|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.59 |
| Max. Negotiated Rate |
$1,067.08 |
| Rate for Payer: Aetna Commercial |
$1,007.79
|
| Rate for Payer: Aetna Medicare |
$308.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.51
|
| Rate for Payer: BCBS Complete |
$474.26
|
| Rate for Payer: BCBS MAPPO |
$296.41
|
| Rate for Payer: BCBS Trust/PPO |
$974.71
|
| Rate for Payer: BCN Commercial |
$921.84
|
| Rate for Payer: BCN Medicare Advantage |
$296.41
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,019.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.41
|
| Rate for Payer: Healthscope Commercial |
$1,067.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: Nomi Health Commercial |
$972.22
|
| Rate for Payer: PACE Senior Care Partners |
$281.59
|
| Rate for Payer: PACE SWMI |
$296.41
|
| Rate for Payer: PHP Commercial |
$1,007.79
|
| Rate for Payer: PHP Medicare Advantage |
$296.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,031.51
|
| Rate for Payer: Priority Health Medicare |
$299.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$794.38
|
| Rate for Payer: Railroad Medicare Medicare |
$296.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.36
|
| Rate for Payer: UHC Core |
$990.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.41
|
| Rate for Payer: UHC Exchange |
$296.41
|
| Rate for Payer: UHC Medicare Advantage |
$296.41
|
| Rate for Payer: VA VA |
$296.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.23
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$770.67 |
| Max. Negotiated Rate |
$1,067.08 |
| Rate for Payer: Aetna Commercial |
$1,007.79
|
| Rate for Payer: BCBS Trust/PPO |
$967.84
|
| Rate for Payer: BCN Commercial |
$916.26
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,019.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,067.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: Nomi Health Commercial |
$972.22
|
| Rate for Payer: PHP Commercial |
$1,007.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,031.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$794.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.36
|
| Rate for Payer: UHC Core |
$990.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.23
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$131.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Aetna Commercial |
$111.84
|
| Rate for Payer: Aetna Medicare |
$34.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.12
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$108.17
|
| Rate for Payer: BCN Commercial |
$102.30
|
| Rate for Payer: BCN Medicare Advantage |
$32.90
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$113.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$118.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.68
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.54
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: Nomi Health Commercial |
$107.90
|
| Rate for Payer: PACE Senior Care Partners |
$31.25
|
| Rate for Payer: PACE SWMI |
$32.90
|
| Rate for Payer: PHP Commercial |
$111.84
|
| Rate for Payer: PHP Medicare Advantage |
$32.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health HMO/PPO |
$114.47
|
| Rate for Payer: Priority Health Medicare |
$33.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.16
|
| Rate for Payer: Railroad Medicare Medicare |
$32.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.79
|
| Rate for Payer: UHC Core |
$109.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.90
|
| Rate for Payer: UHC Exchange |
$32.90
|
| Rate for Payer: UHC Medicare Advantage |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.68
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$131.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.53 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Aetna Commercial |
$111.84
|
| Rate for Payer: BCBS Trust/PPO |
$107.41
|
| Rate for Payer: BCN Commercial |
$101.69
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$113.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Healthscope Commercial |
$118.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: Nomi Health Commercial |
$107.90
|
| Rate for Payer: PHP Commercial |
$111.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health HMO/PPO |
$114.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.79
|
| Rate for Payer: UHC Core |
$109.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.68
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,896.09
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$4,406.48 |
| Rate for Payer: Aetna Commercial |
$4,161.68
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,996.68
|
| Rate for Payer: BCN Commercial |
$3,783.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$3,916.87
|
| Rate for Payer: Cash Price |
$3,916.87
|
| Rate for Payer: Cofinity Commercial |
$4,210.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$4,406.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,672.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.68
|
| Rate for Payer: Nomi Health Commercial |
$4,014.79
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$4,161.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.46
|
| Rate for Payer: Priority Health HMO/PPO |
$4,259.60
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,280.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,308.56
|
| Rate for Payer: UHC Core |
$4,088.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,672.07
