|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.52 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: Aetna Medicare |
$214.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$257.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$257.27
|
| Rate for Payer: BCBS Complete |
$329.30
|
| Rate for Payer: BCBS MAPPO |
$205.81
|
| Rate for Payer: BCBS Trust/PPO |
$676.79
|
| Rate for Payer: BCN Commercial |
$640.08
|
| Rate for Payer: BCN Medicare Advantage |
$205.81
|
| 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: Health Alliance Plan Medicare Advantage |
$205.81
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: Nomi Health Commercial |
$675.07
|
| Rate for Payer: PACE Senior Care Partners |
$195.52
|
| Rate for Payer: PACE SWMI |
$205.81
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: PHP Medicare Advantage |
$205.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health HMO/PPO |
$716.23
|
| Rate for Payer: Priority Health Medicare |
$207.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.58
|
| Rate for Payer: Railroad Medicare Medicare |
$205.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$724.46
|
| Rate for Payer: UHC Core |
$687.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.81
|
| Rate for Payer: UHC Exchange |
$205.81
|
| Rate for Payer: UHC Medicare Advantage |
$205.81
|
| Rate for Payer: VA VA |
$205.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.44
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$391.04 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna Medicare |
$428.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$514.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$514.52
|
| Rate for Payer: BCBS Complete |
$658.59
|
| Rate for Payer: BCBS MAPPO |
$411.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.57
|
| Rate for Payer: BCN Commercial |
$1,280.14
|
| Rate for Payer: BCN Medicare Advantage |
$411.62
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.62
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$432.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$473.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| Rate for Payer: PACE Senior Care Partners |
$391.04
|
| Rate for Payer: PACE SWMI |
$411.62
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: PHP Medicare Advantage |
$411.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1,432.44
|
| Rate for Payer: Priority Health Medicare |
$415.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,103.14
|
| Rate for Payer: Railroad Medicare Medicare |
$411.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.90
|
| Rate for Payer: UHC Core |
$1,374.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.62
|
| Rate for Payer: UHC Exchange |
$411.62
|
| Rate for Payer: UHC Medicare Advantage |
$411.62
|
| Rate for Payer: VA VA |
$411.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,070.21 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,344.02
|
| Rate for Payer: BCN Commercial |
$1,272.40
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,234.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: Nomi Health Commercial |
$1,350.11
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1,432.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,103.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.90
|
| Rate for Payer: UHC Core |
$1,374.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,234.86
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.47 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: BCBS Trust/PPO |
$241.71
|
| Rate for Payer: BCN Commercial |
$228.83
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health HMO/PPO |
$257.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.57
|
| Rate for Payer: UHC Core |
$247.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$76.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.53
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS MAPPO |
$74.03
|
| Rate for Payer: BCBS Trust/PPO |
$243.42
|
| Rate for Payer: BCN Commercial |
$230.22
|
| Rate for Payer: BCN Medicare Advantage |
$74.03
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.03
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: PACE Senior Care Partners |
$70.32
|
| Rate for Payer: PACE SWMI |
$74.03
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: PHP Medicare Advantage |
$74.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health HMO/PPO |
$257.61
|
| Rate for Payer: Priority Health Medicare |
$74.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.39
|
| Rate for Payer: Railroad Medicare Medicare |
$74.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.57
|
| Rate for Payer: UHC Core |
$247.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.03
|
| Rate for Payer: UHC Exchange |
$74.03
|
| Rate for Payer: UHC Medicare Advantage |
$74.03
|
| Rate for Payer: VA VA |
$74.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$76.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.53
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS MAPPO |
$74.03
|
| Rate for Payer: BCBS Trust/PPO |
$243.42
|
| Rate for Payer: BCN Commercial |
$230.22
|
| Rate for Payer: BCN Medicare Advantage |
$74.03
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.03
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: PACE Senior Care Partners |
$70.32
|
| Rate for Payer: PACE SWMI |
$74.03
