|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
IP
|
$9.76
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: BCBS Trust/PPO |
$8.06
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$8.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.81
|
| Rate for Payer: Healthscope Commercial |
$8.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Nomi Health Commercial |
$8.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.32
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.59
|
| Rate for Payer: UHC Core |
$8.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.32
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
OP
|
$9.76
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.05
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: BCBS MAPPO |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$8.02
|
| Rate for Payer: BCN Commercial |
$8.02
|
| Rate for Payer: BCN Medicare Advantage |
$2.44
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$8.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$8.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.32
|
| Rate for Payer: Mclaren Medicaid |
$1.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.56
|
| Rate for Payer: Meridian Medicaid |
$1.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.30
|
| Rate for Payer: Nomi Health Commercial |
$8.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.32
|
| Rate for Payer: PACE Senior Care Partners |
$2.32
|
| Rate for Payer: PACE SWMI |
$2.44
|
| Rate for Payer: PHP Commercial |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$2.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.49
|
| Rate for Payer: Priority Health Medicare |
$2.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.59
|
| Rate for Payer: UHC Core |
$8.15
|
| Rate for Payer: UHC Exchange |
$2.44
|
| Rate for Payer: UHC Medicaid |
$1.72
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: UHCCP Medicaid |
$1.72
|
| Rate for Payer: VA VA |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.32
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
OP
|
$95.93
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$86.34 |
| Rate for Payer: Aetna Commercial |
$81.54
|
| Rate for Payer: Aetna Medicare |
$24.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.98
|
| Rate for Payer: BCBS Complete |
$17.76
|
| Rate for Payer: BCBS MAPPO |
$23.98
|
| Rate for Payer: BCBS Trust/PPO |
$78.86
|
| Rate for Payer: BCN Commercial |
$78.86
|
| Rate for Payer: BCN Medicare Advantage |
$23.98
|
| Rate for Payer: Cash Price |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$86.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.95
|
| Rate for Payer: Mclaren Medicaid |
$16.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.18
|
| Rate for Payer: Meridian Medicaid |
$17.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.54
|
| Rate for Payer: Nomi Health Commercial |
$78.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.95
|
| Rate for Payer: PACE Senior Care Partners |
$22.78
|
| Rate for Payer: PACE SWMI |
$23.98
|
| Rate for Payer: PHP Commercial |
$81.54
|
| Rate for Payer: PHP Medicare Advantage |
$23.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.46
|
| Rate for Payer: Priority Health Medicare |
$24.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.42
|
| Rate for Payer: UHC Core |
$80.10
|
| Rate for Payer: UHC Exchange |
$23.98
|
| Rate for Payer: UHC Medicaid |
$16.91
|
| Rate for Payer: UHC Medicare Advantage |
$23.98
|
| Rate for Payer: UHCCP Medicaid |
$16.91
|
| Rate for Payer: VA VA |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.95
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
IP
|
$95.93
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.77 |
| Max. Negotiated Rate |
$86.34 |
| Rate for Payer: Aetna Commercial |
$81.54
|
| Rate for Payer: BCBS Trust/PPO |
$79.23
|
| Rate for Payer: BCN Commercial |
$79.23
|
| Rate for Payer: Cash Price |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.74
|
| Rate for Payer: Healthscope Commercial |
$86.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.54
|
| Rate for Payer: Nomi Health Commercial |
$78.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.95
|
| Rate for Payer: PHP Commercial |
$81.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.42
|
| Rate for Payer: UHC Core |
$80.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.95
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$19.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.41
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$18.73
|
| Rate for Payer: BCBS Trust/PPO |
$61.58
|
| Rate for Payer: BCN Commercial |
$61.58
|
| Rate for Payer: BCN Medicare Advantage |
$18.73
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.73
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.66
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: PACE Senior Care Partners |
$17.79
|
| Rate for Payer: PACE SWMI |
$18.73
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: PHP Medicare Advantage |
$18.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.17
|
| Rate for Payer: Priority Health Medicare |
$18.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.14
|
| Rate for Payer: Railroad Medicare Medicare |
$18.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.92
|
| Rate for Payer: UHC Core |
$62.55
|
| Rate for Payer: UHC Exchange |
$18.73
|
| Rate for Payer: UHC Medicaid |
$13.21
|
| Rate for Payer: UHC Medicare Advantage |
$18.73
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| Rate for Payer: VA VA |
