|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,427.92
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,051.63 |
| Max. Negotiated Rate |
$3,985.13 |
| Rate for Payer: Aetna Commercial |
$3,763.73
|
| Rate for Payer: Aetna Medicare |
$1,151.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,383.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,383.72
|
| Rate for Payer: BCBS Complete |
$1,771.17
|
| Rate for Payer: BCBS MAPPO |
$1,106.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,442.71
|
| Rate for Payer: BCN Commercial |
$3,442.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,106.98
|
| Rate for Payer: Cash Price |
$3,542.34
|
| Rate for Payer: Cofinity Commercial |
$3,808.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,106.98
|
| Rate for Payer: Healthscope Commercial |
$3,985.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,320.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,162.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,273.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,763.73
|
| Rate for Payer: PACE Senior Care Partners |
$1,051.63
|
| Rate for Payer: PACE SWMI |
$1,106.98
|
| Rate for Payer: PHP Commercial |
$3,763.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,106.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,099.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,852.29
|
| Rate for Payer: Priority Health Medicare |
$1,106.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,700.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,106.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,896.57
|
| Rate for Payer: UHC Core |
$3,697.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,106.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,140.19
|
| Rate for Payer: VA VA |
$1,106.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,320.94
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,427.92
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,700.59 |
| Max. Negotiated Rate |
$3,985.13 |
| Rate for Payer: Aetna Commercial |
$3,763.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,421.90
|
| Rate for Payer: BCN Commercial |
$3,421.90
|
| Rate for Payer: Cash Price |
$3,542.34
|
| Rate for Payer: Cofinity Commercial |
$3,808.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.34
|
| Rate for Payer: Healthscope Commercial |
$3,985.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,320.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,763.73
|
| Rate for Payer: PHP Commercial |
$3,763.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,099.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,852.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,700.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,896.57
|
| Rate for Payer: UHC Core |
$3,697.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,320.94
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$18.92
|
| Rate for Payer: BCN Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$19.03
|
| Rate for Payer: BCN Commercial |
$19.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PACE Senior Care Partners |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$6.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.30
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.44
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$33.43
|
| Rate for Payer: BCN Commercial |
$33.43
|
| Rate for Payer: BCN Medicare Advantage |
$10.75
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PACE Senior Care Partners |
$10.21
|
| Rate for Payer: PACE SWMI |
$10.75
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: PHP Medicare Advantage |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.41
|
| Rate for Payer: Priority Health Medicare |
$10.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.23
|
| Rate for Payer: Railroad Medicare Medicare |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$11.07
|
| Rate for Payer: VA VA |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: BCBS Trust/PPO |
$33.23
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$406.40
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.52 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: Aetna Medicare |
$105.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.00
|
| Rate for Payer: BCBS Complete |
$162.56
|
| Rate for Payer: BCBS MAPPO |
$101.60
|
| Rate for Payer: BCBS Trust/PPO |
$315.98
|
| Rate for Payer: BCN Commercial |
$315.98
|
| Rate for Payer: BCN Medicare Advantage |
$101.60
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.60
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PACE Senior Care Partners |
$96.52
|
| Rate for Payer: PACE SWMI |
$101.60
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: PHP Medicare Advantage |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.57
|
| Rate for Payer: Priority Health Medicare |
$101.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.86
|
| Rate for Payer: Railroad Medicare Medicare |
$101.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.63
|
| Rate for Payer: UHC Core |
$339.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.60
|
| Rate for Payer: UHC Medicare Advantage |
$104.65
|
| Rate for Payer: VA VA |
$101.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.80
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$406.40
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.86 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: BCBS Trust/PPO |
$314.07
|
| Rate for Payer: BCN Commercial |
$314.07
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.12
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.63
|
| Rate for Payer: UHC Core |
$339.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.80
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$929.67
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$836.70 |
| Rate for Payer: Aetna Commercial |
$790.22
|
| Rate for Payer: BCBS Trust/PPO |
$718.45
|
| Rate for Payer: BCN Commercial |
$718.45
|
| Rate for Payer: Cash Price |
$743.74
|
