|
HC KERECIS OMEGA3 MARIGEN 3X3.5, PER SQ CM
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600272
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.72 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: BCBS Trust/PPO |
$150.37
|
| Rate for Payer: BCN Commercial |
$150.37
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.22
|
| Rate for Payer: UHC Core |
$152.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.55
|
|
|
HC KERECIS OMEGA3 MARIGEN 3X3.5, PER SQ CM
|
Facility
|
OP
|
$182.07
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600272
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna Medicare |
$47.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.90
|
| Rate for Payer: BCBS Complete |
$33.70
|
| Rate for Payer: BCBS MAPPO |
$45.52
|
| Rate for Payer: BCBS Trust/PPO |
$149.68
|
| Rate for Payer: BCN Commercial |
$149.68
|
| Rate for Payer: BCN Medicare Advantage |
$45.52
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.52
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.55
|
| Rate for Payer: Mclaren Medicaid |
$32.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.79
|
| Rate for Payer: Meridian Medicaid |
$33.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$149.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PACE Senior Care Partners |
$43.24
|
| Rate for Payer: PACE SWMI |
$45.52
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: PHP Medicare Advantage |
$45.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.40
|
| Rate for Payer: Priority Health Medicare |
$45.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.72
|
| Rate for Payer: Railroad Medicare Medicare |
$45.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.22
|
| Rate for Payer: UHC Core |
$152.03
|
| Rate for Payer: UHC Exchange |
$45.52
|
| Rate for Payer: UHC Medicaid |
$32.10
|
| Rate for Payer: UHC Medicare Advantage |
$45.52
|
| Rate for Payer: UHCCP Medicaid |
$32.10
|
| Rate for Payer: VA VA |
$45.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.55
|
|
|
HC KERECIS OMEGA3 MARIGEN CIRC 16 MM, PER SQ CM
|
Facility
|
OP
|
$687.50
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600275
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.21 |
| Max. Negotiated Rate |
$618.75 |
| Rate for Payer: Aetna Commercial |
$584.38
|
| Rate for Payer: Aetna Medicare |
$178.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.84
|
| Rate for Payer: BCBS Complete |
$127.26
|
| Rate for Payer: BCBS MAPPO |
$171.88
|
| Rate for Payer: BCBS Trust/PPO |
$565.19
|
| Rate for Payer: BCN Commercial |
$565.19
|
| Rate for Payer: BCN Medicare Advantage |
$171.88
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cofinity Commercial |
$591.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.88
|
| Rate for Payer: Healthscope Commercial |
$618.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.62
|
| Rate for Payer: Mclaren Medicaid |
$121.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.47
|
| Rate for Payer: Meridian Medicaid |
$127.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$189.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.38
|
| Rate for Payer: Nomi Health Commercial |
$563.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.62
|
| Rate for Payer: PACE Senior Care Partners |
$163.28
|
| Rate for Payer: PACE SWMI |
$171.88
|
| Rate for Payer: PHP Commercial |
$584.38
|
| Rate for Payer: PHP Medicare Advantage |
$171.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$598.12
|
| Rate for Payer: Priority Health Medicare |
$173.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$478.50
|
| Rate for Payer: Railroad Medicare Medicare |
$171.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.00
|
| Rate for Payer: UHC Core |
$574.06
|
| Rate for Payer: UHC Exchange |
$171.88
|
| Rate for Payer: UHC Medicaid |
$121.21
|
| Rate for Payer: UHC Medicare Advantage |
$171.88
|
| Rate for Payer: UHCCP Medicaid |
$121.21
|
| Rate for Payer: VA VA |
$171.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.62
|
|
|
HC KERECIS OMEGA3 MARIGEN CIRC 16 MM, PER SQ CM
|
Facility
|
IP
|
$687.50
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600275
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$478.50 |
| Max. Negotiated Rate |
$618.75 |
| Rate for Payer: Aetna Commercial |
$584.38
|
| Rate for Payer: BCBS Trust/PPO |
$567.81
|
| Rate for Payer: BCN Commercial |
$567.81
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cofinity Commercial |
$591.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.00
|