$18.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.18
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.87
|
| Rate for Payer: BCN Commercial |
$61.87
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.92
|
| Rate for Payer: UHC Core |
$62.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.18
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.61
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS MAPPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Medicare Advantage |
$9.29
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.75
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.82
|
| Rate for Payer: PACE SWMI |
$9.29
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$9.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Medicare |
$9.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: UHC Exchange |
$9.29
|
| Rate for Payer: UHC Medicaid |
$6.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: UHCCP Medicaid |
$6.55
|
| Rate for Payer: VA VA |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.54
|
| Rate for Payer: BCN Commercial |
$131.54
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC GOLDENROD IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GOLDENROD IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
OP
|
$624.69
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.13 |
| Max. Negotiated Rate |
$562.22 |
| Rate for Payer: Aetna Commercial |
$530.99
|
| Rate for Payer: Aetna Medicare |
$162.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$195.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$195.22
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$156.17
|
| Rate for Payer: BCBS Trust/PPO |
$513.56
|
| Rate for Payer: BCN Commercial |
$513.56
|
| Rate for Payer: BCN Medicare Advantage |
$156.17
|
| Rate for Payer: Cash Price |
$499.75
|
| Rate for Payer: Cofinity Commercial |
$537.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.17
|
| Rate for Payer: Healthscope Commercial |
$562.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.52
|
| Rate for Payer: Mclaren Medicaid |
$110.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.98
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.99
|
| Rate for Payer: Nomi Health Commercial |
$512.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.52
|
| Rate for Payer: PACE Senior Care Partners |
$148.36
|
| Rate for Payer: PACE SWMI |
$156.17
|
| Rate for Payer: PHP Commercial |
$530.99
|
| Rate for Payer: PHP Medicare Advantage |
$156.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$543.48
|
| Rate for Payer: Priority Health Medicare |
$157.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.78
|
| Rate for Payer: Railroad Medicare Medicare |
$156.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.73
|
| Rate for Payer: UHC Core |
$521.62
|
| Rate for Payer: UHC Exchange |
$156.17
|
| Rate for Payer: UHC Medicaid |
$110.13
|
| Rate for Payer: UHC Medicare Advantage |
$156.17
|
| Rate for Payer: UHCCP Medicaid |
$110.13
|
| Rate for Payer: VA VA |
$156.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.52
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
IP
|
$624.69
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$434.78 |
| Max. Negotiated Rate |
$562.22 |
| Rate for Payer: Aetna Commercial |
$530.99
|
| Rate for Payer: BCBS Trust/PPO |
$515.93
|
| Rate for Payer: BCN Commercial |
$515.93
|
| Rate for Payer: Cash Price |
$499.75
|
| Rate for Payer: Cofinity Commercial |
$537.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.75
|
| Rate for Payer: Healthscope Commercial |
$562.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.99
|
| Rate for Payer: Nomi Health Commercial |
$512.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.52
|
| Rate for Payer: PHP Commercial |
$530.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$543.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.73
|
| Rate for Payer: UHC Core |
$521.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.52
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
IP
|
$778.23
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$541.65 |
| Max. Negotiated Rate |
$700.41 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: BCBS Trust/PPO |
$642.74
|
| Rate for Payer: BCN Commercial |
$642.74
|
| Rate for Payer: Cash Price |
$622.58
|
| Rate for Payer: Cofinity Commercial |
$669.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.58
|
| Rate for Payer: Healthscope Commercial |
$700.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.50
|
| Rate for Payer: Nomi Health Commercial |
$638.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.67
|
| Rate for Payer: PHP Commercial |
$661.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$677.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$541.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.84
|
| Rate for Payer: UHC Core |
$649.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.67
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
OP
|
$778.23
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$700.41 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Medicare |
$202.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.20
|
| Rate for Payer: BCBS Complete |
$144.05
|
| Rate for Payer: BCBS MAPPO |
$194.56
|
| Rate for Payer: BCBS Trust/PPO |
$639.78
|
| Rate for Payer: BCN Commercial |
$639.78
|
| Rate for Payer: BCN Medicare Advantage |
$194.56
|
| Rate for Payer: Cash Price |
$622.58
|
| Rate for Payer: Cofinity Commercial |
$669.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$700.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.67