| Rate for Payer: Cofinity Commercial |
$799.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.74
|
| Rate for Payer: Healthscope Commercial |
$836.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$790.22
|
| Rate for Payer: PHP Commercial |
$790.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$808.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$567.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.11
|
| Rate for Payer: UHC Core |
$776.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.25
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$929.67
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$836.70 |
| Rate for Payer: Aetna Commercial |
$790.22
|
| Rate for Payer: Aetna Medicare |
$241.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.52
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$232.42
|
| Rate for Payer: BCBS Trust/PPO |
$722.82
|
| Rate for Payer: BCN Commercial |
$722.82
|
| Rate for Payer: BCN Medicare Advantage |
$232.42
|
| Rate for Payer: Cash Price |
$743.74
|
| Rate for Payer: Cash Price |
$743.74
|
| Rate for Payer: Cofinity Commercial |
$799.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.42
|
| Rate for Payer: Healthscope Commercial |
$836.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.25
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$244.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$790.22
|
| Rate for Payer: PACE Senior Care Partners |
$220.80
|
| Rate for Payer: PACE SWMI |
$232.42
|
| Rate for Payer: PHP Commercial |
$790.22
|
| Rate for Payer: PHP Medicare Advantage |
$232.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$808.81
|
| Rate for Payer: Priority Health Medicare |
$232.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$567.01
|
| Rate for Payer: Railroad Medicare Medicare |
$232.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.11
|
| Rate for Payer: UHC Core |
$776.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.42
|
| Rate for Payer: UHC Medicare Advantage |
$239.39
|
| Rate for Payer: VA VA |
$232.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.25
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$211.74
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.14 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna Commercial |
$179.98
|
| Rate for Payer: BCBS Trust/PPO |
$163.63
|
| Rate for Payer: BCN Commercial |
$163.63
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.39
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.98
|
| Rate for Payer: PHP Commercial |
$179.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.33
|
| Rate for Payer: UHC Core |
$176.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.80
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$211.74
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.29 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna Commercial |
$179.98
|
| Rate for Payer: Aetna Medicare |
$55.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.17
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$52.94
|
| Rate for Payer: BCBS Trust/PPO |
$164.63
|
| Rate for Payer: BCN Commercial |
$164.63
|
| Rate for Payer: BCN Medicare Advantage |
$52.94
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.94
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.80
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.98
|
| Rate for Payer: PACE Senior Care Partners |
$50.29
|
| Rate for Payer: PACE SWMI |
$52.94
|
| Rate for Payer: PHP Commercial |
$179.98
|
| Rate for Payer: PHP Medicare Advantage |
$52.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.21
|
| Rate for Payer: Priority Health Medicare |
$52.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.14
|
| Rate for Payer: Railroad Medicare Medicare |
$52.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.33
|
| Rate for Payer: UHC Core |
$176.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.94
|
| Rate for Payer: UHC Medicare Advantage |
$54.52
|
| Rate for Payer: VA VA |
$52.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.80
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$604.35
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.53 |
| Max. Negotiated Rate |
$543.92 |
| Rate for Payer: Aetna Commercial |
$513.70
|
| Rate for Payer: Aetna Medicare |
$157.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.86
|
| Rate for Payer: BCBS Complete |
$241.74
|
| Rate for Payer: BCBS MAPPO |
$151.09
|
| Rate for Payer: BCBS Trust/PPO |
$469.88
|
| Rate for Payer: BCN Commercial |
$469.88
|
| Rate for Payer: BCN Medicare Advantage |
$151.09
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cofinity Commercial |
$519.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.09
|
| Rate for Payer: Healthscope Commercial |
$543.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.70
|
| Rate for Payer: PACE Senior Care Partners |
$143.53
|
| Rate for Payer: PACE SWMI |
$151.09
|
| Rate for Payer: PHP Commercial |
$513.70
|
| Rate for Payer: PHP Medicare Advantage |
$151.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.78
|
| Rate for Payer: Priority Health Medicare |
$151.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.59
|
| Rate for Payer: Railroad Medicare Medicare |
$151.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.83
|
| Rate for Payer: UHC Core |
$504.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.09
|
| Rate for Payer: UHC Medicare Advantage |
$155.62
|
| Rate for Payer: VA VA |
$151.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.26
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$604.35
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$368.59 |
| Max. Negotiated Rate |
$543.92 |
| Rate for Payer: Aetna Commercial |
$513.70
|
| Rate for Payer: BCBS Trust/PPO |
$467.04
|
| Rate for Payer: BCN Commercial |
$467.04
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cofinity Commercial |
$519.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.48
|
| Rate for Payer: Healthscope Commercial |
$543.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.70