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: PHP Medicare Advantage |
$74.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health HMO/PPO |
$257.61
|
| Rate for Payer: Priority Health Medicare |
$74.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.39
|
| Rate for Payer: Railroad Medicare Medicare |
$74.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.57
|
| Rate for Payer: UHC Core |
$247.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.03
|
| Rate for Payer: UHC Exchange |
$74.03
|
| Rate for Payer: UHC Medicare Advantage |
$74.03
|
| Rate for Payer: VA VA |
$74.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.47 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: BCBS Trust/PPO |
$241.71
|
| Rate for Payer: BCN Commercial |
$228.83
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: Nomi Health Commercial |
$242.80
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health HMO/PPO |
$257.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.57
|
| Rate for Payer: UHC Core |
$247.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.07
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.95
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS MAPPO |
$1.56
|
| Rate for Payer: BCBS Trust/PPO |
$5.13
|
| Rate for Payer: BCN Commercial |
$4.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.56
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.56
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.64
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PACE Senior Care Partners |
$1.48
|
| Rate for Payer: PACE SWMI |
$1.56
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$1.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health HMO/PPO |
$5.43
|
| Rate for Payer: Priority Health Medicare |
$1.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.49
|
| Rate for Payer: UHC Core |
$5.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.56
|
| Rate for Payer: UHC Exchange |
$1.56
|
| Rate for Payer: UHC Medicare Advantage |
$1.56
|
| Rate for Payer: UHCCP Medicaid |
$3.22
|
| Rate for Payer: VA VA |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: BCBS Trust/PPO |
$5.09
|
| Rate for Payer: BCN Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health HMO/PPO |
$5.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.49
|
| Rate for Payer: UHC Core |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$613.64 |
| Max. Negotiated Rate |
$849.65 |
| Rate for Payer: Aetna Commercial |
$802.45
|
| Rate for Payer: BCBS Trust/PPO |
$770.64
|
| Rate for Payer: BCN Commercial |
$729.57
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$811.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Healthscope Commercial |
$849.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: Nomi Health Commercial |
$774.13
|
| Rate for Payer: PHP Commercial |
$802.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health HMO/PPO |
$821.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.77
|
| Rate for Payer: UHC Core |
$788.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.04
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$224.21 |
| Max. Negotiated Rate |
$849.65 |
| Rate for Payer: Aetna Commercial |
$802.45
|
| Rate for Payer: Aetna Medicare |
$245.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.02
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$236.01
|
| Rate for Payer: BCBS Trust/PPO |
$776.11
|
| Rate for Payer: BCN Commercial |
$734.01
|
| Rate for Payer: BCN Medicare Advantage |
$236.01
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$811.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.01
|
| Rate for Payer: Healthscope Commercial |
$849.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.04
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.82
|
| Rate for Payer: Meridian Medicaid |
$496.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: Nomi Health Commercial |
$774.13
|
| Rate for Payer: PACE Senior Care Partners |
$224.21
|
| Rate for Payer: PACE SWMI |
$236.01
|
| Rate for Payer: PHP Commercial |
$802.45
|
| Rate for Payer: PHP Medicare Advantage |
$236.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health HMO/PPO |
$821.33
|
| Rate for Payer: Priority Health Medicare |
$238.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.52
|
| Rate for Payer: Railroad Medicare Medicare |
$236.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.77
|
| Rate for Payer: UHC Core |
$788.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.01
|
| Rate for Payer: UHC Exchange |
$236.01
|
| Rate for Payer: UHC Medicare Advantage |
$236.01
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$236.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.04
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,236.20 |
| Max. Negotiated Rate |
$4,684.55 |
| Rate for Payer: Aetna Commercial |
$4,424.30
|
| Rate for Payer: Aetna Medicare |
$1,353.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,626.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,626.58
|
| Rate for Payer: BCBS Complete |
$1,388.75
|
| Rate for Payer: BCBS MAPPO |
$1,301.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,279.08
|
| Rate for Payer: BCN Commercial |
$4,046.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,301.27
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,476.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,301.27
|
| Rate for Payer: Healthscope Commercial |