| Rate for Payer: Healthscope Commercial |
$618.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.38
|
| Rate for Payer: Nomi Health Commercial |
$563.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.62
|
| Rate for Payer: PHP Commercial |
$584.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$598.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$478.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.00
|
| Rate for Payer: UHC Core |
$574.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.62
|
|
|
HC KERECIS OMEGA3 MARIGEN EXPANSE 2X2, PER SQ CM
|
Facility
|
IP
|
$626.88
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$436.31 |
| Max. Negotiated Rate |
$564.19 |
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: BCBS Trust/PPO |
$517.74
|
| Rate for Payer: BCN Commercial |
$517.74
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cofinity Commercial |
$539.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.50
|
| Rate for Payer: Healthscope Commercial |
$564.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.85
|
| Rate for Payer: Nomi Health Commercial |
$514.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.16
|
| Rate for Payer: PHP Commercial |
$532.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$545.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.65
|
| Rate for Payer: UHC Core |
$523.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.16
|
|
|
HC KERECIS OMEGA3 MARIGEN EXPANSE 2X2, PER SQ CM
|
Facility
|
OP
|
$626.88
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600273
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.52 |
| Max. Negotiated Rate |
$564.19 |
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: Aetna Medicare |
$162.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$195.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$195.90
|
| Rate for Payer: BCBS Complete |
$116.04
|
| Rate for Payer: BCBS MAPPO |
$156.72
|
| Rate for Payer: BCBS Trust/PPO |
$515.36
|
| Rate for Payer: BCN Commercial |
$515.36
|
| Rate for Payer: BCN Medicare Advantage |
$156.72
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cofinity Commercial |
$539.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.72
|
| Rate for Payer: Healthscope Commercial |
$564.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.16
|
| Rate for Payer: Mclaren Medicaid |
$110.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.56
|
| Rate for Payer: Meridian Medicaid |
$116.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$172.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.85
|
| Rate for Payer: Nomi Health Commercial |
$514.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.16
|
| Rate for Payer: PACE Senior Care Partners |
$148.88
|
| Rate for Payer: PACE SWMI |
$156.72
|
| Rate for Payer: PHP Commercial |
$532.85
|
| Rate for Payer: PHP Medicare Advantage |
$156.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$545.39
|
| Rate for Payer: Priority Health Medicare |
$158.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.31
|
| Rate for Payer: Railroad Medicare Medicare |
$156.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.65
|
| Rate for Payer: UHC Core |
$523.44
|
| Rate for Payer: UHC Exchange |
$156.72
|
| Rate for Payer: UHC Medicaid |
$110.52
|
| Rate for Payer: UHC Medicare Advantage |
$156.72
|
| Rate for Payer: UHCCP Medicaid |
$110.52
|
| Rate for Payer: VA VA |
$156.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.16
|
|
|
HC KERECIS OMEGA3 MARIGEN MICRO 4 SQ CM, PER SQ CM
|
Facility
|
IP
|
$365.06
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.08 |
| Max. Negotiated Rate |
$328.55 |
| Rate for Payer: Aetna Commercial |
$310.30
|
| Rate for Payer: BCBS Trust/PPO |
$301.50
|
| Rate for Payer: BCN Commercial |
$301.50
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cofinity Commercial |
$313.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.05
|
| Rate for Payer: Healthscope Commercial |
$328.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.30
|
| Rate for Payer: Nomi Health Commercial |
$299.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.80
|
| Rate for Payer: PHP Commercial |
$310.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.25
|
| Rate for Payer: UHC Core |
$304.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.80
|
|
|
HC KERECIS OMEGA3 MARIGEN MICRO 4 SQ CM, PER SQ CM
|
Facility
|
OP
|
$365.06
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$328.55 |
| Rate for Payer: Aetna Commercial |
$310.30
|
| Rate for Payer: Aetna Medicare |