|
| Rate for Payer: PHP Commercial |
$513.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.83
|
| Rate for Payer: UHC Core |
$504.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.26
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$322.52
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$290.27 |
| Rate for Payer: Aetna Commercial |
$274.14
|
| Rate for Payer: Aetna Medicare |
$83.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.79
|
| Rate for Payer: BCBS Complete |
$129.01
|
| Rate for Payer: BCBS MAPPO |
$80.63
|
| Rate for Payer: BCBS Trust/PPO |
$250.76
|
| Rate for Payer: BCN Commercial |
$250.76
|
| Rate for Payer: BCN Medicare Advantage |
$80.63
|
| Rate for Payer: Cash Price |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$277.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.63
|
| Rate for Payer: Healthscope Commercial |
$290.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.14
|
| Rate for Payer: PACE Senior Care Partners |
$76.60
|
| Rate for Payer: PACE SWMI |
$80.63
|
| Rate for Payer: PHP Commercial |
$274.14
|
| Rate for Payer: PHP Medicare Advantage |
$80.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.59
|
| Rate for Payer: Priority Health Medicare |
$80.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.70
|
| Rate for Payer: Railroad Medicare Medicare |
$80.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.82
|
| Rate for Payer: UHC Core |
$269.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.63
|
| Rate for Payer: UHC Medicare Advantage |
$83.05
|
| Rate for Payer: VA VA |
$80.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.89
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$322.52
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$290.27 |
| Rate for Payer: Aetna Commercial |
$274.14
|
| Rate for Payer: BCBS Trust/PPO |
$249.24
|
| Rate for Payer: BCN Commercial |
$249.24
|
| Rate for Payer: Cash Price |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$277.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.02
|
| Rate for Payer: Healthscope Commercial |
$290.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.14
|
| Rate for Payer: PHP Commercial |
$274.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.82
|
| Rate for Payer: UHC Core |
$269.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.89
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$302.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.69 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: BCBS Trust/PPO |
$234.02
|
| Rate for Payer: BCN Commercial |
$234.02
|
| Rate for Payer: Cash Price |
$242.26
|
| Rate for Payer: Cofinity Commercial |
$260.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.26
|
| Rate for Payer: Healthscope Commercial |
$272.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.40
|
| Rate for Payer: PHP Commercial |
$257.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.48
|
| Rate for Payer: UHC Core |
$252.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.12
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$302.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.92 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Medicare |
$78.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.63
|
| Rate for Payer: BCBS Complete |
$121.13
|
| Rate for Payer: BCBS MAPPO |
$75.70
|
| Rate for Payer: BCBS Trust/PPO |
$235.44
|
| Rate for Payer: BCN Commercial |
$235.44
|
| Rate for Payer: BCN Medicare Advantage |
$75.70
|
| Rate for Payer: Cash Price |
$242.26
|
| Rate for Payer: Cofinity Commercial |
$260.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.70
|
| Rate for Payer: Healthscope Commercial |
$272.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.40
|
| Rate for Payer: PACE Senior Care Partners |
$71.92
|
| Rate for Payer: PACE SWMI |
$75.70
|
| Rate for Payer: PHP Commercial |
$257.40
|
| Rate for Payer: PHP Medicare Advantage |
$75.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.45
|
| Rate for Payer: Priority Health Medicare |
$75.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.69
|
| Rate for Payer: Railroad Medicare Medicare |
$75.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.48
|
| Rate for Payer: UHC Core |
$252.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.70
|
| Rate for Payer: UHC Medicare Advantage |
$77.98
|
| Rate for Payer: VA VA |
$75.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.12
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$292.19
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$262.97 |
| Rate for Payer: Aetna Commercial |
$248.36
|
| Rate for Payer: BCBS Trust/PPO |
$225.80
|
| Rate for Payer: BCN Commercial |
$225.80
|
| Rate for Payer: Cash Price |
$233.75
|
| Rate for Payer: Cofinity Commercial |
$251.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.75
|
| Rate for Payer: Healthscope Commercial |
$262.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.36
|
| Rate for Payer: PHP Commercial |
$248.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.13
|
| Rate for Payer: UHC Core |
$243.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.14
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$292.19
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$262.97 |
| Rate for Payer: Aetna Commercial |
$248.36
|
| Rate for Payer: Aetna Medicare |
$75.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.31
|
| Rate for Payer: BCBS Complete |
$116.88
|
| Rate for Payer: BCBS MAPPO |
$73.05
|
| Rate for Payer: BCBS Trust/PPO |
$227.18
|
| Rate for Payer: BCN Commercial |
$227.18
|
| Rate for Payer: BCN Medicare Advantage |
$73.05
|
| Rate for Payer: Cash Price |
$233.75
|
| Rate for Payer: Cofinity Commercial |
$251.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.05
|
| Rate for Payer: Healthscope Commercial |
$262.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.36
|
| Rate for Payer: PACE Senior Care Partners |
$69.40
|
| Rate for Payer: PACE SWMI |
$73.05
|
| Rate for Payer: PHP Commercial |
$248.36
|
| Rate for Payer: PHP Medicare Advantage |