|
| Rate for Payer: Mclaren Medicaid |
$137.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.29
|
| Rate for Payer: Meridian Medicaid |
$144.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.50
|
| Rate for Payer: Nomi Health Commercial |
$638.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.67
|
| Rate for Payer: PACE Senior Care Partners |
$184.83
|
| Rate for Payer: PACE SWMI |
$194.56
|
| Rate for Payer: PHP Commercial |
$661.50
|
| Rate for Payer: PHP Medicare Advantage |
$194.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$677.06
|
| Rate for Payer: Priority Health Medicare |
$196.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$541.65
|
| Rate for Payer: Railroad Medicare Medicare |
$194.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.84
|
| Rate for Payer: UHC Core |
$649.82
|
| Rate for Payer: UHC Exchange |
$194.56
|
| Rate for Payer: UHC Medicaid |
$137.20
|
| Rate for Payer: UHC Medicare Advantage |
$194.56
|
| Rate for Payer: UHCCP Medicaid |
$137.20
|
| Rate for Payer: VA VA |
$194.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.67
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$787.95
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.92 |
| Max. Negotiated Rate |
$709.15 |
| Rate for Payer: Aetna Commercial |
$669.76
|
| Rate for Payer: Aetna Medicare |
$204.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.23
|
| Rate for Payer: BCBS Complete |
$145.85
|
| Rate for Payer: BCBS MAPPO |
$196.99
|
| Rate for Payer: BCBS Trust/PPO |
$647.77
|
| Rate for Payer: BCN Commercial |
$647.77
|
| Rate for Payer: BCN Medicare Advantage |
$196.99
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cofinity Commercial |
$677.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.99
|
| Rate for Payer: Healthscope Commercial |
$709.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.96
|
| Rate for Payer: Mclaren Medicaid |
$138.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.84
|
| Rate for Payer: Meridian Medicaid |
$145.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$216.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.76
|
| Rate for Payer: Nomi Health Commercial |
$646.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$590.96
|
| Rate for Payer: PACE Senior Care Partners |
$187.14
|
| Rate for Payer: PACE SWMI |
$196.99
|
| Rate for Payer: PHP Commercial |
$669.76
|
| Rate for Payer: PHP Medicare Advantage |
$196.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$685.52
|
| Rate for Payer: Priority Health Medicare |
$198.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$548.41
|
| Rate for Payer: Railroad Medicare Medicare |
$196.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.40
|
| Rate for Payer: UHC Core |
$657.94
|
| Rate for Payer: UHC Exchange |
$196.99
|
| Rate for Payer: UHC Medicaid |
$138.92
|
| Rate for Payer: UHC Medicare Advantage |
$196.99
|
| Rate for Payer: UHCCP Medicaid |
$138.92
|
| Rate for Payer: VA VA |
$196.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.96
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$787.95
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$548.41 |
| Max. Negotiated Rate |
$709.15 |
| Rate for Payer: Aetna Commercial |
$669.76
|
| Rate for Payer: BCBS Trust/PPO |
$650.77
|
| Rate for Payer: BCN Commercial |
$650.77
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cofinity Commercial |
$677.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.36
|
| Rate for Payer: Healthscope Commercial |
$709.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.76
|
| Rate for Payer: Nomi Health Commercial |
$646.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$590.96
|
| Rate for Payer: PHP Commercial |
$669.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$685.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$548.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.40
|
| Rate for Payer: UHC Core |
$657.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.96
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$486.40
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.53 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Aetna Commercial |
$413.44
|
| Rate for Payer: BCBS Trust/PPO |
$401.72
|
| Rate for Payer: BCN Commercial |
$401.72
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cofinity Commercial |
$418.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.12
|
| Rate for Payer: Healthscope Commercial |
$437.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.44
|
| Rate for Payer: Nomi Health Commercial |
$398.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.80
|
| Rate for Payer: PHP Commercial |
$413.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$423.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.03
|
| Rate for Payer: UHC Core |
$406.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.80
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$486.40
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Aetna Commercial |
$413.44
|
| Rate for Payer: Aetna Medicare |
$126.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.00
|
| Rate for Payer: BCBS Complete |
$90.03
|
| Rate for Payer: BCBS MAPPO |
$121.60
|
| Rate for Payer: BCBS Trust/PPO |
$399.87
|
| Rate for Payer: BCN Commercial |
$399.87
|
| Rate for Payer: BCN Medicare Advantage |
$121.60
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cofinity Commercial |
$418.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.60
|
| Rate for Payer: Healthscope Commercial |