$94.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.08
|
| Rate for Payer: BCBS Complete |
$67.57
|
| Rate for Payer: BCBS MAPPO |
$91.27
|
| Rate for Payer: BCBS Trust/PPO |
$300.12
|
| Rate for Payer: BCN Commercial |
$300.12
|
| Rate for Payer: BCN Medicare Advantage |
$91.27
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cofinity Commercial |
$313.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.27
|
| Rate for Payer: Healthscope Commercial |
$328.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.80
|
| Rate for Payer: Mclaren Medicaid |
$64.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.83
|
| Rate for Payer: Meridian Medicaid |
$67.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.30
|
| Rate for Payer: Nomi Health Commercial |
$299.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.80
|
| Rate for Payer: PACE Senior Care Partners |
$86.70
|
| Rate for Payer: PACE SWMI |
$91.27
|
| Rate for Payer: PHP Commercial |
$310.30
|
| Rate for Payer: PHP Medicare Advantage |
$91.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$317.60
|
| Rate for Payer: Priority Health Medicare |
$92.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.08
|
| Rate for Payer: Railroad Medicare Medicare |
$91.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.25
|
| Rate for Payer: UHC Core |
$304.83
|
| Rate for Payer: UHC Exchange |
$91.27
|
| Rate for Payer: UHC Medicaid |
$64.36
|
| Rate for Payer: UHC Medicare Advantage |
$91.27
|
| Rate for Payer: UHCCP Medicaid |
$64.36
|
| Rate for Payer: VA VA |
$91.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.80
|
|
|
HC KETONES (ACETONE)
|
Facility
|
IP
|
$37.56
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: BCBS Trust/PPO |
$31.02
|
| Rate for Payer: BCN Commercial |
$31.02
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.17
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.05
|
| Rate for Payer: UHC Core |
$31.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.17
|
|
|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$37.56
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna Medicare |
$9.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.74
|
| Rate for Payer: BCBS Complete |
$6.95
|
| Rate for Payer: BCBS MAPPO |
$9.39
|
| Rate for Payer: BCBS Trust/PPO |
$30.88
|
| Rate for Payer: BCN Commercial |
$30.88
|
| Rate for Payer: BCN Medicare Advantage |
$9.39
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.39
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.17
|
| Rate for Payer: Mclaren Medicaid |
$6.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.86
|
| Rate for Payer: Meridian Medicaid |
$6.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.17
|
| Rate for Payer: PACE Senior Care Partners |
$8.92
|
| Rate for Payer: PACE SWMI |
$9.39
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: PHP Medicare Advantage |
$9.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.68
|
| Rate for Payer: Priority Health Medicare |
$9.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.14
|
| Rate for Payer: Railroad Medicare Medicare |
$9.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.05
|
| Rate for Payer: UHC Core |
$31.36
|
| Rate for Payer: UHC Exchange |
$9.39
|
| Rate for Payer: UHC Medicaid |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.39
|
| Rate for Payer: UHCCP Medicaid |
$6.62
|
| Rate for Payer: VA VA |
$9.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.17
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$6,089.22
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,073.53 |
| Max. Negotiated Rate |
$5,480.30 |
| Rate for Payer: Aetna Commercial |
$5,175.84
|
| Rate for Payer: Aetna Medicare |
$1,583.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.88
|
| Rate for Payer: BCBS Complete |
$1,127.11
|
| Rate for Payer: BCBS MAPPO |
$1,522.31
|
| Rate for Payer: BCBS Trust/PPO |
$5,005.95
|
| Rate for Payer: BCN Commercial |
$5,005.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.31
|
| Rate for Payer: Cash Price |
$4,871.38
|
| Rate for Payer: Cofinity Commercial |
$5,236.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,871.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.31
|
| Rate for Payer: Healthscope Commercial |
$5,480.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,566.91
|
| Rate for Payer: Mclaren Medicaid |
$1,073.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.42
|
| Rate for Payer: Meridian Medicaid |
