|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: BCBS Trust/PPO |
$424.64
|
| Rate for Payer: BCN Commercial |
$402.01
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.13
|
| Rate for Payer: Priority Health HMO/PPO |
$452.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.78
|
| Rate for Payer: UHC Core |
$434.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.55 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna Medicare |
$135.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.56
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$427.66
|
| Rate for Payer: BCN Commercial |
$404.46
|
| Rate for Payer: BCN Medicare Advantage |
$130.05
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.05
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.55
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: PACE Senior Care Partners |
$123.55
|
| Rate for Payer: PACE SWMI |
$130.05
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: PHP Medicare Advantage |
$130.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.13
|
| Rate for Payer: Priority Health HMO/PPO |
$452.57
|
| Rate for Payer: Priority Health Medicare |
$131.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.53
|
| Rate for Payer: Railroad Medicare Medicare |
$130.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.78
|
| Rate for Payer: UHC Core |
$434.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.05
|
| Rate for Payer: UHC Exchange |
$130.05
|
| Rate for Payer: UHC Medicare Advantage |
$130.05
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$130.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$851.15
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.25 |
| Max. Negotiated Rate |
$766.03 |
| Rate for Payer: Aetna Commercial |
$723.48
|
| Rate for Payer: BCBS Trust/PPO |
$694.79
|
| Rate for Payer: BCN Commercial |
$657.77
|
| Rate for Payer: Cash Price |
$680.92
|
| Rate for Payer: Cofinity Commercial |
$731.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.92
|
| Rate for Payer: Healthscope Commercial |
$766.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.48
|
| Rate for Payer: Nomi Health Commercial |
$697.94
|
| Rate for Payer: PHP Commercial |
$723.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.25
|
| Rate for Payer: Priority Health HMO/PPO |
$740.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.01
|
| Rate for Payer: UHC Core |
$710.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.36
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$851.15
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.15 |
| Max. Negotiated Rate |
$766.03 |
| Rate for Payer: Aetna Commercial |
$723.48
|
| Rate for Payer: Aetna Medicare |
$221.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.98
|
| Rate for Payer: BCBS Complete |
$340.46
|
| Rate for Payer: BCBS MAPPO |
$212.79
|
| Rate for Payer: BCBS Trust/PPO |
$699.73
|
| Rate for Payer: BCN Commercial |
$661.77
|
| Rate for Payer: BCN Medicare Advantage |
$212.79
|
| Rate for Payer: Cash Price |
$680.92
|
| Rate for Payer: Cofinity Commercial |
$731.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.79
|
| Rate for Payer: Healthscope Commercial |
$766.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.48
|
| Rate for Payer: Nomi Health Commercial |
$697.94
|
| Rate for Payer: PACE Senior Care Partners |
$202.15
|
| Rate for Payer: PACE SWMI |
$212.79
|
| Rate for Payer: PHP Commercial |
$723.48
|
| Rate for Payer: PHP Medicare Advantage |
$212.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.25
|
| Rate for Payer: Priority Health HMO/PPO |
$740.50
|
| Rate for Payer: Priority Health Medicare |
$214.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.27
|
| Rate for Payer: Railroad Medicare Medicare |
$212.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.01
|
| Rate for Payer: UHC Core |
$710.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.79
|
| Rate for Payer: UHC Exchange |
$212.79
|
| Rate for Payer: UHC Medicare Advantage |
$212.79
|
| Rate for Payer: VA VA |
$212.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.36
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
OP
|
$94.42
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$84.98 |
| Rate for Payer: Aetna Commercial |
$80.26
|
| Rate for Payer: Aetna Medicare |
$24.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.51
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$23.61
|
| Rate for Payer: BCBS Trust/PPO |
$77.62
|
| Rate for Payer: BCN Commercial |
$73.41
|
| Rate for Payer: BCN Medicare Advantage |
$23.61
|
| Rate for Payer: Cash Price |
$75.54
|
| Rate for Payer: Cash Price |
$75.54
|
| Rate for Payer: Cofinity Commercial |
$81.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.61
|
| Rate for Payer: Healthscope Commercial |
$84.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.81
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.79
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.26
|
| Rate for Payer: Nomi Health Commercial |
$77.42
|
| Rate for Payer: PACE Senior Care Partners |
$22.42
|
| Rate for Payer: PACE SWMI |
$23.61
|
| Rate for Payer: PHP Commercial |
$80.26
|
| Rate for Payer: PHP Medicare Advantage |
$23.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.37
|
| Rate for Payer: Priority Health HMO/PPO |
$82.15
|
| Rate for Payer: Priority Health Medicare |
$23.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.26
|
| Rate for Payer: Railroad Medicare Medicare |
$23.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.09
|
| Rate for Payer: UHC Core |
