|
HC PULSERIDER
|
Facility
|
OP
|
$16,734.38
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,974.42 |
| Max. Negotiated Rate |
$15,060.94 |
| Rate for Payer: Aetna Commercial |
$14,224.22
|
| Rate for Payer: Aetna Medicare |
$4,350.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,229.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,229.49
|
| Rate for Payer: BCBS Complete |
$6,693.75
|
| Rate for Payer: BCBS MAPPO |
$4,183.60
|
| Rate for Payer: BCBS Trust/PPO |
$13,010.98
|
| Rate for Payer: BCN Commercial |
$13,010.98
|
| Rate for Payer: BCN Medicare Advantage |
$4,183.60
|
| Rate for Payer: Cash Price |
$13,387.50
|
| Rate for Payer: Cofinity Commercial |
$14,391.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,387.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,183.60
|
| Rate for Payer: Healthscope Commercial |
$15,060.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,550.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,392.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,811.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,224.22
|
| Rate for Payer: PACE Senior Care Partners |
$3,974.42
|
| Rate for Payer: PACE SWMI |
$4,183.60
|
| Rate for Payer: PHP Commercial |
$14,224.22
|
| Rate for Payer: PHP Medicare Advantage |
$4,183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,714.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,558.91
|
| Rate for Payer: Priority Health Medicare |
$4,183.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,206.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4,183.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,726.25
|
| Rate for Payer: UHC Core |
$13,973.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,183.60
|
| Rate for Payer: UHC Medicare Advantage |
$4,309.10
|
| Rate for Payer: VA VA |
$4,183.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,550.78
|
|
|
HC PULSERIDER
|
Facility
|
IP
|
$16,734.38
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,206.30 |
| Max. Negotiated Rate |
$15,060.94 |
| Rate for Payer: Aetna Commercial |
$14,224.22
|
| Rate for Payer: BCBS Trust/PPO |
$12,932.33
|
| Rate for Payer: BCN Commercial |
$12,932.33
|
| Rate for Payer: Cash Price |
$13,387.50
|
| Rate for Payer: Cofinity Commercial |
$14,391.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,387.50
|
| Rate for Payer: Healthscope Commercial |
$15,060.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,550.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,224.22
|
| Rate for Payer: PHP Commercial |
$14,224.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,714.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,558.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,206.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,726.25
|
| Rate for Payer: UHC Core |
$13,973.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,550.78
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
OP
|
$448.28
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.47 |
| Max. Negotiated Rate |
$403.45 |
| Rate for Payer: Aetna Commercial |
$381.04
|
| Rate for Payer: Aetna Medicare |
$116.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.09
|
| Rate for Payer: BCBS Complete |
$179.31
|
| Rate for Payer: BCBS MAPPO |
$112.07
|
| Rate for Payer: BCBS Trust/PPO |
$348.54
|
| Rate for Payer: BCN Commercial |
$348.54
|
| Rate for Payer: BCN Medicare Advantage |
$112.07
|
| Rate for Payer: Cash Price |
$358.62
|
| Rate for Payer: Cofinity Commercial |
$385.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.07
|
| Rate for Payer: Healthscope Commercial |
$403.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.04
|
| Rate for Payer: PACE Senior Care Partners |
$106.47
|
| Rate for Payer: PACE SWMI |
$112.07
|
| Rate for Payer: PHP Commercial |
$381.04
|
| Rate for Payer: PHP Medicare Advantage |
$112.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.00
|
| Rate for Payer: Priority Health Medicare |
$112.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.41
|
| Rate for Payer: Railroad Medicare Medicare |
$112.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.49
|
| Rate for Payer: UHC Core |
$374.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.07
|
| Rate for Payer: UHC Medicare Advantage |
$115.43
|
| Rate for Payer: VA VA |
$112.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.21
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
IP
|
$448.28
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$273.41 |
| Max. Negotiated Rate |
$403.45 |
| Rate for Payer: Aetna Commercial |
$381.04
|
| Rate for Payer: BCBS Trust/PPO |
$346.43
|
| Rate for Payer: BCN Commercial |
$346.43
|
| Rate for Payer: Cash Price |
$358.62
|
| Rate for Payer: Cofinity Commercial |
$385.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.62
|
| Rate for Payer: Healthscope Commercial |
$403.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.04
|
| Rate for Payer: PHP Commercial |
$381.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.49
|
| Rate for Payer: UHC Core |
$374.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.21
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$81.91