$73.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.21
|
| Rate for Payer: Priority Health Medicare |
$73.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.21
|
| Rate for Payer: Railroad Medicare Medicare |
$73.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.13
|
| Rate for Payer: UHC Core |
$243.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.24
|
| Rate for Payer: VA VA |
$73.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.14
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$227.11
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna Commercial |
$193.04
|
| Rate for Payer: Aetna Medicare |
$59.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.97
|
| Rate for Payer: BCBS Complete |
$90.84
|
| Rate for Payer: BCBS MAPPO |
$56.78
|
| Rate for Payer: BCBS Trust/PPO |
$176.58
|
| Rate for Payer: BCN Commercial |
$176.58
|
| Rate for Payer: BCN Medicare Advantage |
$56.78
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Commercial |
$195.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.78
|
| Rate for Payer: Healthscope Commercial |
$204.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.04
|
| Rate for Payer: PACE Senior Care Partners |
$53.94
|
| Rate for Payer: PACE SWMI |
$56.78
|
| Rate for Payer: PHP Commercial |
$193.04
|
| Rate for Payer: PHP Medicare Advantage |
$56.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.59
|
| Rate for Payer: Priority Health Medicare |
$56.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.51
|
| Rate for Payer: Railroad Medicare Medicare |
$56.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.86
|
| Rate for Payer: UHC Core |
$189.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.78
|
| Rate for Payer: UHC Medicare Advantage |
$58.48
|
| Rate for Payer: VA VA |
$56.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.33
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$227.11
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.51 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna Commercial |
$193.04
|
| Rate for Payer: BCBS Trust/PPO |
$175.51
|
| Rate for Payer: BCN Commercial |
$175.51
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cofinity Commercial |
$195.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.69
|
| Rate for Payer: Healthscope Commercial |
$204.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.04
|
| Rate for Payer: PHP Commercial |
$193.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.86
|
| Rate for Payer: UHC Core |
$189.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.33
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$159.38
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$143.44 |
| Rate for Payer: Aetna Commercial |
$135.47
|
| Rate for Payer: Aetna Medicare |
$41.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.81
|
| Rate for Payer: BCBS Complete |
$63.75
|
| Rate for Payer: BCBS MAPPO |
$39.84
|
| Rate for Payer: BCBS Trust/PPO |
$123.92
|
| Rate for Payer: BCN Commercial |
$123.92
|
| Rate for Payer: BCN Medicare Advantage |
$39.84
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cofinity Commercial |
$137.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.84
|
| Rate for Payer: Healthscope Commercial |
$143.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.47
|
| Rate for Payer: PACE Senior Care Partners |
$37.85
|
| Rate for Payer: PACE SWMI |
$39.84
|
| Rate for Payer: PHP Commercial |
$135.47
|
| Rate for Payer: PHP Medicare Advantage |
$39.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.66
|
| Rate for Payer: Priority Health Medicare |
$39.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.21
|
| Rate for Payer: Railroad Medicare Medicare |
$39.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.25
|
| Rate for Payer: UHC Core |
$133.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.84
|
| Rate for Payer: UHC Medicare Advantage |
$41.04
|
| Rate for Payer: VA VA |
$39.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.54
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$159.38
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$143.44 |
| Rate for Payer: Aetna Commercial |
$135.47
|
| Rate for Payer: BCBS Trust/PPO |
$123.17
|
| Rate for Payer: BCN Commercial |
$123.17
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cofinity Commercial |
$137.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.50
|
| Rate for Payer: Healthscope Commercial |
$143.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.47
|
| Rate for Payer: PHP Commercial |
$135.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.25
|
| Rate for Payer: UHC Core |
$133.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.54
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$141.11
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna Commercial |
$119.94
|
| Rate for Payer: Aetna Medicare |
$36.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.10
|
| Rate for Payer: BCBS Complete |
$56.44
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCBS Trust/PPO |
$109.71
|
| Rate for Payer: BCN Commercial |
$109.71
|
| Rate for Payer: BCN Medicare Advantage |
$35.28
|
| Rate for Payer: Cash Price |
$112.89
|
| Rate for Payer: Cofinity Commercial |
$121.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.28
|
| Rate for Payer: Healthscope Commercial |
$127.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.94
|
| Rate for Payer: PACE Senior Care Partners |
$33.51
|
| Rate for Payer: PACE SWMI |
$35.28
|
| Rate for Payer: PHP Commercial |
$119.94
|
| Rate for Payer: PHP Medicare Advantage |
$35.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.77
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.06
|
| Rate for Payer: Railroad Medicare Medicare |
$35.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.18
|
| Rate for Payer: UHC Core |
$117.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.28
|
| Rate for Payer: UHC Medicare Advantage |
$36.34
|
| Rate for Payer: VA VA |
$35.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.83
|
|
