|
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 HOME USE INR MONITOR
|
Facility
|
OP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.29 |
| 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 |
$95.86
|
| 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 |
$91.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.93
|
| Rate for Payer: Meridian Medicaid |
$95.86
|
| 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 |
$91.29
|
| 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 |
$91.29
|
| 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 |
$421.40
|
| 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 |
$421.40
|
|
|
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 |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$140.46
|
| Rate for Payer: BCBS Trust/PPO |
$461.91
|
| Rate for Payer: BCN Commercial |
$436.85
|
| Rate for Payer: BCN Medicare Advantage |
$140.46
|
| 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 |
$140.46
|
| Rate for Payer: Healthscope Commercial |
$505.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.40
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.49
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| 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 |
$140.46
|
| Rate for Payer: PHP Commercial |
$477.58
|
| Rate for Payer: PHP Medicare Advantage |
$140.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| 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 |
$140.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.44
|
| Rate for Payer: UHC Core |
$469.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.46
|
| Rate for Payer: UHC Exchange |
$140.46
|
| Rate for Payer: UHC Medicare Advantage |
$140.46
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$140.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.40
|
|
|
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 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 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
|
|
|
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 DESTR LESION ROOF OF MOUTH
|
Facility
|
IP
|
$8,109.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,270.85 |
| Max. Negotiated Rate |
$7,298.10 |
| Rate for Payer: Aetna Commercial |
$6,892.65
|
| Rate for Payer: BCBS Trust/PPO |
$6,619.38
|
| Rate for Payer: BCN Commercial |
$6,266.64
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$6,973.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Healthscope Commercial |
$7,298.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,081.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: PHP Commercial |
$6,892.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health HMO/PPO |
$7,054.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,433.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,135.92
|
| Rate for Payer: UHC Core |
$6,771.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,081.75
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
OP
|
$8,109.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.89 |
| Max. Negotiated Rate |
$7,298.10 |
| Rate for Payer: Aetna Commercial |
$6,892.65
|
| Rate for Payer: Aetna Medicare |
$2,108.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,534.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,534.06
|
| Rate for Payer: BCBS Complete |
$2,412.36
|
| Rate for Payer: BCBS MAPPO |
$2,027.25
|
| Rate for Payer: BCBS Trust/PPO |
$6,666.41
|
| Rate for Payer: BCN Commercial |
$6,304.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,027.25
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$6,973.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,027.25
|
| Rate for Payer: Healthscope Commercial |
$7,298.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,081.75
|
| Rate for Payer: Mclaren Medicaid |
$2,297.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,128.61
|
| Rate for Payer: Meridian Medicaid |
$2,412.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,331.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,925.89
|
| Rate for Payer: PACE SWMI |
$2,027.25
|
| Rate for Payer: PHP Commercial |
$6,892.65
|
| Rate for Payer: PHP Medicare Advantage |
$2,027.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,297.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health HMO/PPO |
$7,054.83
|
| Rate for Payer: Priority Health Medicare |
$2,047.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,433.03
|
| Rate for Payer: Railroad Medicare Medicare |
$2,027.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,135.92
|
| Rate for Payer: UHC Core |
$6,771.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,027.25
|
| Rate for Payer: UHC Exchange |
$2,027.25
|
| Rate for Payer: UHC Medicare Advantage |
$2,027.25
|
| Rate for Payer: UHCCP Medicaid |
$2,297.33
|
| Rate for Payer: VA VA |
$2,027.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,081.75
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
OP
|
$242.62
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.62 |
| Max. Negotiated Rate |
$218.36 |
| Rate for Payer: Aetna Commercial |
$206.23
|
| Rate for Payer: Aetna Medicare |
