|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$229.86
|
| Rate for Payer: BCN Commercial |
$217.61
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$73.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.00
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$231.50
|
| Rate for Payer: BCN Commercial |
$218.94
|
| Rate for Payer: BCN Medicare Advantage |
$70.40
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.40
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.92
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PACE Senior Care Partners |
$66.88
|
| Rate for Payer: PACE SWMI |
$70.40
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: PHP Medicare Advantage |
$70.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Medicare |
$71.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: Railroad Medicare Medicare |
$70.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.40
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$70.40
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
IP
|
$176.53
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.74 |
| Max. Negotiated Rate |
$158.88 |
| Rate for Payer: Aetna Commercial |
$150.05
|
| Rate for Payer: BCBS Trust/PPO |
$144.10
|
| Rate for Payer: BCN Commercial |
$136.42
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cofinity Commercial |
$151.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.22
|
| Rate for Payer: Healthscope Commercial |
$158.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.05
|
| Rate for Payer: Nomi Health Commercial |
$144.75
|
| Rate for Payer: PHP Commercial |
$150.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.74
|
| Rate for Payer: Priority Health HMO/PPO |
$153.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.35
|
| Rate for Payer: UHC Core |
$147.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.40
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
OP
|
$176.53
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$158.88 |
| Rate for Payer: Aetna Commercial |
$150.05
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.17
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$44.13
|
| Rate for Payer: BCBS Trust/PPO |
$145.13
|
| Rate for Payer: BCN Commercial |
$137.25
|
| Rate for Payer: BCN Medicare Advantage |
$44.13
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cofinity Commercial |
$151.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.13
|
| Rate for Payer: Healthscope Commercial |
$158.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.40
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.34
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.05
|
| Rate for Payer: Nomi Health Commercial |
$144.75
|
| Rate for Payer: PACE Senior Care Partners |
$41.93
|
| Rate for Payer: PACE SWMI |
$44.13
|
| Rate for Payer: PHP Commercial |
$150.05
|
| Rate for Payer: PHP Medicare Advantage |
$44.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.74
|
| Rate for Payer: Priority Health HMO/PPO |
$153.58
|
| Rate for Payer: Priority Health Medicare |
$44.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.28
|
| Rate for Payer: Railroad Medicare Medicare |
$44.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.35
|
| Rate for Payer: UHC Core |
$147.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.13
|
| Rate for Payer: UHC Exchange |
$44.13
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$44.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.40
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
OP
|
$35.48
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$31.93 |
| Rate for Payer: Aetna Commercial |
$30.16
|
| Rate for Payer: Aetna Medicare |
$9.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.09
|
| Rate for Payer: BCBS Complete |
$14.19
|
| Rate for Payer: BCBS MAPPO |
$8.87
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: BCN Medicare Advantage |
$8.87
|
| Rate for Payer: Cash Price |
$28.38
|
| Rate for Payer: Cofinity Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$31.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.16
|
| Rate for Payer: Nomi Health Commercial |
$29.09
|
| Rate for Payer: PACE Senior Care Partners |
$8.43
|
| Rate for Payer: PACE SWMI |
$8.87
|
| Rate for Payer: PHP Commercial |
$30.16
|
| Rate for Payer: PHP Medicare Advantage |
$8.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.06
|
| Rate for Payer: Priority Health HMO/PPO |
$30.87
|
| Rate for Payer: Priority Health Medicare |
$8.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.22
|
| Rate for Payer: UHC Core |
$29.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.87
|
| Rate for Payer: UHC Exchange |
$8.87
|
| Rate for Payer: UHC Medicare Advantage |
$8.87
|
| Rate for Payer: VA VA |
$8.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.61
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
IP
|
$35.48
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$31.93 |
| Rate for Payer: Aetna Commercial |
$30.16
|
| Rate for Payer: BCBS Trust/PPO |
$28.96
|
| Rate for Payer: BCN Commercial |
$27.42
|
| Rate for Payer: Cash Price |
$28.38
|
| Rate for Payer: Cofinity Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.38
|
| Rate for Payer: Healthscope Commercial |
$31.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.16
|
| Rate for Payer: Nomi Health Commercial |
$29.09
|
| Rate for Payer: PHP Commercial |
$30.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.06
|