$78.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.61
|
| Rate for Payer: UHC Exchange |
$23.61
|
| Rate for Payer: UHC Medicare Advantage |
$23.61
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$23.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.81
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
IP
|
$94.42
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.37 |
| Max. Negotiated Rate |
$84.98 |
| Rate for Payer: Aetna Commercial |
$80.26
|
| Rate for Payer: BCBS Trust/PPO |
$77.08
|
| Rate for Payer: BCN Commercial |
$72.97
|
| Rate for Payer: Cash Price |
$75.54
|
| Rate for Payer: Cofinity Commercial |
$81.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.54
|
| Rate for Payer: Healthscope Commercial |
$84.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.26
|
| Rate for Payer: Nomi Health Commercial |
$77.42
|
| Rate for Payer: PHP Commercial |
$80.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.37
|
| Rate for Payer: Priority Health HMO/PPO |
$82.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.09
|
| Rate for Payer: UHC Core |
$78.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.81
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
IP
|
$114.46
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$103.01 |
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: BCBS Trust/PPO |
$93.43
|
| Rate for Payer: BCN Commercial |
$88.45
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cofinity Commercial |
$98.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.57
|
| Rate for Payer: Healthscope Commercial |
$103.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.29
|
| Rate for Payer: Nomi Health Commercial |
$93.86
|
| Rate for Payer: PHP Commercial |
$97.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: Priority Health HMO/PPO |
$99.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.72
|
| Rate for Payer: UHC Core |
$95.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.84
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
OP
|
$114.46
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$103.01 |
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: Aetna Medicare |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.77
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$28.61
|
| Rate for Payer: BCBS Trust/PPO |
$94.10
|
| Rate for Payer: BCN Commercial |
$88.99
|
| Rate for Payer: BCN Medicare Advantage |
$28.61
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cofinity Commercial |
$98.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.61
|
| Rate for Payer: Healthscope Commercial |
$103.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.84
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.05
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.29
|
| Rate for Payer: Nomi Health Commercial |
$93.86
|
| Rate for Payer: PACE Senior Care Partners |
$27.18
|
| Rate for Payer: PACE SWMI |
$28.61
|
| Rate for Payer: PHP Commercial |
$97.29
|
| Rate for Payer: PHP Medicare Advantage |
$28.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: Priority Health HMO/PPO |
$99.58
|
| Rate for Payer: Priority Health Medicare |
$28.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.69
|
| Rate for Payer: Railroad Medicare Medicare |
$28.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.72
|
| Rate for Payer: UHC Core |
$95.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.61
|
| Rate for Payer: UHC Exchange |
$28.61
|
| Rate for Payer: UHC Medicare Advantage |
$28.61
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.84
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,113.39
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.43 |
| Max. Negotiated Rate |
$1,002.05 |
| Rate for Payer: Aetna Commercial |
$946.38
|
| Rate for Payer: Aetna Medicare |
$289.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$347.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$347.93
|
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: BCBS MAPPO |
$278.35
|
| Rate for Payer: BCBS Trust/PPO |
$915.32
|
| Rate for Payer: BCN Commercial |
$865.66
|
| Rate for Payer: BCN Medicare Advantage |
$278.35
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cofinity Commercial |
$957.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$890.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.35
|
| Rate for Payer: Healthscope Commercial |
$1,002.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.04
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.26
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.38
|
| Rate for Payer: Nomi Health Commercial |
$912.98
|
| Rate for Payer: PACE Senior Care Partners |
$264.43
|
| Rate for Payer: PACE SWMI |
$278.35
|
| Rate for Payer: PHP Commercial |
$946.38
|
| Rate for Payer: PHP Medicare Advantage |
$278.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.70
|
| Rate for Payer: Priority Health HMO/PPO |
$968.65
|
| Rate for Payer: Priority Health Medicare |
$281.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.97
|
| Rate for Payer: Railroad Medicare Medicare |
$278.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.78
|
| Rate for Payer: UHC Core |
$929.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.35
|
| Rate for Payer: UHC Exchange |
$278.35
|
| Rate for Payer: UHC Medicare Advantage |
$278.35
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
| Rate for Payer: VA VA |
$278.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.04
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$1,113.39
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.70 |
| Max. Negotiated Rate |