$63.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.82
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$60.66
|
| Rate for Payer: BCBS Trust/PPO |
$199.46
|
| Rate for Payer: BCN Commercial |
$188.64
|
| Rate for Payer: BCN Medicare Advantage |
$60.66
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cofinity Commercial |
$208.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.66
|
| Rate for Payer: Healthscope Commercial |
$218.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.96
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.69
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.23
|
| Rate for Payer: Nomi Health Commercial |
$198.95
|
| Rate for Payer: PACE Senior Care Partners |
$57.62
|
| Rate for Payer: PACE SWMI |
$60.66
|
| Rate for Payer: PHP Commercial |
$206.23
|
| Rate for Payer: PHP Medicare Advantage |
$60.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.70
|
| Rate for Payer: Priority Health HMO/PPO |
$211.08
|
| Rate for Payer: Priority Health Medicare |
$61.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.56
|
| Rate for Payer: Railroad Medicare Medicare |
$60.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.51
|
| Rate for Payer: UHC Core |
$202.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.66
|
| Rate for Payer: UHC Exchange |
$60.66
|
| Rate for Payer: UHC Medicare Advantage |
$60.66
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$60.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.96
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
IP
|
$242.62
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$218.36 |
| Rate for Payer: Aetna Commercial |
$206.23
|
| Rate for Payer: BCBS Trust/PPO |
$198.05
|
| Rate for Payer: BCN Commercial |
$187.50
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cofinity Commercial |
$208.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.10
|
| Rate for Payer: Healthscope Commercial |
$218.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.23
|
| Rate for Payer: Nomi Health Commercial |
$198.95
|
| Rate for Payer: PHP Commercial |
$206.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.70
|
| Rate for Payer: Priority Health HMO/PPO |
$211.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.51
|
| Rate for Payer: UHC Core |
$202.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.96
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
IP
|
$392.23
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.95 |
| Max. Negotiated Rate |
$353.01 |
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: BCBS Trust/PPO |
$320.18
|
| Rate for Payer: BCN Commercial |
$303.12
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health HMO/PPO |
$341.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.16
|
| Rate for Payer: UHC Core |
$327.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
OP
|
$392.23
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$353.01 |
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: Aetna Medicare |
$101.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.57
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$98.06
|
| Rate for Payer: BCBS Trust/PPO |
$322.45
|
| Rate for Payer: BCN Commercial |
$304.96
|
| Rate for Payer: BCN Medicare Advantage |
$98.06
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.06
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.96
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PACE Senior Care Partners |
$93.15
|
| Rate for Payer: PACE SWMI |
$98.06
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: PHP Medicare Advantage |
$98.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health HMO/PPO |
$341.24
|
| Rate for Payer: Priority Health Medicare |
$99.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.79
|
| Rate for Payer: Railroad Medicare Medicare |
$98.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.16
|
| Rate for Payer: UHC Core |
$327.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.06
|
| Rate for Payer: UHC Exchange |
$98.06
|
| Rate for Payer: UHC Medicare Advantage |
$98.06
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$98.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
IP
|
$392.23
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.95 |
| Max. Negotiated Rate |
$353.01 |
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: BCBS Trust/PPO |
$320.18
|
| Rate for Payer: BCN Commercial |
$303.12
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health HMO/PPO |
$341.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.16
|
| Rate for Payer: UHC Core |
$327.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
OP
|
$392.23
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.15 |
| Max. Negotiated Rate |
$353.01 |
| Rate for Payer: Aetna Commercial |
$333.40
|
| Rate for Payer: Aetna Medicare |
$101.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.57
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$98.06
|
| Rate for Payer: BCBS Trust/PPO |
$322.45
|
| Rate for Payer: BCN Commercial |
$304.96
|
| Rate for Payer: BCN Medicare Advantage |
$98.06
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$337.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.06
