|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
IP
|
$9.57
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: BCBS Trust/PPO |
$7.81
|
| Rate for Payer: BCN Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO |
$8.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.42
|
| Rate for Payer: UHC Core |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
OP
|
$9.57
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Medicare |
$2.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.99
|
| Rate for Payer: BCBS Complete |
$2.49
|
| Rate for Payer: BCBS MAPPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$7.87
|
| Rate for Payer: BCN Commercial |
$7.44
|
| Rate for Payer: BCN Medicare Advantage |
$2.39
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: Mclaren Medicaid |
$2.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$7.85
|
| Rate for Payer: PACE Senior Care Partners |
$2.27
|
| Rate for Payer: PACE SWMI |
$2.39
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: PHP Medicare Advantage |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO |
$8.33
|
| Rate for Payer: Priority Health Medicare |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.42
|
| Rate for Payer: UHC Core |
$7.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.39
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UHC Medicare Advantage |
$2.39
|
| Rate for Payer: UHCCP Medicaid |
$2.37
|
| Rate for Payer: VA VA |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$24.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.39
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$23.51
|
| Rate for Payer: BCBS Trust/PPO |
$77.32
|
| Rate for Payer: BCN Commercial |
$73.12
|
| Rate for Payer: BCN Medicare Advantage |
$23.51
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.54
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.69
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: PACE Senior Care Partners |
$22.34
|
| Rate for Payer: PACE SWMI |
$23.51
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$23.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health HMO/PPO |
$81.82
|
| Rate for Payer: Priority Health Medicare |
$23.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.01
|
| Rate for Payer: Railroad Medicare Medicare |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.76
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.51
|
| Rate for Payer: UHC Exchange |
$23.51
|
| Rate for Payer: UHC Medicare Advantage |
$23.51
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.54
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: BCBS Trust/PPO |
$76.77
|
| Rate for Payer: BCN Commercial |
$72.68
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health HMO/PPO |
$81.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.76
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.54
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$59.95
|
| Rate for Payer: BCN Commercial |
$56.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.38
|
| Rate for Payer: BCN Commercial |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$17.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.36
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.93
|
| Rate for Payer: BCN Commercial |
$28.31
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$7.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.56
|
| Rate for Payer: Meridian Medicaid |
$7.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.65
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$7.02
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC GOLDENROD IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC GOLDENROD IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
OP
|
$612.44
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$551.20 |
| Rate for Payer: Aetna Commercial |
$520.57
|
| Rate for Payer: Aetna Medicare |
$159.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.39
|
| Rate for Payer: BCBS Complete |
$244.98
|
| Rate for Payer: BCBS MAPPO |
$153.11
|
| Rate for Payer: BCBS Trust/PPO |
$503.49
|
| Rate for Payer: BCN Commercial |
$476.17
|
| Rate for Payer: BCN Medicare Advantage |
$153.11
|
| Rate for Payer: Cash Price |
$489.95
|
| Rate for Payer: Cofinity Commercial |
$526.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.11
|
| Rate for Payer: Healthscope Commercial |
$551.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.57
|
| Rate for Payer: Nomi Health Commercial |
$502.20
|
| Rate for Payer: PACE Senior Care Partners |
$145.45
|
| Rate for Payer: PACE SWMI |
$153.11
|
| Rate for Payer: PHP Commercial |
$520.57
|
| Rate for Payer: PHP Medicare Advantage |
$153.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.09
|
| Rate for Payer: Priority Health HMO/PPO |
$532.82
|
| Rate for Payer: Priority Health Medicare |
$154.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.33
|
| Rate for Payer: Railroad Medicare Medicare |
$153.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.95
|
| Rate for Payer: UHC Core |
$511.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.11
|
| Rate for Payer: UHC Exchange |
$153.11
|
| Rate for Payer: UHC Medicare Advantage |
$153.11
|
| Rate for Payer: VA VA |
$153.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.33
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
IP
|
$612.44
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$398.09 |