$4,684.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,903.80
|
| Rate for Payer: Mclaren Medicaid |
$1,322.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,366.33
|
| Rate for Payer: Meridian Medicaid |
$1,388.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,496.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: Nomi Health Commercial |
$4,268.15
|
| Rate for Payer: PACE Senior Care Partners |
$1,236.20
|
| Rate for Payer: PACE SWMI |
$1,301.27
|
| Rate for Payer: PHP Commercial |
$4,424.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,301.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,322.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health HMO/PPO |
$4,528.40
|
| Rate for Payer: Priority Health Medicare |
$1,314.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,487.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,301.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,580.45
|
| Rate for Payer: UHC Core |
$4,346.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,301.27
|
| Rate for Payer: UHC Exchange |
$1,301.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.27
|
| Rate for Payer: UHCCP Medicaid |
$1,322.53
|
| Rate for Payer: VA VA |
$1,301.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,903.80
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,383.29 |
| Max. Negotiated Rate |
$4,684.55 |
| Rate for Payer: Aetna Commercial |
$4,424.30
|
| Rate for Payer: BCBS Trust/PPO |
$4,248.89
|
| Rate for Payer: BCN Commercial |
$4,022.47
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,476.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Healthscope Commercial |
$4,684.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,903.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: Nomi Health Commercial |
$4,268.15
|
| Rate for Payer: PHP Commercial |
$4,424.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health HMO/PPO |
$4,528.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,487.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,580.45
|
| Rate for Payer: UHC Core |
$4,346.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,903.80
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$544.18 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Aetna Commercial |
$711.62
|
| Rate for Payer: BCBS Trust/PPO |
$683.41
|
| Rate for Payer: BCN Commercial |
$646.99
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$719.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: Nomi Health Commercial |
$686.50
|
| Rate for Payer: PHP Commercial |
$711.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health HMO/PPO |
$728.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$560.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$736.74
|
| Rate for Payer: UHC Core |
$699.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.90
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$198.84 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Aetna Commercial |
$711.62
|
| Rate for Payer: Aetna Medicare |
$217.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$261.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$261.62
|
| Rate for Payer: BCBS Complete |
$496.81
|
| Rate for Payer: BCBS MAPPO |
$209.30
|
| Rate for Payer: BCBS Trust/PPO |
$688.26
|
| Rate for Payer: BCN Commercial |
$650.92
|
| Rate for Payer: BCN Medicare Advantage |
$209.30
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$719.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.30
|
| Rate for Payer: Healthscope Commercial |
$753.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$627.90
|
| Rate for Payer: Mclaren Medicaid |
$473.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.76
|
| Rate for Payer: Meridian Medicaid |
$496.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: Nomi Health Commercial |
$686.50
|
| Rate for Payer: PACE Senior Care Partners |
$198.84
|
| Rate for Payer: PACE SWMI |
$209.30
|
| Rate for Payer: PHP Commercial |
$711.62
|
| Rate for Payer: PHP Medicare Advantage |
$209.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health HMO/PPO |
$728.36
|
| Rate for Payer: Priority Health Medicare |
$211.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$560.92
|
| Rate for Payer: Railroad Medicare Medicare |
$209.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$736.74
|
| Rate for Payer: UHC Core |
$699.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.30
|
| Rate for Payer: UHC Exchange |
$209.30
|
| Rate for Payer: UHC Medicare Advantage |
$209.30
|
| Rate for Payer: UHCCP Medicaid |
$473.12
|
| Rate for Payer: VA VA |
$209.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$627.90
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$220.44 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: BCBS Trust/PPO |
$199.94
|
| Rate for Payer: BCN Commercial |
$189.28
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO |
$213.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.54
|
| Rate for Payer: UHC Core |
$204.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.70
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$58.17 |
| Max. Negotiated Rate |
$220.44 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna Medicare |
$63.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.54
|
| Rate for Payer: BCBS Complete |
$154.41
|
| Rate for Payer: BCBS MAPPO |
$61.23
|
| Rate for Payer: BCBS Trust/PPO |
$201.36
|
| Rate for Payer: BCN Commercial |