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna Medicare |
$21.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.60
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: BCBS MAPPO |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$63.69
|
| Rate for Payer: BCN Commercial |
$63.69
|
| Rate for Payer: BCN Medicare Advantage |
$20.48
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.48
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: PACE Senior Care Partners |
$19.45
|
| Rate for Payer: PACE SWMI |
$20.48
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: PHP Medicare Advantage |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.26
|
| Rate for Payer: Priority Health Medicare |
$20.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.96
|
| Rate for Payer: Railroad Medicare Medicare |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.08
|
| Rate for Payer: UHC Core |
$68.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.48
|
| Rate for Payer: UHC Medicare Advantage |
$21.09
|
| Rate for Payer: VA VA |
$20.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.43
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$81.91
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: BCBS Trust/PPO |
$63.30
|
| Rate for Payer: BCN Commercial |
$63.30
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.53
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.08
|
| Rate for Payer: UHC Core |
$68.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.43
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$270.30
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$243.27 |
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: BCBS Trust/PPO |
$208.89
|
| Rate for Payer: BCN Commercial |
$208.89
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$232.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Healthscope Commercial |
$243.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.86
|
| Rate for Payer: UHC Core |
$225.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.72
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$270.30
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$274.65 |
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: Aetna Medicare |
$70.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.47
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$67.58
|
| Rate for Payer: BCBS Trust/PPO |
$210.16
|
| Rate for Payer: BCN Commercial |
$210.16
|
| Rate for Payer: BCN Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$232.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.58
|
| Rate for Payer: Healthscope Commercial |
$243.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.72
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PACE Senior Care Partners |
$64.20
|
| Rate for Payer: PACE SWMI |
$67.58
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: PHP Medicare Advantage |
$67.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.16
|
| Rate for Payer: Priority Health Medicare |
$67.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.86
|
| Rate for Payer: Railroad Medicare Medicare |
$67.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.86
|
| Rate for Payer: UHC Core |
$225.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.58
|
| Rate for Payer: UHC Medicare Advantage |
$69.60
|
| Rate for Payer: VA VA |
$67.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.72
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
IP
|
$933.32
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$569.23 |
| Max. Negotiated Rate |
$839.99 |
| Rate for Payer: Aetna Commercial |
$793.32
|
| Rate for Payer: BCBS Trust/PPO |
$721.27
|
| Rate for Payer: BCN Commercial |
$721.27
|
| Rate for Payer: Cash Price |
$746.66
|
| Rate for Payer: Cofinity Commercial |
$802.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.66
|
| Rate for Payer: Healthscope Commercial |
$839.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$793.32
|
| Rate for Payer: PHP Commercial |
$793.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$569.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.32
|
| Rate for Payer: UHC Core |
$779.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.99
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
OP
|
$933.32
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.66 |
| Max. Negotiated Rate |
$839.99 |
| Rate for Payer: Aetna Commercial |
$793.32
|
| Rate for Payer: Aetna Medicare |
$242.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$291.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$291.66
|
| Rate for Payer: BCBS Complete |
$484.61
|
| Rate for Payer: BCBS MAPPO |
$233.33
|
| Rate for Payer: BCBS Trust/PPO |
$725.66
|
| Rate for Payer: BCN Commercial |
$725.66
|
| Rate for Payer: BCN Medicare Advantage |
$233.33
|
| Rate for Payer: Cash Price |
$746.66
|
| Rate for Payer: Cash Price |
$746.66
|
| Rate for Payer: Cofinity Commercial |
$802.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$746.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.33
|
| Rate for Payer: Healthscope Commercial |
$839.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$699.99
|
| Rate for Payer: Mclaren Medicaid |