| Rate for Payer: Priority Health HMO/PPO |
$30.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.22
|
| Rate for Payer: UHC Core |
$29.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.61
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
OP
|
$3,898.53
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.90 |
| Max. Negotiated Rate |
$3,508.68 |
| Rate for Payer: Aetna Commercial |
$3,313.75
|
| Rate for Payer: Aetna Medicare |
$1,013.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,218.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,218.29
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$974.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,204.98
|
| Rate for Payer: BCN Commercial |
$3,031.11
|
| Rate for Payer: BCN Medicare Advantage |
$974.63
|
| Rate for Payer: Cash Price |
$3,118.82
|
| Rate for Payer: Cash Price |
$3,118.82
|
| Rate for Payer: Cofinity Commercial |
$3,352.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,118.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.63
|
| Rate for Payer: Healthscope Commercial |
$3,508.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,923.90
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,023.36
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,120.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,313.75
|
| Rate for Payer: Nomi Health Commercial |
$3,196.79
|
| Rate for Payer: PACE Senior Care Partners |
$925.90
|
| Rate for Payer: PACE SWMI |
$974.63
|
| Rate for Payer: PHP Commercial |
$3,313.75
|
| Rate for Payer: PHP Medicare Advantage |
$974.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,534.04
|
| Rate for Payer: Priority Health HMO/PPO |
$3,391.72
|
| Rate for Payer: Priority Health Medicare |
$984.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,612.02
|
| Rate for Payer: Railroad Medicare Medicare |
$974.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,430.71
|
| Rate for Payer: UHC Core |
$3,255.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.63
|
| Rate for Payer: UHC Exchange |
$974.63
|
| Rate for Payer: UHC Medicare Advantage |
$974.63
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$974.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,923.90
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
IP
|
$3,898.53
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,534.04 |
| Max. Negotiated Rate |
$3,508.68 |
| Rate for Payer: Aetna Commercial |
$3,313.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,182.37
|
| Rate for Payer: BCN Commercial |
$3,012.78
|
| Rate for Payer: Cash Price |
$3,118.82
|
| Rate for Payer: Cofinity Commercial |
$3,352.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,118.82
|
| Rate for Payer: Healthscope Commercial |
$3,508.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,923.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,313.75
|
| Rate for Payer: Nomi Health Commercial |
$3,196.79
|
| Rate for Payer: PHP Commercial |
$3,313.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,534.04
|
| Rate for Payer: Priority Health HMO/PPO |
$3,391.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,612.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,430.71
|
| Rate for Payer: UHC Core |
$3,255.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,923.90
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
OP
|
$24,667.58
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,858.55 |
| Max. Negotiated Rate |
$22,200.82 |
| Rate for Payer: Aetna Commercial |
$20,967.44
|
| Rate for Payer: Aetna Medicare |
$6,413.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,708.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,708.62
|
| Rate for Payer: BCBS Complete |
$8,609.76
|
| Rate for Payer: BCBS MAPPO |
$6,166.90
|
| Rate for Payer: BCBS Trust/PPO |
$20,279.22
|
| Rate for Payer: BCN Commercial |
$19,179.04
|
| Rate for Payer: BCN Medicare Advantage |
$6,166.90
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$21,214.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,166.90
|
| Rate for Payer: Healthscope Commercial |
$22,200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,500.69
|
| Rate for Payer: Mclaren Medicaid |
$8,199.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,475.24
|
| Rate for Payer: Meridian Medicaid |
$8,609.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,091.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| Rate for Payer: PACE Senior Care Partners |
$5,858.55
|
| Rate for Payer: PACE SWMI |
$6,166.90
|
| Rate for Payer: PHP Commercial |
$20,967.44
|
| Rate for Payer: PHP Medicare Advantage |
$6,166.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,199.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21,460.79
|
| Rate for Payer: Priority Health Medicare |
$6,228.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16,527.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6,166.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,707.47
|
| Rate for Payer: UHC Core |
$20,597.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,166.90
|
| Rate for Payer: UHC Exchange |
$6,166.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,166.90
|
| Rate for Payer: UHCCP Medicaid |
$8,199.23
|
| Rate for Payer: VA VA |
$6,166.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,500.69
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
IP
|
$24,667.58
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,033.93 |
