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
IP
|
$535.18
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.87 |
| Max. Negotiated Rate |
$481.66 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: BCBS Trust/PPO |
$436.87
|
| Rate for Payer: BCN Commercial |
$413.59
|
| Rate for Payer: Cash Price |
$428.14
|
| Rate for Payer: Cofinity Commercial |
$460.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.14
|
| Rate for Payer: Healthscope Commercial |
$481.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.90
|
| Rate for Payer: Nomi Health Commercial |
$438.85
|
| Rate for Payer: PHP Commercial |
$454.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.87
|
| Rate for Payer: Priority Health HMO/PPO |
$465.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.96
|
| Rate for Payer: UHC Core |
$446.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.38
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
OP
|
$535.18
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.11 |
| Max. Negotiated Rate |
$481.66 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Medicare |
$139.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.24
|
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: BCBS MAPPO |
$133.79
|
| Rate for Payer: BCBS Trust/PPO |
$439.97
|
| Rate for Payer: BCN Commercial |
$416.10
|
| Rate for Payer: BCN Medicare Advantage |
$133.79
|
| Rate for Payer: Cash Price |
$428.14
|
| Rate for Payer: Cash Price |
$428.14
|
| Rate for Payer: Cofinity Commercial |
$460.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.79
|
| Rate for Payer: Healthscope Commercial |
$481.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.38
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.48
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.90
|
| Rate for Payer: Nomi Health Commercial |
$438.85
|
| Rate for Payer: PACE Senior Care Partners |
$127.11
|
| Rate for Payer: PACE SWMI |
$133.79
|
| Rate for Payer: PHP Commercial |
$454.90
|
| Rate for Payer: PHP Medicare Advantage |
$133.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.87
|
| Rate for Payer: Priority Health HMO/PPO |
$465.61
|
| Rate for Payer: Priority Health Medicare |
$135.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.57
|
| Rate for Payer: Railroad Medicare Medicare |
$133.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.96
|
| Rate for Payer: UHC Core |
$446.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.79
|
| Rate for Payer: UHC Exchange |
$133.79
|
| Rate for Payer: UHC Medicare Advantage |
$133.79
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
| Rate for Payer: VA VA |
$133.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.38
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
IP
|
$1,342.32
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.51 |
| Max. Negotiated Rate |
$1,208.09 |
| Rate for Payer: Aetna Commercial |
$1,140.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,095.74
|
| Rate for Payer: BCN Commercial |
$1,037.34
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,154.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Healthscope Commercial |
$1,208.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: PHP Commercial |
$1,140.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,167.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$899.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.24
|
| Rate for Payer: UHC Core |
$1,120.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.74
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
OP
|
$1,342.32
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.80 |
| Max. Negotiated Rate |
$1,208.09 |
| Rate for Payer: Aetna Commercial |
$1,140.97
|
| Rate for Payer: Aetna Medicare |
$349.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$419.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$419.48
|
| Rate for Payer: BCBS Complete |
$386.62
|
| Rate for Payer: BCBS MAPPO |
$335.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.52
|
| Rate for Payer: BCN Commercial |
$1,043.65
|
| Rate for Payer: BCN Medicare Advantage |
$335.58
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cash Price |
$1,073.86
|
| Rate for Payer: Cofinity Commercial |
$1,154.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.58
|
| Rate for Payer: Healthscope Commercial |
$1,208.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.74
|
| Rate for Payer: Mclaren Medicaid |
$368.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.36
|
| Rate for Payer: Meridian Medicaid |
$386.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.97
|
| Rate for Payer: Nomi Health Commercial |
$1,100.70
|
| Rate for Payer: PACE Senior Care Partners |
$318.80
|
| Rate for Payer: PACE SWMI |
$335.58
|
| Rate for Payer: PHP Commercial |
$1,140.97
|
| Rate for Payer: PHP Medicare Advantage |
$335.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,167.82
|
| Rate for Payer: Priority Health Medicare |
$338.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$899.35
|
| Rate for Payer: Railroad Medicare Medicare |
$335.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.24
|
| Rate for Payer: UHC Core |
$1,120.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.58
|
| Rate for Payer: UHC Exchange |
$335.58
|
| Rate for Payer: UHC Medicare Advantage |
$335.58
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$335.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.74
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,657.20
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,077.18 |
| Max. Negotiated Rate |
$1,491.48 |
| Rate for Payer: Aetna Commercial |
$1,408.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.77
|
| Rate for Payer: BCN Commercial |
$1,280.68
|
| Rate for Payer: Cash Price |
$1,325.76
|
| Rate for Payer: Cofinity Commercial |
$1,425.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.76
|
| Rate for Payer: Healthscope Commercial |
$1,491.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.62