$461.54
|
| Rate for Payer: Meridian Medicaid |
$484.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$245.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$793.32
|
| Rate for Payer: PACE Senior Care Partners |
$221.66
|
| Rate for Payer: PACE SWMI |
$233.33
|
| Rate for Payer: PHP Commercial |
$793.32
|
| Rate for Payer: PHP Medicare Advantage |
$233.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.99
|
| Rate for Payer: Priority Health Medicare |
$233.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$569.23
|
| Rate for Payer: Railroad Medicare Medicare |
$233.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.32
|
| Rate for Payer: UHC Core |
$779.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.33
|
| Rate for Payer: UHC Medicare Advantage |
$240.33
|
| Rate for Payer: VA VA |
$233.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$699.99
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
IP
|
$269.89
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.61 |
| Max. Negotiated Rate |
$242.90 |
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: BCBS Trust/PPO |
$208.57
|
| Rate for Payer: BCN Commercial |
$208.57
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$232.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.91
|
| Rate for Payer: Healthscope Commercial |
$242.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.41
|
| Rate for Payer: PHP Commercial |
$229.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.50
|
| Rate for Payer: UHC Core |
$225.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.42
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$269.89
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.10 |
| Max. Negotiated Rate |
$274.65 |
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: Aetna Medicare |
$70.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.34
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$67.47
|
| Rate for Payer: BCBS Trust/PPO |
$209.84
|
| Rate for Payer: BCN Commercial |
$209.84
|
| Rate for Payer: BCN Medicare Advantage |
$67.47
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$232.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.47
|
| Rate for Payer: Healthscope Commercial |
$242.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.42
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.41
|
| Rate for Payer: PACE Senior Care Partners |
$64.10
|
| Rate for Payer: PACE SWMI |
$67.47
|
| Rate for Payer: PHP Commercial |
$229.41
|
| Rate for Payer: PHP Medicare Advantage |
$67.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.80
|
| Rate for Payer: Priority Health Medicare |
$67.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.61
|
| Rate for Payer: Railroad Medicare Medicare |
$67.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.50
|
| Rate for Payer: UHC Core |
$225.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.47
|
| Rate for Payer: UHC Medicare Advantage |
$69.50
|
| Rate for Payer: VA VA |
$67.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.42
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.08 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna Medicare |
$198.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.27
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$190.62
|
| Rate for Payer: BCBS Trust/PPO |
$592.81
|
| Rate for Payer: BCN Commercial |
$592.81
|
| Rate for Payer: BCN Medicare Advantage |
$190.62
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.62
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PACE Senior Care Partners |
$181.08
|
| Rate for Payer: PACE SWMI |
$190.62
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: PHP Medicare Advantage |
$190.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$663.34
|
| Rate for Payer: Priority Health Medicare |
$190.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$465.02
|
| Rate for Payer: Railroad Medicare Medicare |
$190.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.96
|
| Rate for Payer: UHC Core |
$636.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.62
|
| Rate for Payer: UHC Medicare Advantage |
$196.33
|
| Rate for Payer: VA VA |
$190.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.02 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: BCBS Trust/PPO |
$589.23
|
| Rate for Payer: BCN Commercial |
$589.23
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$663.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$465.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.96
|
| Rate for Payer: UHC Core |
$636.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.08 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna Medicare |
$198.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.27
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$190.62
|
| Rate for Payer: BCBS Trust/PPO |
$592.81
|
| Rate for Payer: BCN Commercial |
$592.81
|
| Rate for Payer: BCN Medicare Advantage |
$190.62
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.62
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PACE Senior Care Partners |
$181.08
|
| Rate for Payer: PACE SWMI |
$190.62