|
| Rate for Payer: Healthscope Commercial |
$353.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.17
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.96
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PACE Senior Care Partners |
$93.15
|
| Rate for Payer: PACE SWMI |
$98.06
|
| Rate for Payer: PHP Commercial |
$333.40
|
| Rate for Payer: PHP Medicare Advantage |
$98.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health HMO/PPO |
$341.24
|
| Rate for Payer: Priority Health Medicare |
$99.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.79
|
| Rate for Payer: Railroad Medicare Medicare |
$98.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.16
|
| Rate for Payer: UHC Core |
$327.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.06
|
| Rate for Payer: UHC Exchange |
$98.06
|
| Rate for Payer: UHC Medicare Advantage |
$98.06
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$98.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.17
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
OP
|
$602.39
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.07 |
| Max. Negotiated Rate |
$542.15 |
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: Aetna Medicare |
$156.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.25
|
| Rate for Payer: BCBS Complete |
$455.33
|
| Rate for Payer: BCBS MAPPO |
$150.60
|
| Rate for Payer: BCBS Trust/PPO |
$495.22
|
| Rate for Payer: BCN Commercial |
$468.36
|
| Rate for Payer: BCN Medicare Advantage |
$150.60
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.60
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Mclaren Medicaid |
$433.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.13
|
| Rate for Payer: Meridian Medicaid |
$455.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: PACE Senior Care Partners |
$143.07
|
| Rate for Payer: PACE SWMI |
$150.60
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: PHP Medicare Advantage |
$150.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health HMO/PPO |
$524.08
|
| Rate for Payer: Priority Health Medicare |
$152.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$403.60
|
| Rate for Payer: Railroad Medicare Medicare |
$150.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.10
|
| Rate for Payer: UHC Core |
$503.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.60
|
| Rate for Payer: UHC Exchange |
$150.60
|
| Rate for Payer: UHC Medicare Advantage |
$150.60
|
| Rate for Payer: UHCCP Medicaid |
$433.62
|
| Rate for Payer: VA VA |
$150.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
IP
|
$602.39
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.55 |
| Max. Negotiated Rate |
$542.15 |
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: BCBS Trust/PPO |
$491.73
|
| Rate for Payer: BCN Commercial |
$465.53
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health HMO/PPO |
$524.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$403.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.10
|
| Rate for Payer: UHC Core |
$503.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM >4 CM
|
Facility
|
IP
|
$602.39
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
76100158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.55 |
| Max. Negotiated Rate |
$542.15 |
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: BCBS Trust/PPO |
$491.73
|
| Rate for Payer: BCN Commercial |
$465.53
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health HMO/PPO |
$524.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$403.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.10
|
| Rate for Payer: UHC Core |
$503.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM >4 CM
|
Facility
|
OP
|
$602.39
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
76100158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.07 |
| Max. Negotiated Rate |
$542.15 |
| Rate for Payer: Aetna Commercial |
$512.03
|
| Rate for Payer: Aetna Medicare |
$156.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.25
|
| Rate for Payer: BCBS Complete |
$455.33
|
| Rate for Payer: BCBS MAPPO |
$150.60
|
| Rate for Payer: BCBS Trust/PPO |
$495.22
|
| Rate for Payer: BCN Commercial |
$468.36
|
| Rate for Payer: BCN Medicare Advantage |
$150.60
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$518.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.60
|
| Rate for Payer: Healthscope Commercial |
$542.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.79
|
| Rate for Payer: Mclaren Medicaid |
$433.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.13
|
| Rate for Payer: Meridian Medicaid |
$455.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: PACE Senior Care Partners |
$143.07
|
| Rate for Payer: PACE SWMI |
$150.60
|
| Rate for Payer: PHP Commercial |
$512.03
|
| Rate for Payer: PHP Medicare Advantage |
$150.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health HMO/PPO |
$524.08
|
| Rate for Payer: Priority Health Medicare |
$152.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$403.60
|
| Rate for Payer: Railroad Medicare Medicare |
$150.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.10