|
| Rate for Payer: Nomi Health Commercial |
$1,358.90
|
| Rate for Payer: PHP Commercial |
$1,408.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.18
|
| Rate for Payer: Priority Health HMO/PPO |
$1,441.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.34
|
| Rate for Payer: UHC Core |
$1,383.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.90
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,657.20
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.58 |
| Max. Negotiated Rate |
$1,491.48 |
| Rate for Payer: Aetna Commercial |
$1,408.62
|
| Rate for Payer: Aetna Medicare |
$430.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$517.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$517.88
|
| Rate for Payer: BCBS Complete |
$662.88
|
| Rate for Payer: BCBS MAPPO |
$414.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.38
|
| Rate for Payer: BCN Commercial |
$1,288.47
|
| Rate for Payer: BCN Medicare Advantage |
$414.30
|
| Rate for Payer: Cash Price |
$1,325.76
|
| Rate for Payer: Cofinity Commercial |
$1,425.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.30
|
| Rate for Payer: Healthscope Commercial |
$1,491.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.62
|
| Rate for Payer: Nomi Health Commercial |
$1,358.90
|
| Rate for Payer: PACE Senior Care Partners |
$393.58
|
| Rate for Payer: PACE SWMI |
$414.30
|
| Rate for Payer: PHP Commercial |
$1,408.62
|
| Rate for Payer: PHP Medicare Advantage |
$414.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.18
|
| Rate for Payer: Priority Health HMO/PPO |
$1,441.76
|
| Rate for Payer: Priority Health Medicare |
$418.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.32
|
| Rate for Payer: Railroad Medicare Medicare |
$414.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.34
|
| Rate for Payer: UHC Core |
$1,383.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.30
|
| Rate for Payer: UHC Exchange |
$414.30
|
| Rate for Payer: UHC Medicare Advantage |
$414.30
|
| Rate for Payer: VA VA |
$414.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.90
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.98 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$290.08
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: Priority Health HMO/PPO |
$326.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.32
|
| Rate for Payer: UHC Core |
$313.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
OP
|
$375.36
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.15 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna Medicare |
$97.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.30
|
| Rate for Payer: BCBS Complete |
$150.14
|
| Rate for Payer: BCBS MAPPO |
$93.84
|
| Rate for Payer: BCBS Trust/PPO |
$308.58
|
| Rate for Payer: BCN Commercial |
$291.84
|
| Rate for Payer: BCN Medicare Advantage |
$93.84
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: PACE Senior Care Partners |
$89.15
|
| Rate for Payer: PACE SWMI |
$93.84
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: PHP Medicare Advantage |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.98
|
| Rate for Payer: Priority Health HMO/PPO |
$326.56
|
| Rate for Payer: Priority Health Medicare |
$94.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.49
|
| Rate for Payer: Railroad Medicare Medicare |
$93.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.32
|
| Rate for Payer: UHC Core |
$313.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.84
|
| Rate for Payer: UHC Exchange |
$93.84
|
| Rate for Payer: UHC Medicare Advantage |
$93.84
|
| Rate for Payer: VA VA |
$93.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
IP
|
$382.87
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.87 |
| Max. Negotiated Rate |
$344.58 |
| Rate for Payer: Aetna Commercial |
$325.44
|
| Rate for Payer: BCBS Trust/PPO |
$312.54
|
| Rate for Payer: BCN Commercial |
$295.88
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Commercial |
$329.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$344.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Nomi Health Commercial |
$313.95
|
| Rate for Payer: PHP Commercial |
$325.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.87
|
| Rate for Payer: Priority Health HMO/PPO |
$333.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.93
|
| Rate for Payer: UHC Core |
$319.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.15
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
OP
|
$382.87
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$344.58 |
| Rate for Payer: Aetna Commercial |
$325.44
|
| Rate for Payer: Aetna Medicare |
$99.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.65
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$95.72
|
| Rate for Payer: BCBS Trust/PPO |
$314.76
|
| Rate for Payer: BCN Commercial |
$297.68
|
| Rate for Payer: BCN Medicare Advantage |
$95.72
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Commercial |
$329.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$344.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.15
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.50
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Nomi Health Commercial |
$313.95
|
| Rate for Payer: PACE Senior Care Partners |
$90.93
|
| Rate for Payer: PACE SWMI |
$95.72
|
| Rate for Payer: PHP Commercial |
$325.44
|
| Rate for Payer: PHP Medicare Advantage |
$95.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.87
|
| Rate for Payer: Priority Health HMO/PPO |
$333.10
|
| Rate for Payer: Priority Health Medicare |
$96.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.52
|
| Rate for Payer: Railroad Medicare Medicare |
$95.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.93
|
| Rate for Payer: UHC Core |
$319.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.72
|
| Rate for Payer: UHC Exchange |
$95.72
|
| Rate for Payer: UHC Medicare Advantage |
$95.72
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.15
|
|