$190.43
|
| Rate for Payer: BCN Medicare Advantage |
$61.23
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.23
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.70
|
| Rate for Payer: Mclaren Medicaid |
$147.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.29
|
| Rate for Payer: Meridian Medicaid |
$154.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: PACE Senior Care Partners |
$58.17
|
| Rate for Payer: PACE SWMI |
$61.23
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: PHP Medicare Advantage |
$61.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO |
$213.09
|
| Rate for Payer: Priority Health Medicare |
$61.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.10
|
| Rate for Payer: Railroad Medicare Medicare |
$61.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.54
|
| Rate for Payer: UHC Core |
$204.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.23
|
| Rate for Payer: UHC Exchange |
$61.23
|
| Rate for Payer: UHC Medicare Advantage |
$61.23
|
| Rate for Payer: UHCCP Medicaid |
$147.05
|
| Rate for Payer: VA VA |
$61.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.70
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$527.75 |
| Rate for Payer: Aetna Commercial |
$498.43
|
| Rate for Payer: Aetna Medicare |
$152.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.25
|
| Rate for Payer: BCBS Complete |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$146.60
|
| Rate for Payer: BCBS Trust/PPO |
$482.07
|
| Rate for Payer: BCN Commercial |
$455.92
|
| Rate for Payer: BCN Medicare Advantage |
$146.60
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$504.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.60
|
| Rate for Payer: Healthscope Commercial |
$527.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.79
|
| Rate for Payer: Mclaren Medicaid |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.93
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: Nomi Health Commercial |
$480.84
|
| Rate for Payer: PACE Senior Care Partners |
$139.27
|
| Rate for Payer: PACE SWMI |
$146.60
|
| Rate for Payer: PHP Commercial |
$498.43
|
| Rate for Payer: PHP Medicare Advantage |
$146.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health HMO/PPO |
$510.16
|
| Rate for Payer: Priority Health Medicare |
$148.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.88
|
| Rate for Payer: Railroad Medicare Medicare |
$146.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.02
|
| Rate for Payer: UHC Core |
$489.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.60
|
| Rate for Payer: UHC Exchange |
$146.60
|
| Rate for Payer: UHC Medicare Advantage |
$146.60
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| Rate for Payer: VA VA |
$146.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.79
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$527.75 |
| Rate for Payer: Aetna Commercial |
$498.43
|
| Rate for Payer: BCBS Trust/PPO |
$478.67
|
| Rate for Payer: BCN Commercial |
$453.16
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$504.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Healthscope Commercial |
$527.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$439.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: Nomi Health Commercial |
$480.84
|
| Rate for Payer: PHP Commercial |
$498.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health HMO/PPO |
$510.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.02
|
| Rate for Payer: UHC Core |
$489.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$439.79
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.21 |
| Max. Negotiated Rate |
$505.67 |
| Rate for Payer: Aetna Commercial |
$477.58
|
| Rate for Payer: BCBS Trust/PPO |
$458.65
|
| Rate for Payer: BCN Commercial |
$434.21
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cofinity Commercial |
$483.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.49
|
| Rate for Payer: Healthscope Commercial |
$505.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: Nomi Health Commercial |
$460.73
|
| Rate for Payer: PHP Commercial |
$477.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.21
|
| Rate for Payer: Priority Health HMO/PPO |
$488.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.44
|
| Rate for Payer: UHC Core |
$469.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.39
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.44 |
| Max. Negotiated Rate |
$505.67 |
| Rate for Payer: Aetna Commercial |
$477.58
|
| Rate for Payer: Aetna Medicare |
$146.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.58
|
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: BCBS MAPPO |
$140.47
|
| Rate for Payer: BCBS Trust/PPO |
$461.91
|
| Rate for Payer: BCN Commercial |
$436.85
|
| Rate for Payer: BCN Medicare Advantage |
$140.47
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cofinity Commercial |
$483.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.47
|
| Rate for Payer: Healthscope Commercial |
$505.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.39
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.49
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: Nomi Health Commercial |
$460.73
|
| Rate for Payer: PACE Senior Care Partners |
$133.44
|
| Rate for Payer: PACE SWMI |
$140.47
|
| Rate for Payer: PHP Commercial |
$477.58
|
| Rate for Payer: PHP Medicare Advantage |