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$2,965.64
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$2,669.08 |
| Rate for Payer: Aetna Commercial |
$2,520.79
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,420.85
|
| Rate for Payer: BCN Commercial |
$2,291.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$2,372.51
|
| Rate for Payer: Cash Price |
$2,372.51
|
| Rate for Payer: Cofinity Commercial |
$2,550.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,372.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$2,669.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,224.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,520.79
|
| Rate for Payer: Nomi Health Commercial |
$2,431.82
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$2,520.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,927.67
|
| Rate for Payer: Priority Health HMO/PPO |
$2,580.11
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,986.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,609.76
|
| Rate for Payer: UHC Core |
$2,476.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,224.23
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$536.85
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$483.16 |
| Rate for Payer: Aetna Commercial |
$456.32
|
| Rate for Payer: Aetna Medicare |
$139.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.77
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$134.21
|
| Rate for Payer: BCBS Trust/PPO |
$441.34
|
| Rate for Payer: BCN Commercial |
$417.40
|
| Rate for Payer: BCN Medicare Advantage |
$134.21
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cofinity Commercial |
$461.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.21
|
| Rate for Payer: Healthscope Commercial |
$483.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.64
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.92
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.32
|
| Rate for Payer: Nomi Health Commercial |
$440.22
|
| Rate for Payer: PACE Senior Care Partners |
$127.50
|
| Rate for Payer: PACE SWMI |
$134.21
|
| Rate for Payer: PHP Commercial |
$456.32
|
| Rate for Payer: PHP Medicare Advantage |
$134.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.95
|
| Rate for Payer: Priority Health HMO/PPO |
$467.06
|
| Rate for Payer: Priority Health Medicare |
$135.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$359.69
|
| Rate for Payer: Railroad Medicare Medicare |
$134.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.43
|
| Rate for Payer: UHC Core |
$448.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.21
|
| Rate for Payer: UHC Exchange |
$134.21
|
| Rate for Payer: UHC Medicare Advantage |
$134.21
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$134.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.64
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$536.85
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.95 |
| Max. Negotiated Rate |
$483.16 |
| Rate for Payer: Aetna Commercial |
$456.32
|
| Rate for Payer: BCBS Trust/PPO |
$438.23
|
| Rate for Payer: BCN Commercial |
$414.88
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cofinity Commercial |
$461.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.48
|
| Rate for Payer: Healthscope Commercial |
$483.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.32
|
| Rate for Payer: Nomi Health Commercial |
$440.22
|
| Rate for Payer: PHP Commercial |
$456.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.95
|
| Rate for Payer: Priority Health HMO/PPO |
$467.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$359.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.43
|
| Rate for Payer: UHC Core |
$448.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.64
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
IP
|
$1,888.39
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,227.45 |
| Max. Negotiated Rate |
$1,699.55 |
| Rate for Payer: Aetna Commercial |
$1,605.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,541.49
|
| Rate for Payer: BCN Commercial |
$1,459.35
|
| Rate for Payer: Cash Price |
$1,510.71
|
| Rate for Payer: Cofinity Commercial |
$1,624.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.71
|
| Rate for Payer: Healthscope Commercial |
$1,699.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.13
|
| Rate for Payer: Nomi Health Commercial |
$1,548.48
|
| Rate for Payer: PHP Commercial |
$1,605.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,642.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,265.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,661.78
|
| Rate for Payer: UHC Core |
$1,576.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.29
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
OP
|
$1,888.39
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$448.49 |
| Max. Negotiated Rate |
$1,699.55 |
| Rate for Payer: Aetna Commercial |
$1,605.13
|
| Rate for Payer: Aetna Medicare |
$490.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$590.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$590.12
|
| Rate for Payer: BCBS Complete |
$755.36
|
| Rate for Payer: BCBS MAPPO |
$472.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,552.45
|
| Rate for Payer: BCN Commercial |
$1,468.22
|
| Rate for Payer: BCN Medicare Advantage |
$472.10
|
| Rate for Payer: Cash Price |
$1,510.71
|
| Rate for Payer: Cofinity Commercial |
$1,624.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.10
|
| Rate for Payer: Healthscope Commercial |
