|
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 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 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
|
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 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 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 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 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 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 (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
|
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 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 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 |
$84.11
|
| Rate for Payer: BCBS Trust/PPO |
$276.60
|
| Rate for Payer: BCN Commercial |
$261.60
|
| Rate for Payer: BCN Medicare Advantage |
$84.11
|
| 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 |
$84.11
|
| 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 |
$84.11
|
| Rate for Payer: PHP Commercial |
$285.99
|
| Rate for Payer: PHP Medicare Advantage |
$84.11
|
| 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 |
$84.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.08
|
| Rate for Payer: UHC Core |
$280.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.11
|
| Rate for Payer: UHC Exchange |
$84.11
|
| Rate for Payer: UHC Medicare Advantage |
$84.11
|
| Rate for Payer: VA VA |
$84.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.34
|
|
|
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 4 PER SQ CM
|
Facility
|
IP
|
$277.98
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.69 |
| Max. Negotiated Rate |
$250.18 |
| Rate for Payer: Aetna Commercial |
$236.28
|
| Rate for Payer: BCBS Trust/PPO |
$226.92
|
| Rate for Payer: BCN Commercial |
$214.82
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cofinity Commercial |
$239.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.38
|
| Rate for Payer: Healthscope Commercial |
$250.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.28
|
| Rate for Payer: Nomi Health Commercial |
$227.94
|
| Rate for Payer: PHP Commercial |
$236.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.69
|
| Rate for Payer: Priority Health HMO/PPO |
$241.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.62
|
| Rate for Payer: UHC Core |
$232.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.49
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
OP
|
$277.98
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.02 |
| Max. Negotiated Rate |
$250.18 |
| Rate for Payer: Aetna Commercial |
$236.28
|
| Rate for Payer: Aetna Medicare |
$72.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.87
|
| Rate for Payer: BCBS Complete |
$111.19
|
| Rate for Payer: BCBS MAPPO |
$69.50
|
| Rate for Payer: BCBS Trust/PPO |
$228.53
|
| Rate for Payer: BCN Commercial |
$216.13
|
| Rate for Payer: BCN Medicare Advantage |
$69.50
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cofinity Commercial |
$239.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.50
|
| Rate for Payer: Healthscope Commercial |
$250.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.28
|
| Rate for Payer: Nomi Health Commercial |
$227.94
|
| Rate for Payer: PACE Senior Care Partners |
$66.02
|
| Rate for Payer: PACE SWMI |
$69.50
|
| Rate for Payer: PHP Commercial |
$236.28
|
| Rate for Payer: PHP Medicare Advantage |
$69.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.69
|
| Rate for Payer: Priority Health HMO/PPO |
$241.84
|
| Rate for Payer: Priority Health Medicare |
$70.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.25
|
| Rate for Payer: Railroad Medicare Medicare |
$69.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.62
|
| Rate for Payer: UHC Core |
$232.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.50
|
| Rate for Payer: UHC Exchange |
$69.50
|
| Rate for Payer: UHC Medicare Advantage |
$69.50
|
| Rate for Payer: VA VA |
$69.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.49
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
OP
|
$2,458.78
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$583.96 |
| Max. Negotiated Rate |
$2,212.90 |
| Rate for Payer: Aetna Commercial |
$2,089.96
|
| Rate for Payer: Aetna Medicare |
$639.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.37
|
| Rate for Payer: BCBS Complete |
$1,388.75
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,021.36
|
| Rate for Payer: BCN Commercial |
$1,911.70
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$1,967.02
|
| Rate for Payer: Cash Price |
$1,967.02
|
| Rate for Payer: Cofinity Commercial |
$2,114.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$2,212.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,844.09
|
| Rate for Payer: Mclaren Medicaid |
$1,322.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.43
|
| Rate for Payer: Meridian Medicaid |
$1,388.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.96
|
| Rate for Payer: Nomi Health Commercial |
$2,016.20
|
| Rate for Payer: PACE Senior Care Partners |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$2,089.96
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,322.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.21
|
| Rate for Payer: Priority Health HMO/PPO |
$2,139.14
|
| Rate for Payer: Priority Health Medicare |
$620.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,647.38
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,163.73
|
| Rate for Payer: UHC Core |
$2,053.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$614.70
|
| Rate for Payer: UHC Medicare Advantage |
$614.70
|
| Rate for Payer: UHCCP Medicaid |
$1,322.53
|
| Rate for Payer: VA VA |
$614.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,844.09
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
IP
|
$2,458.78
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,598.21 |
| Max. Negotiated Rate |
$2,212.90 |
| Rate for Payer: Aetna Commercial |
$2,089.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,007.10
|
| Rate for Payer: BCN Commercial |
$1,900.15
|
| Rate for Payer: Cash Price |
$1,967.02
|