$140.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.21
|
| Rate for Payer: Priority Health HMO/PPO |
$488.82
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.45
|
| Rate for Payer: Railroad Medicare Medicare |
$140.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.44
|
| Rate for Payer: UHC Core |
$469.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.47
|
| Rate for Payer: UHC Exchange |
$140.47
|
| Rate for Payer: UHC Medicare Advantage |
$140.47
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
| Rate for Payer: VA VA |
$140.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.39
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
OP
|
$85.56
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna Commercial |
$72.73
|
| Rate for Payer: Aetna Medicare |
$22.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.74
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$21.39
|
| Rate for Payer: BCBS Trust/PPO |
$70.34
|
| Rate for Payer: BCN Commercial |
$66.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.39
|
| Rate for Payer: Cash Price |
$68.45
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.73
|
| Rate for Payer: Nomi Health Commercial |
$70.16
|
| Rate for Payer: PACE Senior Care Partners |
$20.32
|
| Rate for Payer: PACE SWMI |
$21.39
|
| Rate for Payer: PHP Commercial |
$72.73
|
| Rate for Payer: PHP Medicare Advantage |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.61
|
| Rate for Payer: Priority Health HMO/PPO |
$74.44
|
| Rate for Payer: Priority Health Medicare |
$21.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.33
|
| Rate for Payer: Railroad Medicare Medicare |
$21.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.29
|
| Rate for Payer: UHC Core |
$71.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.39
|
| Rate for Payer: UHC Exchange |
$21.39
|
| Rate for Payer: UHC Medicare Advantage |
$21.39
|
| Rate for Payer: VA VA |
$21.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.17
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
IP
|
$85.56
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.61 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna Commercial |
$72.73
|
| Rate for Payer: BCBS Trust/PPO |
$69.84
|
| Rate for Payer: BCN Commercial |
$66.12
|
| Rate for Payer: Cash Price |
$68.45
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.45
|
| Rate for Payer: Healthscope Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.73
|
| Rate for Payer: Nomi Health Commercial |
$70.16
|
| Rate for Payer: PHP Commercial |
$72.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.61
|
| Rate for Payer: Priority Health HMO/PPO |
$74.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.29
|
| Rate for Payer: UHC Core |
$71.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.17
|
|
|
HC DES ADD.BRANCH
|
Facility
|
OP
|
$17,010.57
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,040.01 |
| Max. Negotiated Rate |
$15,309.51 |
| Rate for Payer: Aetna Commercial |
$14,458.98
|
| Rate for Payer: Aetna Medicare |
$4,422.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,315.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,315.80
|
| Rate for Payer: BCBS Complete |
$6,804.23
|
| Rate for Payer: BCBS MAPPO |
$4,252.64
|
| Rate for Payer: BCBS Trust/PPO |
$13,984.39
|
| Rate for Payer: BCN Commercial |
$13,225.72
|
| Rate for Payer: BCN Medicare Advantage |
$4,252.64
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$14,629.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,252.64
|
| Rate for Payer: Healthscope Commercial |
$15,309.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,757.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,465.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,890.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: PACE Senior Care Partners |
$4,040.01
|
| Rate for Payer: PACE SWMI |
$4,252.64
|
| Rate for Payer: PHP Commercial |
$14,458.98
|
| Rate for Payer: PHP Medicare Advantage |
$4,252.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health HMO/PPO |
$14,799.20
|
| Rate for Payer: Priority Health Medicare |
$4,295.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,397.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4,252.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,969.30
|
| Rate for Payer: UHC Core |
$14,203.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,252.64
|
| Rate for Payer: UHC Exchange |
$4,252.64
|
| Rate for Payer: UHC Medicare Advantage |
$4,252.64
|
| Rate for Payer: VA VA |
$4,252.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,757.93
|
|
|
HC DES ADD.BRANCH
|
Facility
|
IP
|
$17,010.57
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,056.87 |
| Max. Negotiated Rate |
$15,309.51 |
| Rate for Payer: Aetna Commercial |
$14,458.98
|
| Rate for Payer: BCBS Trust/PPO |
$13,885.73
|
| Rate for Payer: BCN Commercial |
$13,145.77
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$14,629.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$15,309.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,757.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: PHP Commercial |
$14,458.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health HMO/PPO |
$14,799.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,397.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,969.30
|
| Rate for Payer: UHC Core |
$14,203.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,757.93
|
|