| Max. Negotiated Rate |
$551.20 |
| Rate for Payer: Aetna Commercial |
$520.57
|
| Rate for Payer: BCBS Trust/PPO |
$499.93
|
| Rate for Payer: BCN Commercial |
$473.29
|
| Rate for Payer: Cash Price |
$489.95
|
| Rate for Payer: Cofinity Commercial |
$526.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.95
|
| Rate for Payer: Healthscope Commercial |
$551.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.57
|
| Rate for Payer: Nomi Health Commercial |
$502.20
|
| Rate for Payer: PHP Commercial |
$520.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.09
|
| Rate for Payer: Priority Health HMO/PPO |
$532.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.95
|
| Rate for Payer: UHC Core |
$511.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.33
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
IP
|
$762.97
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$495.93 |
| Max. Negotiated Rate |
$686.67 |
| Rate for Payer: Aetna Commercial |
$648.52
|
| Rate for Payer: BCBS Trust/PPO |
$622.81
|
| Rate for Payer: BCN Commercial |
$589.62
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cofinity Commercial |
$656.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.38
|
| Rate for Payer: Healthscope Commercial |
$686.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.52
|
| Rate for Payer: Nomi Health Commercial |
$625.64
|
| Rate for Payer: PHP Commercial |
$648.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health HMO/PPO |
$663.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.41
|
| Rate for Payer: UHC Core |
$637.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.23
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
OP
|
$762.97
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$686.67 |
| Rate for Payer: Aetna Commercial |
$648.52
|
| Rate for Payer: Aetna Medicare |
$198.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.43
|
| Rate for Payer: BCBS Complete |
$305.19
|
| Rate for Payer: BCBS MAPPO |
$190.74
|
| Rate for Payer: BCBS Trust/PPO |
$627.24
|
| Rate for Payer: BCN Commercial |
$593.21
|
| Rate for Payer: BCN Medicare Advantage |
$190.74
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cofinity Commercial |
$656.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.74
|
| Rate for Payer: Healthscope Commercial |
$686.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.52
|
| Rate for Payer: Nomi Health Commercial |
$625.64
|
| Rate for Payer: PACE Senior Care Partners |
$181.21
|
| Rate for Payer: PACE SWMI |
$190.74
|
| Rate for Payer: PHP Commercial |
$648.52
|
| Rate for Payer: PHP Medicare Advantage |
$190.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health HMO/PPO |
$663.78
|
| Rate for Payer: Priority Health Medicare |
$192.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.19
|
| Rate for Payer: Railroad Medicare Medicare |
$190.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.41
|
| Rate for Payer: UHC Core |
$637.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.74
|
| Rate for Payer: UHC Exchange |
$190.74
|
| Rate for Payer: UHC Medicare Advantage |
$190.74
|
| Rate for Payer: VA VA |
$190.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.23
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$772.50
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.47 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$656.62
|
| Rate for Payer: Aetna Medicare |
$200.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$241.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$241.41
|
| Rate for Payer: BCBS Complete |
$309.00
|
| Rate for Payer: BCBS MAPPO |
$193.12
|
| Rate for Payer: BCBS Trust/PPO |
$635.07
|
| Rate for Payer: BCN Commercial |
$600.62
|
| Rate for Payer: BCN Medicare Advantage |
$193.12
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cofinity Commercial |
$664.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.12
|
| Rate for Payer: Healthscope Commercial |
$695.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.62
|
| Rate for Payer: Nomi Health Commercial |
$633.45
|
| Rate for Payer: PACE Senior Care Partners |
$183.47
|
| Rate for Payer: PACE SWMI |
$193.12
|
| Rate for Payer: PHP Commercial |
$656.62
|
| Rate for Payer: PHP Medicare Advantage |
$193.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.12
|
| Rate for Payer: Priority Health HMO/PPO |
$672.08
|
| Rate for Payer: Priority Health Medicare |
$195.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.58
|
| Rate for Payer: Railroad Medicare Medicare |
$193.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$679.80
|
| Rate for Payer: UHC Core |
$645.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.12
|
| Rate for Payer: UHC Exchange |
$193.12
|
| Rate for Payer: UHC Medicare Advantage |
$193.12
|
| Rate for Payer: VA VA |
$193.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.38
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$772.50
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$656.62
|
| Rate for Payer: BCBS Trust/PPO |
$630.59
|
| Rate for Payer: BCN Commercial |
$596.99
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cofinity Commercial |
$664.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.00
|
| Rate for Payer: Healthscope Commercial |
$695.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.62
|
| Rate for Payer: Nomi Health Commercial |