|
| Rate for Payer: UHC Core |
$503.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.60
|
| Rate for Payer: UHC Exchange |
$150.60
|
| Rate for Payer: UHC Medicare Advantage |
$150.60
|
| Rate for Payer: UHCCP Medicaid |
$433.62
|
| Rate for Payer: VA VA |
$150.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.79
|
|
|
HC DESTR PENIS LESION, SIMPLE, CRYO
|
Facility
|
OP
|
$176.87
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$159.18 |
| Rate for Payer: Aetna Commercial |
$150.34
|
| Rate for Payer: Aetna Medicare |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.27
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$145.40
|
| Rate for Payer: BCN Commercial |
$137.52
|
| Rate for Payer: BCN Medicare Advantage |
$44.22
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$152.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$159.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.65
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.43
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: Nomi Health Commercial |
$145.03
|
| Rate for Payer: PACE Senior Care Partners |
$42.01
|
| Rate for Payer: PACE SWMI |
$44.22
|
| Rate for Payer: PHP Commercial |
$150.34
|
| Rate for Payer: PHP Medicare Advantage |
$44.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: Priority Health HMO/PPO |
$153.88
|
| Rate for Payer: Priority Health Medicare |
$44.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.50
|
| Rate for Payer: Railroad Medicare Medicare |
$44.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.65
|
| Rate for Payer: UHC Core |
$147.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.22
|
| Rate for Payer: UHC Exchange |
$44.22
|
| Rate for Payer: UHC Medicare Advantage |
$44.22
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$44.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.65
|
|
|
HC DESTR PENIS LESION, SIMPLE, CRYO
|
Facility
|
IP
|
$176.87
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.97 |
| Max. Negotiated Rate |
$159.18 |
| Rate for Payer: Aetna Commercial |
$150.34
|
| Rate for Payer: BCBS Trust/PPO |
$144.38
|
| Rate for Payer: BCN Commercial |
$136.69
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$152.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Healthscope Commercial |
$159.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: Nomi Health Commercial |
$145.03
|
| Rate for Payer: PHP Commercial |
$150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: Priority Health HMO/PPO |
$153.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.65
|
| Rate for Payer: UHC Core |
$147.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.65
|
|
|
HC DESTRUCT ANAL LESN(S) SIMPLE CHEM
|
Facility
|
OP
|
$490.03
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.38 |
| Max. Negotiated Rate |
$441.03 |
| Rate for Payer: Aetna Commercial |
$416.53
|
| Rate for Payer: Aetna Medicare |
$127.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.13
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$122.51
|
| Rate for Payer: BCBS Trust/PPO |
$402.85
|
| Rate for Payer: BCN Commercial |
$381.00
|
| Rate for Payer: BCN Medicare Advantage |
$122.51
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$421.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.51
|
| Rate for Payer: Healthscope Commercial |
$441.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.52
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.63
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: Nomi Health Commercial |
$401.82
|
| Rate for Payer: PACE Senior Care Partners |
$116.38
|
| Rate for Payer: PACE SWMI |
$122.51
|
| Rate for Payer: PHP Commercial |
$416.53
|
| Rate for Payer: PHP Medicare Advantage |
$122.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: Priority Health HMO/PPO |
$426.33
|
| Rate for Payer: Priority Health Medicare |
$123.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.32
|
| Rate for Payer: Railroad Medicare Medicare |
$122.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.23
|
| Rate for Payer: UHC Core |
$409.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.51
|
| Rate for Payer: UHC Exchange |
$122.51
|
| Rate for Payer: UHC Medicare Advantage |
$122.51
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$122.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.52
|
|
|
HC DESTRUCT ANAL LESN(S) SIMPLE CHEM
|
Facility
|
IP
|
$490.03
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.52 |
| Max. Negotiated Rate |
$441.03 |
| Rate for Payer: Aetna Commercial |
$416.53
|
| Rate for Payer: BCBS Trust/PPO |
$400.01
|
| Rate for Payer: BCN Commercial |
$378.70
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$421.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Healthscope Commercial |
$441.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: Nomi Health Commercial |
$401.82
|
| Rate for Payer: PHP Commercial |
$416.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: Priority Health HMO/PPO |
$426.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.23
|
| Rate for Payer: UHC Core |
$409.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.52
|
|