| Max. Negotiated Rate |
$22,200.82 |
| Rate for Payer: Aetna Commercial |
$20,967.44
|
| Rate for Payer: BCBS Trust/PPO |
$20,136.15
|
| Rate for Payer: BCN Commercial |
$19,063.11
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$21,214.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Healthscope Commercial |
$22,200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,500.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| Rate for Payer: PHP Commercial |
$20,967.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21,460.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16,527.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,707.47
|
| Rate for Payer: UHC Core |
$20,597.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,500.69
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
IP
|
$379.19
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$341.27 |
| Rate for Payer: Aetna Commercial |
$322.31
|
| Rate for Payer: BCBS Trust/PPO |
$309.53
|
| Rate for Payer: BCN Commercial |
$293.04
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$326.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Healthscope Commercial |
$341.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: PHP Commercial |
$322.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: Priority Health HMO/PPO |
$329.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.69
|
| Rate for Payer: UHC Core |
$316.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.39
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
OP
|
$379.19
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$341.27 |
| Rate for Payer: Aetna Commercial |
$322.31
|
| Rate for Payer: Aetna Medicare |
$98.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.50
|
| Rate for Payer: BCBS Complete |
$151.68
|
| Rate for Payer: BCBS MAPPO |
$94.80
|
| Rate for Payer: BCBS Trust/PPO |
$311.73
|
| Rate for Payer: BCN Commercial |
$294.82
|
| Rate for Payer: BCN Medicare Advantage |
$94.80
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$326.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.80
|
| Rate for Payer: Healthscope Commercial |
$341.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: PACE Senior Care Partners |
$90.06
|
| Rate for Payer: PACE SWMI |
$94.80
|
| Rate for Payer: PHP Commercial |
$322.31
|
| Rate for Payer: PHP Medicare Advantage |
$94.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: Priority Health HMO/PPO |
$329.90
|
| Rate for Payer: Priority Health Medicare |
$95.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.06
|
| Rate for Payer: Railroad Medicare Medicare |
$94.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.69
|
| Rate for Payer: UHC Core |
$316.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.80
|
| Rate for Payer: UHC Exchange |
$94.80
|
| Rate for Payer: UHC Medicare Advantage |
$94.80
|
| Rate for Payer: VA VA |
$94.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.39
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
OP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.39 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna Commercial |
$806.65
|
| Rate for Payer: Aetna Medicare |
$246.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.56
|
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: BCBS MAPPO |
$237.25
|
| Rate for Payer: BCBS Trust/PPO |
$780.17
|
| Rate for Payer: BCN Commercial |
$737.85
|
| Rate for Payer: BCN Medicare Advantage |
$237.25
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.25
|
| Rate for Payer: Healthscope Commercial |
$854.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$778.18
|
| Rate for Payer: PACE Senior Care Partners |
$225.39
|
| Rate for Payer: PACE SWMI |
$237.25
|
| Rate for Payer: PHP Commercial |
$806.65
|
| Rate for Payer: PHP Medicare Advantage |
$237.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.85
|
| Rate for Payer: Priority Health HMO/PPO |
$825.63
|
| Rate for Payer: Priority Health Medicare |
$239.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$635.83
|
| Rate for Payer: Railroad Medicare Medicare |
$237.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.12
|
| Rate for Payer: UHC Core |
$792.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.25
|
| Rate for Payer: UHC Exchange |
$237.25
|
| Rate for Payer: UHC Medicare Advantage |
$237.25
|
| Rate for Payer: VA VA |
$237.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.75
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
HCPCS 00615
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$387.20 |
| Max. Negotiated Rate |
$629.20 |
| Rate for Payer: Aetna Medicare |
$484.00
|
| Rate for Payer: BCBS Complete |
$387.20
|
| Rate for Payer: Cash Price |
$774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.20
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
HCPCS 00615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$387.20 |
| Max. Negotiated Rate |
$629.20 |
| Rate for Payer: Aetna Medicare |
$484.00
|
| Rate for Payer: BCBS Complete |
$387.20
|
| Rate for Payer: Cash Price |
$774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.20
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
IP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$616.85 |
| Max. Negotiated Rate |
$854.10 |
| Rate for Payer: Aetna Commercial |
$806.65
|
| Rate for Payer: BCBS Trust/PPO |
$774.67
|
| Rate for Payer: BCN Commercial |
$733.39