$1,002.05 |
| Rate for Payer: Aetna Commercial |
$946.38
|
| Rate for Payer: BCBS Trust/PPO |
$908.86
|
| Rate for Payer: BCN Commercial |
$860.43
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cofinity Commercial |
$957.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$890.71
|
| Rate for Payer: Healthscope Commercial |
$1,002.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.38
|
| Rate for Payer: Nomi Health Commercial |
$912.98
|
| Rate for Payer: PHP Commercial |
$946.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.70
|
| Rate for Payer: Priority Health HMO/PPO |
$968.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.78
|
| Rate for Payer: UHC Core |
$929.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.04
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,887.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$1,698.30 |
| Rate for Payer: Aetna Commercial |
$1,603.95
|
| Rate for Payer: Aetna Medicare |
$490.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$589.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$589.69
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$471.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.30
|
| Rate for Payer: BCN Commercial |
$1,467.14
|
| Rate for Payer: BCN Medicare Advantage |
$471.75
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,622.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.75
|
| Rate for Payer: Healthscope Commercial |
$1,698.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,415.25
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.34
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$542.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.95
|
| Rate for Payer: Nomi Health Commercial |
$1,547.34
|
| Rate for Payer: PACE Senior Care Partners |
$448.16
|
| Rate for Payer: PACE SWMI |
$471.75
|
| Rate for Payer: PHP Commercial |
$1,603.95
|
| Rate for Payer: PHP Medicare Advantage |
$471.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,641.69
|
| Rate for Payer: Priority Health Medicare |
$476.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,264.29
|
| Rate for Payer: Railroad Medicare Medicare |
$471.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,660.56
|
| Rate for Payer: UHC Core |
$1,575.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$471.75
|
| Rate for Payer: UHC Exchange |
$471.75
|
| Rate for Payer: UHC Medicare Advantage |
$471.75
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$471.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,415.25
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,887.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,226.55 |
| Max. Negotiated Rate |
$1,698.30 |
| Rate for Payer: Aetna Commercial |
$1,603.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.36
|
| Rate for Payer: BCN Commercial |
$1,458.27
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,622.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.60
|
| Rate for Payer: Healthscope Commercial |
$1,698.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,415.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.95
|
| Rate for Payer: Nomi Health Commercial |
$1,547.34
|
| Rate for Payer: PHP Commercial |
$1,603.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,641.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,264.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,660.56
|
| Rate for Payer: UHC Core |
$1,575.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,415.25
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$969.00 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: Aetna Medicare |
$1,060.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,275.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,275.00
|
| Rate for Payer: BCBS Complete |
$2,172.87
|
| Rate for Payer: BCBS MAPPO |
$1,020.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,354.17
|
| Rate for Payer: BCN Commercial |
$3,172.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,020.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,020.00
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,060.00
|
| Rate for Payer: Mclaren Medicaid |
$2,069.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,071.00
|
| Rate for Payer: Meridian Medicaid |
$2,172.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,173.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: Nomi Health Commercial |
$3,345.60
|
| Rate for Payer: PACE Senior Care Partners |
$969.00
|
| Rate for Payer: PACE SWMI |
$1,020.00
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,020.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,069.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,549.60
|
| Rate for Payer: Priority Health Medicare |
$1,030.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,733.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,020.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,590.40
|
| Rate for Payer: UHC Core |
$3,406.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,020.00
|
| Rate for Payer: UHC Exchange |
$1,020.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,020.00
|
| Rate for Payer: UHCCP Medicaid |
$2,069.26
|
| Rate for Payer: VA VA |
$1,020.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,060.00
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,330.50
|
| Rate for Payer: BCN Commercial |
$3,153.02
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,060.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: Nomi Health Commercial |
$3,345.60