$1,127.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,674.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,175.84
|
| Rate for Payer: Nomi Health Commercial |
$4,993.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,566.91
|
| Rate for Payer: PACE Senior Care Partners |
$1,446.19
|
| Rate for Payer: PACE SWMI |
$1,522.31
|
| Rate for Payer: PHP Commercial |
$5,175.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,073.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,297.62
|
| Rate for Payer: Priority Health Medicare |
$1,537.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,238.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,358.51
|
| Rate for Payer: UHC Core |
$5,084.50
|
| Rate for Payer: UHC Exchange |
$1,522.31
|
| Rate for Payer: UHC Medicaid |
$1,073.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.31
|
| Rate for Payer: UHCCP Medicaid |
$1,073.53
|
| Rate for Payer: VA VA |
$1,522.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,566.91
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$6,089.22
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,238.10 |
| Max. Negotiated Rate |
$5,480.30 |
| Rate for Payer: Aetna Commercial |
$5,175.84
|
| Rate for Payer: BCBS Trust/PPO |
$5,029.09
|
| Rate for Payer: BCN Commercial |
$5,029.09
|
| Rate for Payer: Cash Price |
$4,871.38
|
| Rate for Payer: Cofinity Commercial |
$5,236.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,871.38
|
| Rate for Payer: Healthscope Commercial |
$5,480.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,566.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,175.84
|
| Rate for Payer: Nomi Health Commercial |
$4,993.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,566.91
|
| Rate for Payer: PHP Commercial |
$5,175.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,297.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,238.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,358.51
|
| Rate for Payer: UHC Core |
$5,084.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,566.91
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
OP
|
$141.20
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$127.08 |
| Rate for Payer: Aetna Commercial |
$120.02
|
| Rate for Payer: Aetna Medicare |
$36.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.12
|
| Rate for Payer: BCBS Complete |
$26.14
|
| Rate for Payer: BCBS MAPPO |
$35.30
|
| Rate for Payer: BCBS Trust/PPO |
$116.08
|
| Rate for Payer: BCN Commercial |
$116.08
|
| Rate for Payer: BCN Medicare Advantage |
$35.30
|
| Rate for Payer: Cash Price |
$112.96
|
| Rate for Payer: Cofinity Commercial |
$121.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.30
|
| Rate for Payer: Healthscope Commercial |
$127.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.90
|
| Rate for Payer: Mclaren Medicaid |
$24.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.06
|
| Rate for Payer: Meridian Medicaid |
$26.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.02
|
| Rate for Payer: Nomi Health Commercial |
$115.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.90
|
| Rate for Payer: PACE Senior Care Partners |
$33.53
|
| Rate for Payer: PACE SWMI |
$35.30
|
| Rate for Payer: PHP Commercial |
$120.02
|
| Rate for Payer: PHP Medicare Advantage |
$35.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.84
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.28
|
| Rate for Payer: Railroad Medicare Medicare |
$35.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.26
|
| Rate for Payer: UHC Core |
$117.90
|
| Rate for Payer: UHC Exchange |
$35.30
|
| Rate for Payer: UHC Medicaid |
$24.89
|
| Rate for Payer: UHC Medicare Advantage |
$35.30
|
| Rate for Payer: UHCCP Medicaid |
$24.89
|
| Rate for Payer: VA VA |
$35.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.90
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
IP
|
$141.20
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$127.08 |
| Rate for Payer: Aetna Commercial |
$120.02
|
| Rate for Payer: BCBS Trust/PPO |
$116.62
|
| Rate for Payer: BCN Commercial |
$116.62
|
| Rate for Payer: Cash Price |
$112.96
|
| Rate for Payer: Cofinity Commercial |
$121.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.96
|
| Rate for Payer: Healthscope Commercial |
$127.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.02
|
| Rate for Payer: Nomi Health Commercial |
$115.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.90
|
| Rate for Payer: PHP Commercial |
$120.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.26
|
| Rate for Payer: UHC Core |