$1,699.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$542.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.13
|
| Rate for Payer: Nomi Health Commercial |
$1,548.48
|
| Rate for Payer: PACE Senior Care Partners |
$448.49
|
| Rate for Payer: PACE SWMI |
$472.10
|
| Rate for Payer: PHP Commercial |
$1,605.13
|
| Rate for Payer: PHP Medicare Advantage |
$472.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,642.90
|
| Rate for Payer: Priority Health Medicare |
$476.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,265.22
|
| Rate for Payer: Railroad Medicare Medicare |
$472.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,661.78
|
| Rate for Payer: UHC Core |
$1,576.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.10
|
| Rate for Payer: UHC Exchange |
$472.10
|
| Rate for Payer: UHC Medicare Advantage |
$472.10
|
| Rate for Payer: VA VA |
$472.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.29
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$73.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.00
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$231.50
|
| Rate for Payer: BCN Commercial |
$218.94
|
| Rate for Payer: BCN Medicare Advantage |
$70.40
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.40
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.92
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PACE Senior Care Partners |
$66.88
|
| Rate for Payer: PACE SWMI |
$70.40
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: PHP Medicare Advantage |
$70.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Medicare |
$71.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: Railroad Medicare Medicare |
$70.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.40
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$70.40
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$229.86
|
| Rate for Payer: BCN Commercial |
$217.61
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
OP
|
$309.75
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.57 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: Aetna Medicare |
$80.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.80
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$77.44
|
| Rate for Payer: BCBS Trust/PPO |
$254.65
|
| Rate for Payer: BCN Commercial |
$240.83
|
| Rate for Payer: BCN Medicare Advantage |
$77.44
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.44
|
| Rate for Payer: Healthscope Commercial |
$278.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.31
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.31
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Nomi Health Commercial |
$254.00
|
| Rate for Payer: PACE Senior Care Partners |
$73.57
|
| Rate for Payer: PACE SWMI |
$77.44
|
| Rate for Payer: PHP Commercial |
$263.29
|
| Rate for Payer: PHP Medicare Advantage |
$77.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: Priority Health HMO/PPO |
$269.48
|
| Rate for Payer: Priority Health Medicare |
$78.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.53
|
| Rate for Payer: Railroad Medicare Medicare |
$77.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.58
|
| Rate for Payer: UHC Core |
$258.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.44
|
| Rate for Payer: UHC Exchange |
$77.44
|
| Rate for Payer: UHC Medicare Advantage |
$77.44
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$77.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.31
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$278.78 |
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: BCBS Trust/PPO |
$252.85
|
| Rate for Payer: BCN Commercial |
$239.37
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Healthscope Commercial |
$278.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Nomi Health Commercial |
$254.00
|
| Rate for Payer: PHP Commercial |
$263.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: Priority Health HMO/PPO |
$269.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.58
|
| Rate for Payer: UHC Core |
$258.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.31
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
IP
|
$498.64
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.12 |
| Max. Negotiated Rate |
$448.78 |
| Rate for Payer: Aetna Commercial |
$423.84
|
| Rate for Payer: BCBS Trust/PPO |
$407.04
|
| Rate for Payer: BCN Commercial |
$385.35
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$428.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Healthscope Commercial |
$448.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: PHP Commercial |
$423.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health HMO/PPO |
$433.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.80
|
| Rate for Payer: UHC Core |
$416.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.98
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
OP
|
$498.64
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$448.78 |
| Rate for Payer: Aetna Commercial |
$423.84
|
| Rate for Payer: Aetna Medicare |
$129.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.82
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$124.66
|
| Rate for Payer: BCBS Trust/PPO |
$409.93
|
| Rate for Payer: BCN Commercial |
$387.69
|
| Rate for Payer: BCN Medicare Advantage |
$124.66
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$428.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.66
|
| Rate for Payer: Healthscope Commercial |