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$816.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$854.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$778.18
|
| Rate for Payer: PHP Commercial |
$806.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.85
|
| Rate for Payer: Priority Health HMO/PPO |
$825.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$635.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.12
|
| Rate for Payer: UHC Core |
$792.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.75
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.62 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$263.50
|
| Rate for Payer: Aetna Medicare |
$80.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.88
|
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS MAPPO |
$77.50
|
| Rate for Payer: BCBS Trust/PPO |
$254.85
|
| Rate for Payer: BCN Commercial |
$241.03
|
| Rate for Payer: BCN Medicare Advantage |
$77.50
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$266.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.50
|
| Rate for Payer: Healthscope Commercial |
$279.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: PACE Senior Care Partners |
$73.62
|
| Rate for Payer: PACE SWMI |
$77.50
|
| Rate for Payer: PHP Commercial |
$263.50
|
| Rate for Payer: PHP Medicare Advantage |
$77.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO |
$269.70
|
| Rate for Payer: Priority Health Medicare |
$78.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.70
|
| Rate for Payer: Railroad Medicare Medicare |
$77.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.80
|
| Rate for Payer: UHC Core |
$258.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.50
|
| Rate for Payer: UHC Exchange |
$77.50
|
| Rate for Payer: UHC Medicare Advantage |
$77.50
|
| Rate for Payer: VA VA |
$77.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.50
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 00616
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$263.50
|
| Rate for Payer: BCBS Trust/PPO |
$253.05
|
| Rate for Payer: BCN Commercial |
$239.57
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$266.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$279.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: PHP Commercial |
$263.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO |
$269.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.80
|
| Rate for Payer: UHC Core |
$258.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.50
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 00616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
HC DEVICE NOT RETURNED APNEALINK
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 00602
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$549.25 |
| Rate for Payer: Aetna Medicare |
$422.50
|
| Rate for Payer: BCBS Complete |
$338.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Facility
|
OP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$367.65 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Medicare |
$402.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$483.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$483.75
|
| Rate for Payer: BCBS Complete |
$619.20
|
| Rate for Payer: BCBS MAPPO |
$387.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,272.61
|
| Rate for Payer: BCN Commercial |
$1,203.57
|
| Rate for Payer: BCN Medicare Advantage |
$387.00
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$1,393.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$445.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: PACE Senior Care Partners |
$367.65
|
| Rate for Payer: PACE SWMI |
$387.00
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: PHP Medicare Advantage |
$387.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,346.76
|
| Rate for Payer: Priority Health Medicare |
$390.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.16
|
| Rate for Payer: Railroad Medicare Medicare |
$387.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,362.24
|
| Rate for Payer: UHC Core |
$1,292.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.00
|
| Rate for Payer: UHC Exchange |
$387.00
|
| Rate for Payer: UHC Medicare Advantage |
$387.00
|
| Rate for Payer: VA VA |
$387.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.00
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
HCPCS 00603
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$631.60 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Aetna Medicare |
$789.50
|
| Rate for Payer: BCBS Complete |
$631.60
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.35
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Facility
|
IP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,006.20 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.63
|
| Rate for Payer: BCN Commercial |
$1,196.29
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,393.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,346.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,362.24
|
| Rate for Payer: UHC Core |
$1,292.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.00
|
|
|
HC DEVICE NOT RETURNED APNEALINK PLUS
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
HCPCS 00603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$631.60 |
| Max. Negotiated Rate |
$1,026.35 |
| Rate for Payer: Aetna Medicare |
$789.50
|
| Rate for Payer: BCBS Complete |
$631.60
|
| Rate for Payer: Cash Price |
$1,263.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.35
|
|