$437.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.80
|
| Rate for Payer: Mclaren Medicaid |
$85.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.68
|
| Rate for Payer: Meridian Medicaid |
$90.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.44
|
| Rate for Payer: Nomi Health Commercial |
$398.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.80
|
| Rate for Payer: PACE Senior Care Partners |
$115.52
|
| Rate for Payer: PACE SWMI |
$121.60
|
| Rate for Payer: PHP Commercial |
$413.44
|
| Rate for Payer: PHP Medicare Advantage |
$121.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$423.17
|
| Rate for Payer: Priority Health Medicare |
$122.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.53
|
| Rate for Payer: Railroad Medicare Medicare |
$121.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.03
|
| Rate for Payer: UHC Core |
$406.14
|
| Rate for Payer: UHC Exchange |
$121.60
|
| Rate for Payer: UHC Medicaid |
$85.75
|
| Rate for Payer: UHC Medicare Advantage |
$121.60
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: VA VA |
$121.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.80
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
OP
|
$343.19
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$308.87 |
| Rate for Payer: Aetna Commercial |
$291.71
|
| Rate for Payer: Aetna Medicare |
$89.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.25
|
| Rate for Payer: BCBS Complete |
$63.52
|
| Rate for Payer: BCBS MAPPO |
$85.80
|
| Rate for Payer: BCBS Trust/PPO |
$282.14
|
| Rate for Payer: BCN Commercial |
$282.14
|
| Rate for Payer: BCN Medicare Advantage |
$85.80
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cofinity Commercial |
$295.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.80
|
| Rate for Payer: Healthscope Commercial |
$308.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.39
|
| Rate for Payer: Mclaren Medicaid |
$60.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.09
|
| Rate for Payer: Meridian Medicaid |
$63.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$94.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.71
|
| Rate for Payer: Nomi Health Commercial |
$281.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.39
|
| Rate for Payer: PACE Senior Care Partners |
$81.51
|
| Rate for Payer: PACE SWMI |
$85.80
|
| Rate for Payer: PHP Commercial |
$291.71
|
| Rate for Payer: PHP Medicare Advantage |
$85.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.58
|
| Rate for Payer: Priority Health Medicare |
$86.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.86
|
| Rate for Payer: Railroad Medicare Medicare |
$85.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.01
|
| Rate for Payer: UHC Core |
$286.56
|
| Rate for Payer: UHC Exchange |
$85.80
|
| Rate for Payer: UHC Medicaid |
$60.50
|
| Rate for Payer: UHC Medicare Advantage |
$85.80
|
| Rate for Payer: UHCCP Medicaid |
$60.50
|
| Rate for Payer: VA VA |
$85.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.39
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
IP
|
$343.19
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.86 |
| Max. Negotiated Rate |
$308.87 |
| Rate for Payer: Aetna Commercial |
$291.71
|
| Rate for Payer: BCBS Trust/PPO |
$283.44
|
| Rate for Payer: BCN Commercial |
$283.44
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cofinity Commercial |
$295.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.55
|
| Rate for Payer: Healthscope Commercial |
$308.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.71
|
| Rate for Payer: Nomi Health Commercial |
$281.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.39
|
| Rate for Payer: PHP Commercial |
$291.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.01
|
| Rate for Payer: UHC Core |
$286.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.39
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
OP
|
$283.54
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$255.19 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Aetna Medicare |
$73.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.61
|
| Rate for Payer: BCBS Complete |
$52.48
|
| Rate for Payer: BCBS MAPPO |
$70.89
|
| Rate for Payer: BCBS Trust/PPO |
$233.10
|
| Rate for Payer: BCN Commercial |
$233.10
|
| Rate for Payer: BCN Medicare Advantage |
$70.89
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cofinity Commercial |
$243.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.89
|
| Rate for Payer: Healthscope Commercial |
$255.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.66
|
| Rate for Payer: Mclaren Medicaid |
$49.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.43
|
| Rate for Payer: Meridian Medicaid |
$52.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$232.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.66
|
| Rate for Payer: PACE Senior Care Partners |
$67.34
|
| Rate for Payer: PACE SWMI |
$70.89
|
| Rate for Payer: PHP Commercial |
$241.01
|
| Rate for Payer: PHP Medicare Advantage |
$70.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$246.68
|
| Rate for Payer: Priority Health Medicare |
$71.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.34
|
| Rate for Payer: Railroad Medicare Medicare |
$70.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.52
|
| Rate for Payer: UHC Core |
$236.76
|
| Rate for Payer: UHC Exchange |
$70.89
|
| Rate for Payer: UHC Medicaid |
$49.99
|
| Rate for Payer: UHC Medicare Advantage |
$70.89
|
| Rate for Payer: UHCCP Medicaid |
$49.99
|
| Rate for Payer: VA VA |
$70.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.66
|
|