$448.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.98
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.89
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: PACE Senior Care Partners |
$118.43
|
| Rate for Payer: PACE SWMI |
$124.66
|
| Rate for Payer: PHP Commercial |
$423.84
|
| Rate for Payer: PHP Medicare Advantage |
$124.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health HMO/PPO |
$433.82
|
| Rate for Payer: Priority Health Medicare |
$125.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.09
|
| Rate for Payer: Railroad Medicare Medicare |
$124.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.80
|
| Rate for Payer: UHC Core |
$416.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.66
|
| Rate for Payer: UHC Exchange |
$124.66
|
| Rate for Payer: UHC Medicare Advantage |
$124.66
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$124.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.98
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$73.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.00
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$231.50
|
| Rate for Payer: BCN Commercial |
$218.94
|
| Rate for Payer: BCN Medicare Advantage |
$70.40
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.40
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.92
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PACE Senior Care Partners |
$66.88
|
| Rate for Payer: PACE SWMI |
$70.40
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: PHP Medicare Advantage |
$70.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Medicare |
$71.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: Railroad Medicare Medicare |
$70.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.40
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$70.40
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$229.86
|
| Rate for Payer: BCN Commercial |
$217.61
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$278.78 |
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: BCBS Trust/PPO |
$252.85
|
| Rate for Payer: BCN Commercial |
$239.37
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Healthscope Commercial |
$278.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Nomi Health Commercial |
$254.00
|
| Rate for Payer: PHP Commercial |
$263.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: Priority Health HMO/PPO |
$269.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.58
|
| Rate for Payer: UHC Core |
$258.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.31
|
|
|
HC INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM
|
Facility
|
OP
|
$309.75
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.57 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: Aetna Medicare |
$80.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.80
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$77.44
|
| Rate for Payer: BCBS Trust/PPO |
$254.65
|
| Rate for Payer: BCN Commercial |
$240.83
|
| Rate for Payer: BCN Medicare Advantage |
$77.44
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.44
|
| Rate for Payer: Healthscope Commercial |
$278.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.31
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.31
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Nomi Health Commercial |
$254.00
|
| Rate for Payer: PACE Senior Care Partners |
$73.57
|
| Rate for Payer: PACE SWMI |
$77.44
|
| Rate for Payer: PHP Commercial |
$263.29
|
| Rate for Payer: PHP Medicare Advantage |
$77.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: Priority Health HMO/PPO |
$269.48
|
| Rate for Payer: Priority Health Medicare |
$78.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.53
|
| Rate for Payer: Railroad Medicare Medicare |
$77.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.58
|
| Rate for Payer: UHC Core |
$258.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.44
|
| Rate for Payer: UHC Exchange |
$77.44
|
| Rate for Payer: UHC Medicare Advantage |
$77.44
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$77.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.31
|
|
|
HC INTMD RPR WND FACE/MM 5.1-7.5 CM
|
Facility
|
OP
|
$899.53
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
76100315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$809.58 |
| Rate for Payer: Aetna Commercial |
$764.60
|
| Rate for Payer: Aetna Medicare |
$233.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281.10
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$224.88
|
| Rate for Payer: BCBS Trust/PPO |
$739.50
|
| Rate for Payer: BCN Commercial |
$699.38
|
| Rate for Payer: BCN Medicare Advantage |
$224.88
|
| Rate for Payer: Cash Price |
$719.62
|
| Rate for Payer: Cash Price |
$719.62
|
| Rate for Payer: Cofinity Commercial |
$773.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.88
|
| Rate for Payer: Healthscope Commercial |
$809.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.65
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.13
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.60
|
| Rate for Payer: Nomi Health Commercial |
$737.61
|
| Rate for Payer: PACE Senior Care Partners |
$213.64
|
| Rate for Payer: PACE SWMI |
$224.88
|
| Rate for Payer: PHP Commercial |
$764.60
|
| Rate for Payer: PHP Medicare Advantage |
$224.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.69
|
| Rate for Payer: Priority Health HMO/PPO |
$782.59
|
| Rate for Payer: Priority Health Medicare |