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,549.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,733.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,590.40
|
| Rate for Payer: UHC Core |
$3,406.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,060.00
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$509.07
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$458.16 |
| Rate for Payer: Aetna Commercial |
$432.71
|
| Rate for Payer: Aetna Medicare |
$132.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.08
|
| Rate for Payer: BCBS Complete |
$203.63
|
| Rate for Payer: BCBS MAPPO |
$127.27
|
| Rate for Payer: BCBS Trust/PPO |
$418.51
|
| Rate for Payer: BCN Commercial |
$395.80
|
| Rate for Payer: BCN Medicare Advantage |
$127.27
|
| Rate for Payer: Cash Price |
$407.26
|
| Rate for Payer: Cofinity Commercial |
$437.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.27
|
| Rate for Payer: Healthscope Commercial |
$458.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.71
|
| Rate for Payer: Nomi Health Commercial |
$417.44
|
| Rate for Payer: PACE Senior Care Partners |
$120.90
|
| Rate for Payer: PACE SWMI |
$127.27
|
| Rate for Payer: PHP Commercial |
$432.71
|
| Rate for Payer: PHP Medicare Advantage |
$127.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.90
|
| Rate for Payer: Priority Health HMO/PPO |
$442.89
|
| Rate for Payer: Priority Health Medicare |
$128.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.08
|
| Rate for Payer: Railroad Medicare Medicare |
$127.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.98
|
| Rate for Payer: UHC Core |
$425.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.27
|
| Rate for Payer: UHC Exchange |
$127.27
|
| Rate for Payer: UHC Medicare Advantage |
$127.27
|
| Rate for Payer: VA VA |
$127.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.80
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$509.07
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.90 |
| Max. Negotiated Rate |
$458.16 |
| Rate for Payer: Aetna Commercial |
$432.71
|
| Rate for Payer: BCBS Trust/PPO |
$415.55
|
| Rate for Payer: BCN Commercial |
$393.41
|
| Rate for Payer: Cash Price |
$407.26
|
| Rate for Payer: Cofinity Commercial |
$437.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.26
|
| Rate for Payer: Healthscope Commercial |
$458.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.71
|
| Rate for Payer: Nomi Health Commercial |
$417.44
|
| Rate for Payer: PHP Commercial |
$432.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.90
|
| Rate for Payer: Priority Health HMO/PPO |
$442.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.98
|
| Rate for Payer: UHC Core |
$425.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.80
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$645.08
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.30 |
| Max. Negotiated Rate |
$580.57 |
| Rate for Payer: Aetna Commercial |
$548.32
|
| Rate for Payer: BCBS Trust/PPO |
$526.58
|
| Rate for Payer: BCN Commercial |
$498.52
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cofinity Commercial |
$554.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.06
|
| Rate for Payer: Healthscope Commercial |
$580.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$483.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.32
|
| Rate for Payer: Nomi Health Commercial |
$528.97
|
| Rate for Payer: PHP Commercial |
$548.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.30
|
| Rate for Payer: Priority Health HMO/PPO |
$561.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$432.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$567.67
|
| Rate for Payer: UHC Core |
$538.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$483.81
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$645.08
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.21 |
| Max. Negotiated Rate |
$580.57 |
| Rate for Payer: Aetna Commercial |
$548.32
|
| Rate for Payer: Aetna Medicare |
$167.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.59
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$161.27
|
| Rate for Payer: BCBS Trust/PPO |
$530.32
|
| Rate for Payer: BCN Commercial |
$501.55
|
| Rate for Payer: BCN Medicare Advantage |
$161.27
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cofinity Commercial |
$554.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.27
|
| Rate for Payer: Healthscope Commercial |
$580.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$483.81
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.33
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.32
|
| Rate for Payer: Nomi Health Commercial |
$528.97
|
| Rate for Payer: PACE Senior Care Partners |
$153.21
|
| Rate for Payer: PACE SWMI |
$161.27
|
| Rate for Payer: PHP Commercial |
$548.32
|
| Rate for Payer: PHP Medicare Advantage |
$161.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.30
|
| Rate for Payer: Priority Health HMO/PPO |
$561.22
|
| Rate for Payer: Priority Health Medicare |
$162.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$432.20
|
| Rate for Payer: Railroad Medicare Medicare |
$161.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$567.67
|
| Rate for Payer: UHC Core |
$538.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.27
|
| Rate for Payer: UHC Exchange |
$161.27
|
| Rate for Payer: UHC Medicare Advantage |
$161.27
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$161.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$483.81
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna Medicare |
$9.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.74