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: PHP Medicare Advantage |
$190.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$663.34
|
| Rate for Payer: Priority Health Medicare |
$190.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$465.02
|
| Rate for Payer: Railroad Medicare Medicare |
$190.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.96
|
| Rate for Payer: UHC Core |
$636.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.62
|
| Rate for Payer: UHC Medicare Advantage |
$196.33
|
| Rate for Payer: VA VA |
$190.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.02 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: BCBS Trust/PPO |
$589.23
|
| Rate for Payer: BCN Commercial |
$589.23
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$609.97
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$571.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$663.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$465.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.96
|
| Rate for Payer: UHC Core |
$636.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$571.84
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$722.93
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$650.64 |
| Rate for Payer: Aetna Commercial |
$614.49
|
| Rate for Payer: Aetna Medicare |
$187.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.92
|
| Rate for Payer: BCBS Complete |
$289.17
|
| Rate for Payer: BCBS MAPPO |
$180.73
|
| Rate for Payer: BCBS Trust/PPO |
$562.08
|
| Rate for Payer: BCN Commercial |
$562.08
|
| Rate for Payer: BCN Medicare Advantage |
$180.73
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cofinity Commercial |
$621.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.73
|
| Rate for Payer: Healthscope Commercial |
$650.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$189.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$614.49
|
| Rate for Payer: PACE Senior Care Partners |
$171.70
|
| Rate for Payer: PACE SWMI |
$180.73
|
| Rate for Payer: PHP Commercial |
$614.49
|
| Rate for Payer: PHP Medicare Advantage |
$180.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.95
|
| Rate for Payer: Priority Health Medicare |
$180.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$440.92
|
| Rate for Payer: Railroad Medicare Medicare |
$180.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.18
|
| Rate for Payer: UHC Core |
$603.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.73
|
| Rate for Payer: UHC Medicare Advantage |
$186.15
|
| Rate for Payer: VA VA |
$180.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.20
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$722.93
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.92 |
| Max. Negotiated Rate |
$650.64 |
| Rate for Payer: Aetna Commercial |
$614.49
|
| Rate for Payer: BCBS Trust/PPO |
$558.68
|
| Rate for Payer: BCN Commercial |
$558.68
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cofinity Commercial |
$621.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.34
|
| Rate for Payer: Healthscope Commercial |
$650.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$614.49
|
| Rate for Payer: PHP Commercial |
$614.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$440.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.18
|
| Rate for Payer: UHC Core |
$603.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.20
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$502.03
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.23 |
| Max. Negotiated Rate |
$451.83 |
| Rate for Payer: Aetna Commercial |
$426.73
|
| Rate for Payer: Aetna Medicare |
$130.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.88
|
| Rate for Payer: BCBS Complete |
$200.81
|
| Rate for Payer: BCBS MAPPO |
$125.51
|
| Rate for Payer: BCBS Trust/PPO |
$390.33
|
| Rate for Payer: BCN Commercial |
$390.33
|
| Rate for Payer: BCN Medicare Advantage |
$125.51
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$431.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.51
|
| Rate for Payer: Healthscope Commercial |
$451.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.73
|
| Rate for Payer: PACE Senior Care Partners |
$119.23
|
| Rate for Payer: PACE SWMI |
$125.51
|
| Rate for Payer: PHP Commercial |
$426.73
|
| Rate for Payer: PHP Medicare Advantage |
$125.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.77
|
| Rate for Payer: Priority Health Medicare |
$125.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.19
|
| Rate for Payer: Railroad Medicare Medicare |
$125.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.79
|
| Rate for Payer: UHC Core |
$419.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.51
|
| Rate for Payer: UHC Medicare Advantage |
$129.27
|
| Rate for Payer: VA VA |
$125.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.52
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$502.03
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.19 |
| Max. Negotiated Rate |
$451.83 |
| Rate for Payer: Aetna Commercial |
$426.73
|
| Rate for Payer: BCBS Trust/PPO |
$387.97
|
| Rate for Payer: BCN Commercial |
$387.97