$117.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.90
|
|
|
HC KIT ATS
|
Facility
|
OP
|
$156.06
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.77
|
| Rate for Payer: BCBS Complete |
$28.89
|
| Rate for Payer: BCBS MAPPO |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.30
|
| Rate for Payer: BCN Commercial |
$128.30
|
| Rate for Payer: BCN Medicare Advantage |
$39.02
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Mclaren Medicaid |
$27.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.97
|
| Rate for Payer: Meridian Medicaid |
$28.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PACE Senior Care Partners |
$37.06
|
| Rate for Payer: PACE SWMI |
$39.02
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$39.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Medicare |
$39.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.62
|
| Rate for Payer: Railroad Medicare Medicare |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: UHC Exchange |
$39.02
|
| Rate for Payer: UHC Medicaid |
$27.51
|
| Rate for Payer: UHC Medicare Advantage |
$39.02
|
| Rate for Payer: UHCCP Medicaid |
$27.51
|
| Rate for Payer: VA VA |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC KIT ATS
|
Facility
|
IP
|
$156.06
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: BCBS Trust/PPO |
$128.89
|
| Rate for Payer: BCN Commercial |
$128.89
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC KIT DILATOR VASC
|
Facility
|
IP
|
$546.21
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$380.16 |
| Max. Negotiated Rate |
$491.59 |
| Rate for Payer: Aetna Commercial |
$464.28
|
| Rate for Payer: BCBS Trust/PPO |
$451.11
|
| Rate for Payer: BCN Commercial |
$451.11
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$469.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Healthscope Commercial |
$491.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$447.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: PHP Commercial |
$464.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$475.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$380.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.66
|
| Rate for Payer: UHC Core |
$456.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.66
|
|
|
HC KIT DILATOR VASC
|
Facility
|
OP
|
$546.21
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$491.59 |
| Rate for Payer: Aetna Commercial |
$464.28
|
| Rate for Payer: Aetna Medicare |
$142.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.69
|
| Rate for Payer: BCBS Complete |
$101.10
|
| Rate for Payer: BCBS MAPPO |
$136.55
|
| Rate for Payer: BCBS Trust/PPO |
$449.04
|
| Rate for Payer: BCN Commercial |
$449.04
|
| Rate for Payer: BCN Medicare Advantage |
$136.55
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$469.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.55
|
| Rate for Payer: Healthscope Commercial |
$491.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.66
|
| Rate for Payer: Mclaren Medicaid |
$96.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.38
|
| Rate for Payer: Meridian Medicaid |
$101.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$447.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: PACE Senior Care Partners |
$129.72
|
| Rate for Payer: PACE SWMI |
$136.55
|
| Rate for Payer: PHP Commercial |
$464.28
|
| Rate for Payer: PHP Medicare Advantage |
$136.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$475.20
|
| Rate for Payer: Priority Health Medicare |
$137.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$380.16
|
| Rate for Payer: Railroad Medicare Medicare |
$136.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.66
|
| Rate for Payer: UHC Core |
$456.09
|
| Rate for Payer: UHC Exchange |
$136.55
|
| Rate for Payer: UHC Medicaid |
$96.30
|
| Rate for Payer: UHC Medicare Advantage |
$136.55
|
| Rate for Payer: UHCCP Medicaid |
$96.30
|
| Rate for Payer: VA VA |
$136.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.66
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$125.68
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$87.47 |
| Max. Negotiated Rate |
$113.11 |
| Rate for Payer: Aetna Commercial |
$106.83
|
| Rate for Payer: BCBS Trust/PPO |
$103.80
|
| Rate for Payer: BCN Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$100.54
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.54
|
| Rate for Payer: Healthscope Commercial |
$113.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.83
|
| Rate for Payer: Nomi Health Commercial |
$103.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.26