|
| Rate for Payer: BCBS Complete |
$15.02
|
| Rate for Payer: BCBS MAPPO |
$9.39
|
| Rate for Payer: BCBS Trust/PPO |
$30.88
|
| Rate for Payer: BCN Commercial |
$29.20
|
| Rate for Payer: BCN Medicare Advantage |
$9.39
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.39
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: PACE Senior Care Partners |
$8.92
|
| Rate for Payer: PACE SWMI |
$9.39
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: PHP Medicare Advantage |
$9.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: Priority Health HMO/PPO |
$32.68
|
| Rate for Payer: Priority Health Medicare |
$9.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.17
|
| Rate for Payer: Railroad Medicare Medicare |
$9.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.05
|
| Rate for Payer: UHC Core |
$31.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.39
|
| Rate for Payer: UHC Exchange |
$9.39
|
| Rate for Payer: UHC Medicare Advantage |
$9.39
|
| Rate for Payer: VA VA |
$9.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.17
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: BCBS Trust/PPO |
$30.66
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: Priority Health HMO/PPO |
$32.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.05
|
| Rate for Payer: UHC Core |
$31.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.17
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$434.84 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Aetna Medicare |
$125.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.99
|
| Rate for Payer: BCBS Complete |
$251.82
|
| Rate for Payer: BCBS MAPPO |
$120.79
|
| Rate for Payer: BCBS Trust/PPO |
$397.21
|
| Rate for Payer: BCN Commercial |
$375.66
|
| Rate for Payer: BCN Medicare Advantage |
$120.79
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.79
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.37
|
| Rate for Payer: Mclaren Medicaid |
$239.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.83
|
| Rate for Payer: Meridian Medicaid |
$251.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: Nomi Health Commercial |
$396.19
|
| Rate for Payer: PACE Senior Care Partners |
$114.75
|
| Rate for Payer: PACE SWMI |
$120.79
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: PHP Medicare Advantage |
$120.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health HMO/PPO |
$420.35
|
| Rate for Payer: Priority Health Medicare |
$122.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.72
|
| Rate for Payer: Railroad Medicare Medicare |
$120.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.18
|
| Rate for Payer: UHC Core |
$403.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.79
|
| Rate for Payer: UHC Exchange |
$120.79
|
| Rate for Payer: UHC Medicare Advantage |
$120.79
|
| Rate for Payer: UHCCP Medicaid |
$239.81
|
| Rate for Payer: VA VA |
$120.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.37
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.05 |
| Max. Negotiated Rate |
$434.84 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: BCBS Trust/PPO |
$394.40
|
| Rate for Payer: BCN Commercial |
$373.39
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: Nomi Health Commercial |
$396.19
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health HMO/PPO |
$420.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.18
|
| Rate for Payer: UHC Core |
$403.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.37
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: Aetna Medicare |
$37.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.81
|
| Rate for Payer: BCBS Complete |
$57.35
|
| Rate for Payer: BCBS MAPPO |
$35.84
|
| Rate for Payer: BCBS Trust/PPO |
$117.87
|
| Rate for Payer: BCN Commercial |
$111.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.84
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: Nomi Health Commercial |
$117.57
|
| Rate for Payer: PACE Senior Care Partners |
$34.05
|
| Rate for Payer: PACE SWMI |
$35.84
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health HMO/PPO |
$124.74
|
| Rate for Payer: Priority Health Medicare |
$36.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.06
|
| Rate for Payer: Railroad Medicare Medicare |
$35.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.17
|
| Rate for Payer: UHC Core |
$119.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.84
|
| Rate for Payer: UHC Exchange |
$35.84
|
| Rate for Payer: UHC Medicare Advantage |
$35.84
|
| Rate for Payer: VA VA |
$35.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.53
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: BCBS Trust/PPO |
$117.04
|
| Rate for Payer: BCN Commercial |
$110.80
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: Nomi Health Commercial |
$117.57
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health HMO/PPO |
$124.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.17
|
| Rate for Payer: UHC Core |
$119.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.53
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$535.11 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: BCBS Trust/PPO |
$672.02
|
| Rate for Payer: BCN Commercial |
$636.21
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$708.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: Nomi Health Commercial |
$675.07
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health HMO/PPO |
$716.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$724.46
|
| Rate for Payer: UHC Core |
$687.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.44
|
|