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$431.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$451.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.73
|
| Rate for Payer: PHP Commercial |
$426.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.79
|
| Rate for Payer: UHC Core |
$419.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.52
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$317.95
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.51 |
| Max. Negotiated Rate |
$286.16 |
| Rate for Payer: Aetna Commercial |
$270.26
|
| Rate for Payer: Aetna Medicare |
$82.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.36
|
| Rate for Payer: BCBS Complete |
$127.18
|
| Rate for Payer: BCBS MAPPO |
$79.49
|
| Rate for Payer: BCBS Trust/PPO |
$247.21
|
| Rate for Payer: BCN Commercial |
$247.21
|
| Rate for Payer: BCN Medicare Advantage |
$79.49
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.49
|
| Rate for Payer: Healthscope Commercial |
$286.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.26
|
| Rate for Payer: PACE Senior Care Partners |
$75.51
|
| Rate for Payer: PACE SWMI |
$79.49
|
| Rate for Payer: PHP Commercial |
$270.26
|
| Rate for Payer: PHP Medicare Advantage |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.62
|
| Rate for Payer: Priority Health Medicare |
$79.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.92
|
| Rate for Payer: Railroad Medicare Medicare |
$79.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.80
|
| Rate for Payer: UHC Core |
$265.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.49
|
| Rate for Payer: UHC Medicare Advantage |
$81.87
|
| Rate for Payer: VA VA |
$79.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.46
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$317.95
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.92 |
| Max. Negotiated Rate |
$286.16 |
| Rate for Payer: Aetna Commercial |
$270.26
|
| Rate for Payer: BCBS Trust/PPO |
$245.71
|
| Rate for Payer: BCN Commercial |
$245.71
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.36
|
| Rate for Payer: Healthscope Commercial |
$286.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.26
|
| Rate for Payer: PHP Commercial |
$270.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.80
|
| Rate for Payer: UHC Core |
$265.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.46
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$265.63
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.01 |
| Max. Negotiated Rate |
$239.07 |
| Rate for Payer: Aetna Commercial |
$225.79
|
| Rate for Payer: BCBS Trust/PPO |
$205.28
|
| Rate for Payer: BCN Commercial |
$205.28
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$228.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$239.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.79
|
| Rate for Payer: PHP Commercial |
$225.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.75
|
| Rate for Payer: UHC Core |
$221.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$265.63
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.09 |
| Max. Negotiated Rate |
$239.07 |
| Rate for Payer: Aetna Commercial |
$225.79
|
| Rate for Payer: Aetna Medicare |
$69.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.01
|
| Rate for Payer: BCBS Complete |
$106.25
|
| Rate for Payer: BCBS MAPPO |
$66.41
|
| Rate for Payer: BCBS Trust/PPO |
$206.53
|
| Rate for Payer: BCN Commercial |
$206.53
|
| Rate for Payer: BCN Medicare Advantage |
$66.41
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$228.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.41
|
| Rate for Payer: Healthscope Commercial |
$239.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.79
|
| Rate for Payer: PACE Senior Care Partners |
$63.09
|
| Rate for Payer: PACE SWMI |
$66.41
|
| Rate for Payer: PHP Commercial |
$225.79
|
| Rate for Payer: PHP Medicare Advantage |
$66.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.10
|
| Rate for Payer: Priority Health Medicare |
$66.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.01
|
| Rate for Payer: Railroad Medicare Medicare |
$66.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.75
|
| Rate for Payer: UHC Core |
$221.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.41
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
| Rate for Payer: VA VA |
$66.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.66
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS MAPPO |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$218.09
|
| Rate for Payer: BCN Commercial |
$218.09
|
| Rate for Payer: BCN Medicare Advantage |
$70.12
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.12
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PACE Senior Care Partners |
$66.62
|
| Rate for Payer: PACE SWMI |
$70.12
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: PHP Medicare Advantage |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$70.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.08
|
| Rate for Payer: Railroad Medicare Medicare |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.12
|
| Rate for Payer: UHC Medicare Advantage |
$72.23
|
| Rate for Payer: VA VA |
$70.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