$633.45
|
| Rate for Payer: PHP Commercial |
$656.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.12
|
| Rate for Payer: Priority Health HMO/PPO |
$672.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$517.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$679.80
|
| Rate for Payer: UHC Core |
$645.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.38
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$476.86
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.96 |
| Max. Negotiated Rate |
$429.17 |
| Rate for Payer: Aetna Commercial |
$405.33
|
| Rate for Payer: BCBS Trust/PPO |
$389.26
|
| Rate for Payer: BCN Commercial |
$368.52
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cofinity Commercial |
$410.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.49
|
| Rate for Payer: Healthscope Commercial |
$429.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.33
|
| Rate for Payer: Nomi Health Commercial |
$391.03
|
| Rate for Payer: PHP Commercial |
$405.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.96
|
| Rate for Payer: Priority Health HMO/PPO |
$414.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.64
|
| Rate for Payer: UHC Core |
$398.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.64
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$476.86
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$429.17 |
| Rate for Payer: Aetna Commercial |
$405.33
|
| Rate for Payer: Aetna Medicare |
$123.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.02
|
| Rate for Payer: BCBS Complete |
$190.74
|
| Rate for Payer: BCBS MAPPO |
$119.22
|
| Rate for Payer: BCBS Trust/PPO |
$392.03
|
| Rate for Payer: BCN Commercial |
$370.76
|
| Rate for Payer: BCN Medicare Advantage |
$119.22
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cofinity Commercial |
$410.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.22
|
| Rate for Payer: Healthscope Commercial |
$429.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.33
|
| Rate for Payer: Nomi Health Commercial |
$391.03
|
| Rate for Payer: PACE Senior Care Partners |
$113.25
|
| Rate for Payer: PACE SWMI |
$119.22
|
| Rate for Payer: PHP Commercial |
$405.33
|
| Rate for Payer: PHP Medicare Advantage |
$119.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.96
|
| Rate for Payer: Priority Health HMO/PPO |
$414.87
|
| Rate for Payer: Priority Health Medicare |
$120.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.50
|
| Rate for Payer: Railroad Medicare Medicare |
$119.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.64
|
| Rate for Payer: UHC Core |
$398.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.22
|
| Rate for Payer: UHC Exchange |
$119.22
|
| Rate for Payer: UHC Medicare Advantage |
$119.22
|
| Rate for Payer: VA VA |
$119.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.64
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
IP
|
$336.46
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$218.70 |
| Max. Negotiated Rate |
$302.81 |
| Rate for Payer: Aetna Commercial |
$285.99
|
| Rate for Payer: BCBS Trust/PPO |
$274.65
|
| Rate for Payer: BCN Commercial |
$260.02
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cofinity Commercial |
$289.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.17
|
| Rate for Payer: Healthscope Commercial |
$302.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.99
|
| Rate for Payer: Nomi Health Commercial |
$275.90
|
| Rate for Payer: PHP Commercial |
$285.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.70
|
| Rate for Payer: Priority Health HMO/PPO |
$292.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.08
|
| Rate for Payer: UHC Core |
$280.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.34
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
OP
|
$336.46
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.91 |
| Max. Negotiated Rate |
$302.81 |
| Rate for Payer: Aetna Commercial |
$285.99
|
| Rate for Payer: Aetna Medicare |
$87.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.14
|
| Rate for Payer: BCBS Complete |
$134.58
|
| Rate for Payer: BCBS MAPPO |
$84.12
|
| Rate for Payer: BCBS Trust/PPO |
$276.60
|
| Rate for Payer: BCN Commercial |
$261.60
|
| Rate for Payer: BCN Medicare Advantage |
$84.12
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cofinity Commercial |
$289.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.12
|
| Rate for Payer: Healthscope Commercial |
$302.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.99
|
| Rate for Payer: Nomi Health Commercial |
$275.90
|
| Rate for Payer: PACE Senior Care Partners |
$79.91
|
| Rate for Payer: PACE SWMI |
$84.12
|
| Rate for Payer: PHP Commercial |
$285.99
|
| Rate for Payer: PHP Medicare Advantage |
$84.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.70
|
| Rate for Payer: Priority Health HMO/PPO |
$292.72
|
| Rate for Payer: Priority Health Medicare |
$84.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.43
|
| Rate for Payer: Railroad Medicare Medicare |
$84.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.08
|
| Rate for Payer: UHC Core |
$280.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.12
|
| Rate for Payer: UHC Exchange |
$84.12
|
| Rate for Payer: UHC Medicare Advantage |
$84.12
|
| Rate for Payer: VA VA |
$84.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.34
|
|