| Rate for Payer: Cofinity Commercial |
$2,114.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,967.02
|
| Rate for Payer: Healthscope Commercial |
$2,212.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,844.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.96
|
| Rate for Payer: Nomi Health Commercial |
$2,016.20
|
| Rate for Payer: PHP Commercial |
$2,089.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.21
|
| Rate for Payer: Priority Health HMO/PPO |
$2,139.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,647.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,163.73
|
| Rate for Payer: UHC Core |
$2,053.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,844.09
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
IP
|
$3,219.34
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,092.57 |
| Max. Negotiated Rate |
$2,897.41 |
| Rate for Payer: Aetna Commercial |
$2,736.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,627.95
|
| Rate for Payer: BCN Commercial |
$2,487.91
|
| Rate for Payer: Cash Price |
$2,575.47
|
| Rate for Payer: Cofinity Commercial |
$2,768.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,575.47
|
| Rate for Payer: Healthscope Commercial |
$2,897.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,414.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,736.44
|
| Rate for Payer: Nomi Health Commercial |
$2,639.86
|
| Rate for Payer: PHP Commercial |
$2,736.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.57
|
| Rate for Payer: Priority Health HMO/PPO |
$2,800.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,156.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,833.02
|
| Rate for Payer: UHC Core |
$2,688.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,414.51
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
OP
|
$3,219.34
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.59 |
| Max. Negotiated Rate |
$2,897.41 |
| Rate for Payer: Aetna Commercial |
$2,736.44
|
| Rate for Payer: Aetna Medicare |
$837.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,006.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,006.04
|
| Rate for Payer: BCBS Complete |
$1,388.75
|
| Rate for Payer: BCBS MAPPO |
$804.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,646.62
|
| Rate for Payer: BCN Commercial |
$2,503.04
|
| Rate for Payer: BCN Medicare Advantage |
$804.84
|
| Rate for Payer: Cash Price |
$2,575.47
|
| Rate for Payer: Cash Price |
$2,575.47
|
| Rate for Payer: Cofinity Commercial |
$2,768.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,575.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.84
|
| Rate for Payer: Healthscope Commercial |
$2,897.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,414.51
|
| Rate for Payer: Mclaren Medicaid |
$1,322.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$845.08
|
| Rate for Payer: Meridian Medicaid |
$1,388.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$925.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,736.44
|
| Rate for Payer: Nomi Health Commercial |
$2,639.86
|
| Rate for Payer: PACE Senior Care Partners |
$764.59
|
| Rate for Payer: PACE SWMI |
$804.84
|
| Rate for Payer: PHP Commercial |
$2,736.44
|
| Rate for Payer: PHP Medicare Advantage |
$804.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,322.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.57
|
| Rate for Payer: Priority Health HMO/PPO |
$2,800.83
|
| Rate for Payer: Priority Health Medicare |
$812.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,156.96
|
| Rate for Payer: Railroad Medicare Medicare |
$804.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,833.02
|
| Rate for Payer: UHC Core |
$2,688.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.84
|
| Rate for Payer: UHC Exchange |
$804.84
|
| Rate for Payer: UHC Medicare Advantage |
$804.84
|
| Rate for Payer: UHCCP Medicaid |
$1,322.53
|
| Rate for Payer: VA VA |
$804.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,414.51
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.03
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS MAPPO |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$42.18
|
| Rate for Payer: BCN Commercial |
$39.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.83
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.47
|
| Rate for Payer: Meridian Medicaid |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PACE Senior Care Partners |
$12.19
|
| Rate for Payer: PACE SWMI |
$12.83
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$12.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO |
$44.64
|
| Rate for Payer: Priority Health Medicare |
$12.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.15
|
| Rate for Payer: UHC Core |
$42.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.83
|
| Rate for Payer: UHC Exchange |
$12.83
|
| Rate for Payer: UHC Medicare Advantage |
$12.83
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: BCBS Trust/PPO |
$41.88
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO |
$44.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.15
|
| Rate for Payer: UHC Core |
$42.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC GRANULOCYTES
|
Facility
|
IP
|
$1,925.76
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,251.74 |
| Max. Negotiated Rate |
$1,733.18 |
| Rate for Payer: Aetna Commercial |
$1,636.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.00
|
| Rate for Payer: BCN Commercial |
$1,488.23
|
| Rate for Payer: Cash Price |
$1,540.61
|
| Rate for Payer: Cofinity Commercial |
$1,656.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.61
|
| Rate for Payer: Healthscope Commercial |
$1,733.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,444.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.90
|
| Rate for Payer: Nomi Health Commercial |
$1,579.12
|
| Rate for Payer: PHP Commercial |
$1,636.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,675.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,290.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.67
|
| Rate for Payer: UHC Core |
$1,608.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,444.32
|
|