|
| Rate for Payer: PHP Commercial |
$106.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.60
|
| Rate for Payer: UHC Core |
$104.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.26
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$125.68
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$113.11 |
| Rate for Payer: Aetna Commercial |
$106.83
|
| Rate for Payer: Aetna Medicare |
$32.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.27
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCBS MAPPO |
$31.42
|
| Rate for Payer: BCBS Trust/PPO |
$103.32
|
| Rate for Payer: BCN Commercial |
$103.32
|
| Rate for Payer: BCN Medicare Advantage |
$31.42
|
| Rate for Payer: Cash Price |
$100.54
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.42
|
| Rate for Payer: Healthscope Commercial |
$113.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.26
|
| Rate for Payer: Mclaren Medicaid |
$22.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.99
|
| Rate for Payer: Meridian Medicaid |
$23.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.83
|
| Rate for Payer: Nomi Health Commercial |
$103.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.26
|
| Rate for Payer: PACE Senior Care Partners |
$29.85
|
| Rate for Payer: PACE SWMI |
$31.42
|
| Rate for Payer: PHP Commercial |
$106.83
|
| Rate for Payer: PHP Medicare Advantage |
$31.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.34
|
| Rate for Payer: Priority Health Medicare |
$31.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.47
|
| Rate for Payer: Railroad Medicare Medicare |
$31.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.60
|
| Rate for Payer: UHC Core |
$104.94
|
| Rate for Payer: UHC Exchange |
$31.42
|
| Rate for Payer: UHC Medicaid |
$22.16
|
| Rate for Payer: UHC Medicare Advantage |
$31.42
|
| Rate for Payer: UHCCP Medicaid |
$22.16
|
| Rate for Payer: VA VA |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.26
|
|
|
HC KOH PREPARATION
|
Facility
|
IP
|
$24.41
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: BCBS Trust/PPO |
$20.16
|
| Rate for Payer: BCN Commercial |
$20.16
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$20.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.31
|
|
|
HC KOH PREPARATION
|
Facility
|
OP
|
$24.41
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.63
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS MAPPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$20.07
|
| Rate for Payer: BCN Medicare Advantage |
$6.10
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.10
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.31
|
| Rate for Payer: Mclaren Medicaid |
$4.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.41
|
| Rate for Payer: Meridian Medicaid |
$4.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$20.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PACE Senior Care Partners |
$5.80
|
| Rate for Payer: PACE SWMI |
$6.10
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: PHP Medicare Advantage |
$6.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.24
|
| Rate for Payer: Priority Health Medicare |
$6.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.99
|
| Rate for Payer: Railroad Medicare Medicare |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$20.38
|
| Rate for Payer: UHC Exchange |
$6.10
|
| Rate for Payer: UHC Medicaid |
$4.30
|
| Rate for Payer: UHC Medicare Advantage |
$6.10
|
| Rate for Payer: UHCCP Medicaid |
$4.30
|
| Rate for Payer: VA VA |
$6.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.31
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
OP
|
$2,995.16
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$528.05 |
| Max. Negotiated Rate |
$2,695.64 |
| Rate for Payer: Aetna Commercial |
$2,545.89
|
| Rate for Payer: Aetna Medicare |
$778.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$935.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$935.99
|
| Rate for Payer: BCBS Complete |
$554.40
|
| Rate for Payer: BCBS MAPPO |
$748.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,462.32
|
| Rate for Payer: BCN Commercial |
$2,462.32
|
| Rate for Payer: BCN Medicare Advantage |
$748.79
|
| Rate for Payer: Cash Price |
$2,396.13
|
| Rate for Payer: Cofinity Commercial |
$2,575.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.79
|
| Rate for Payer: Healthscope Commercial |
$2,695.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,246.37
|
| Rate for Payer: Mclaren Medicaid |
$528.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.23