$227.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$602.69
|
| Rate for Payer: Railroad Medicare Medicare |
$224.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.59
|
| Rate for Payer: UHC Core |
$751.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.88
|
| Rate for Payer: UHC Exchange |
$224.88
|
| Rate for Payer: UHC Medicare Advantage |
$224.88
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$224.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.65
|
|
|
HC INTMD RPR WND FACE/MM 5.1-7.5 CM
|
Facility
|
IP
|
$899.53
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
76100315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.69 |
| Max. Negotiated Rate |
$809.58 |
| Rate for Payer: Aetna Commercial |
$764.60
|
| Rate for Payer: BCBS Trust/PPO |
$734.29
|
| Rate for Payer: BCN Commercial |
$695.16
|
| Rate for Payer: Cash Price |
$719.62
|
| Rate for Payer: Cofinity Commercial |
$773.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.62
|
| Rate for Payer: Healthscope Commercial |
$809.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.60
|
| Rate for Payer: Nomi Health Commercial |
$737.61
|
| Rate for Payer: PHP Commercial |
$764.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.69
|
| Rate for Payer: Priority Health HMO/PPO |
$782.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$602.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.59
|
| Rate for Payer: UHC Core |
$751.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.65
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$2,205.80
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
36100083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,433.77 |
| Max. Negotiated Rate |
$1,985.22 |
| Rate for Payer: Aetna Commercial |
$1,874.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,800.59
|
| Rate for Payer: BCN Commercial |
$1,704.64
|
| Rate for Payer: Cash Price |
$1,764.64
|
| Rate for Payer: Cofinity Commercial |
$1,896.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.64
|
| Rate for Payer: Healthscope Commercial |
$1,985.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,654.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,874.93
|
| Rate for Payer: Nomi Health Commercial |
$1,808.76
|
| Rate for Payer: PHP Commercial |
$1,874.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,919.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,941.10
|
| Rate for Payer: UHC Core |
$1,841.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,654.35
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$2,205.80
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
36100083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.88 |
| Max. Negotiated Rate |
$1,985.22 |
| Rate for Payer: Aetna Commercial |
$1,874.93
|
| Rate for Payer: Aetna Medicare |
$573.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$689.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$689.31
|
| Rate for Payer: BCBS Complete |
$882.32
|
| Rate for Payer: BCBS MAPPO |
$551.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,813.39
|
| Rate for Payer: BCN Commercial |
$1,715.01
|
| Rate for Payer: BCN Medicare Advantage |
$551.45
|
| Rate for Payer: Cash Price |
$1,764.64
|
| Rate for Payer: Cofinity Commercial |
$1,896.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.45
|
| Rate for Payer: Healthscope Commercial |
$1,985.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,654.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$634.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,874.93
|
| Rate for Payer: Nomi Health Commercial |
$1,808.76
|
| Rate for Payer: PACE Senior Care Partners |
$523.88
|
| Rate for Payer: PACE SWMI |
$551.45
|
| Rate for Payer: PHP Commercial |
$1,874.93
|
| Rate for Payer: PHP Medicare Advantage |
$551.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.77
|
| Rate for Payer: Priority Health HMO/PPO |
$1,919.05
|
| Rate for Payer: Priority Health Medicare |
$556.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.89
|
| Rate for Payer: Railroad Medicare Medicare |
$551.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,941.10
|
| Rate for Payer: UHC Core |
$1,841.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.45
|
| Rate for Payer: UHC Exchange |
$551.45
|
| Rate for Payer: UHC Medicare Advantage |
$551.45
|
| Rate for Payer: VA VA |
$551.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,654.35
|
|
|
HC INTRA AORTIC BALLOON REMOVAL PERCUTANEOUS
|
Facility
|
IP
|
$1,340.24
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
48100104
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$871.16 |
| Max. Negotiated Rate |
$1,206.22 |
| Rate for Payer: Aetna Commercial |
$1,139.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,094.04
|
| Rate for Payer: BCN Commercial |
$1,035.74
|
| Rate for Payer: Cash Price |
$1,072.19
|
| Rate for Payer: Cofinity Commercial |
$1,152.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.19
|
| Rate for Payer: Healthscope Commercial |
$1,206.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,005.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,139.20
|
| Rate for Payer: Nomi Health Commercial |
$1,099.00
|
| Rate for Payer: PHP Commercial |
$1,139.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,166.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$897.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,179.41
|
| Rate for Payer: UHC Core |
$1,119.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,005.18
|
|