|
| Rate for Payer: Meridian Medicaid |
$554.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$861.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$823.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,545.89
|
| Rate for Payer: Nomi Health Commercial |
$2,456.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,246.37
|
| Rate for Payer: PACE Senior Care Partners |
$711.35
|
| Rate for Payer: PACE SWMI |
$748.79
|
| Rate for Payer: PHP Commercial |
$2,545.89
|
| Rate for Payer: PHP Medicare Advantage |
$748.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$528.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,605.79
|
| Rate for Payer: Priority Health Medicare |
$756.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,084.63
|
| Rate for Payer: Railroad Medicare Medicare |
$748.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,635.74
|
| Rate for Payer: UHC Core |
$2,500.96
|
| Rate for Payer: UHC Exchange |
$748.79
|
| Rate for Payer: UHC Medicaid |
$528.05
|
| Rate for Payer: UHC Medicare Advantage |
$748.79
|
| Rate for Payer: UHCCP Medicaid |
$528.05
|
| Rate for Payer: VA VA |
$748.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,246.37
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
IP
|
$2,995.16
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,084.63 |
| Max. Negotiated Rate |
$2,695.64 |
| Rate for Payer: Aetna Commercial |
$2,545.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,473.70
|
| Rate for Payer: BCN Commercial |
$2,473.70
|
| Rate for Payer: Cash Price |
$2,396.13
|
| Rate for Payer: Cofinity Commercial |
$2,575.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.13
|
| Rate for Payer: Healthscope Commercial |
$2,695.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,246.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,545.89
|
| Rate for Payer: Nomi Health Commercial |
$2,456.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,246.37
|
| Rate for Payer: PHP Commercial |
$2,545.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,605.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,084.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,635.74
|
| Rate for Payer: UHC Core |
$2,500.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,246.37
|
|
|
HC LAAC IMPLANT
|
Facility
|
OP
|
$18,942.56
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,339.57 |
| Max. Negotiated Rate |
$17,048.30 |
| Rate for Payer: Aetna Commercial |
$16,101.18
|
| Rate for Payer: Aetna Medicare |
$4,925.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,919.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,919.55
|
| Rate for Payer: BCBS Complete |
$3,506.27
|
| Rate for Payer: BCBS MAPPO |
$4,735.64
|
| Rate for Payer: BCBS Trust/PPO |
$15,572.68
|
| Rate for Payer: BCN Commercial |
$15,572.68
|
| Rate for Payer: BCN Medicare Advantage |
$4,735.64
|
| Rate for Payer: Cash Price |
$15,154.05
|
| Rate for Payer: Cofinity Commercial |
$16,290.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,154.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,735.64
|
| Rate for Payer: Healthscope Commercial |
$17,048.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,206.92
|
| Rate for Payer: Mclaren Medicaid |
$3,339.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,972.42
|
| Rate for Payer: Meridian Medicaid |
$3,506.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,445.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,209.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,101.18
|
| Rate for Payer: Nomi Health Commercial |
$15,532.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,206.92
|
| Rate for Payer: PACE Senior Care Partners |
$4,498.86
|
| Rate for Payer: PACE SWMI |
$4,735.64
|
| Rate for Payer: PHP Commercial |
$16,101.18
|
| Rate for Payer: PHP Medicare Advantage |
$4,735.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,339.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16,480.03
|
| Rate for Payer: Priority Health Medicare |
$4,783.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13,184.02
|
| Rate for Payer: Railroad Medicare Medicare |
$4,735.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,669.45
|
| Rate for Payer: UHC Core |
$15,817.04
|
| Rate for Payer: UHC Exchange |
$4,735.64
|
| Rate for Payer: UHC Medicaid |
$3,339.57
|
| Rate for Payer: UHC Medicare Advantage |
$4,735.64
|
| Rate for Payer: UHCCP Medicaid |
$3,339.57
|
| Rate for Payer: VA VA |
$4,735.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,206.92
|
|
