|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,432.40
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,483.52 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.76
|
| Rate for Payer: BCN Commercial |
$1,879.76
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,116.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,483.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,140.51
|
| Rate for Payer: UHC Core |
$2,031.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
OP
|
$2,432.40
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: Aetna Medicare |
$632.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$760.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$760.12
|
| Rate for Payer: BCBS Complete |
$1,056.83
|
| Rate for Payer: BCBS MAPPO |
$608.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,891.19
|
| Rate for Payer: BCN Commercial |
$1,891.19
|
| Rate for Payer: BCN Medicare Advantage |
$608.10
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.10
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Mclaren Medicaid |
$1,006.51
|
| Rate for Payer: Meridian Medicaid |
$1,056.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PACE Senior Care Partners |
$577.70
|
| Rate for Payer: PACE SWMI |
$608.10
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: PHP Medicare Advantage |
$608.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,006.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,116.19
|
| Rate for Payer: Priority Health Medicare |
$608.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,483.52
|
| Rate for Payer: Railroad Medicare Medicare |
$608.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,140.51
|
| Rate for Payer: UHC Core |
$2,031.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$608.10
|
| Rate for Payer: UHC Medicare Advantage |
$626.34
|
| Rate for Payer: VA VA |
$608.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,432.40
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,483.52 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.76
|
| Rate for Payer: BCN Commercial |
$1,879.76
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,116.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,483.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,140.51
|
| Rate for Payer: UHC Core |
$2,031.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,432.40
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,067.54
|
| Rate for Payer: Aetna Medicare |
$632.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$760.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$760.12
|
| Rate for Payer: BCBS Complete |
$1,056.83
|
| Rate for Payer: BCBS MAPPO |
$608.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,891.19
|
| Rate for Payer: BCN Commercial |
$1,891.19
|
| Rate for Payer: BCN Medicare Advantage |
$608.10
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cash Price |
$1,945.92
|
| Rate for Payer: Cofinity Commercial |
$2,091.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,945.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.10
|
| Rate for Payer: Healthscope Commercial |
$2,189.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.30
|
| Rate for Payer: Mclaren Medicaid |
$1,006.51
|
| Rate for Payer: Meridian Medicaid |
$1,056.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,067.54
|
| Rate for Payer: PACE Senior Care Partners |
$577.70
|
| Rate for Payer: PACE SWMI |
$608.10
|
| Rate for Payer: PHP Commercial |
$2,067.54
|
| Rate for Payer: PHP Medicare Advantage |
$608.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,006.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,116.19
|
| Rate for Payer: Priority Health Medicare |
$608.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,483.52
|
| Rate for Payer: Railroad Medicare Medicare |
$608.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,140.51
|
| Rate for Payer: UHC Core |
$2,031.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$608.10
|
| Rate for Payer: UHC Medicare Advantage |
$626.34
|
| Rate for Payer: VA VA |
$608.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.30
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: BCBS Trust/PPO |
$86.71
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.06
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$28.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.05
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: PACE Senior Care Partners |
$26.65
|
| Rate for Payer: PACE SWMI |
$28.05
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.61
|
| Rate for Payer: Priority Health Medicare |
$28.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.43
|
| Rate for Payer: Railroad Medicare Medicare |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.89
|
| Rate for Payer: VA VA |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$846.31
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$761.68 |
| Rate for Payer: Aetna Commercial |
$719.36
|
| Rate for Payer: Aetna Medicare |
$220.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.47
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$211.58
|
| Rate for Payer: BCBS Trust/PPO |
$658.01
|
| Rate for Payer: BCN Commercial |
$658.01
|
| Rate for Payer: BCN Medicare Advantage |
$211.58
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cofinity Commercial |
$727.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.58
|
| Rate for Payer: Healthscope Commercial |
$761.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.73
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.36
|
| Rate for Payer: PACE Senior Care Partners |
$201.00
|
| Rate for Payer: PACE SWMI |
$211.58
|
| Rate for Payer: PHP Commercial |
$719.36
|
| Rate for Payer: PHP Medicare Advantage |
$211.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.29
|
| Rate for Payer: Priority Health Medicare |
$211.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.16
|
| Rate for Payer: Railroad Medicare Medicare |
$211.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.75
|
| Rate for Payer: UHC Core |
$706.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.58
|
| Rate for Payer: UHC Medicare Advantage |
$217.92
|
| Rate for Payer: VA VA |
$211.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.73
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$846.31
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.16 |
| Max. Negotiated Rate |
$761.68 |
| Rate for Payer: Aetna Commercial |
$719.36
|
| Rate for Payer: BCBS Trust/PPO |
$654.03
|
| Rate for Payer: BCN Commercial |
$654.03
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cofinity Commercial |
$727.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.05
|
| Rate for Payer: Healthscope Commercial |
$761.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.36
|
| Rate for Payer: PHP Commercial |
$719.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.75
|
| Rate for Payer: UHC Core |
$706.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.73
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: BCBS Trust/PPO |
$45.02
|
| Rate for Payer: BCN Commercial |
$45.02
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.52
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.27
|
| Rate for Payer: UHC Core |
$48.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$45.30
|
| Rate for Payer: BCN Commercial |
$45.30
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.52
|
| Rate for Payer: PACE Senior Care Partners |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.69
|
| Rate for Payer: Priority Health Medicare |
$14.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.53
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.27
|
| Rate for Payer: UHC Core |
$48.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$15.00
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
OP
|
$180.52
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$162.47 |
| Rate for Payer: Aetna Commercial |
$153.44
|
| Rate for Payer: Aetna Medicare |
$46.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.41
|
| Rate for Payer: BCBS Complete |
$72.21
|
| Rate for Payer: BCBS MAPPO |
$45.13
|
| Rate for Payer: BCBS Trust/PPO |
$140.35
|
| Rate for Payer: BCN Commercial |
$140.35
|
| Rate for Payer: BCN Medicare Advantage |
$45.13
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.13
|
| Rate for Payer: Healthscope Commercial |
$162.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.44
|
| Rate for Payer: PACE Senior Care Partners |
$42.87
|
| Rate for Payer: PACE SWMI |
$45.13
|
| Rate for Payer: PHP Commercial |
$153.44
|
| Rate for Payer: PHP Medicare Advantage |
$45.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.05
|
| Rate for Payer: Priority Health Medicare |
$45.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.10
|
| Rate for Payer: Railroad Medicare Medicare |
$45.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.86
|
| Rate for Payer: UHC Core |
$150.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.13
|
| Rate for Payer: UHC Medicare Advantage |
$46.48
|
| Rate for Payer: VA VA |
$45.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.39
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
IP
|
$180.52
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.10 |
| Max. Negotiated Rate |
$162.47 |
| Rate for Payer: Aetna Commercial |
$153.44
|
| Rate for Payer: BCBS Trust/PPO |
$139.51
|
| Rate for Payer: BCN Commercial |
$139.51
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$162.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.44
|
| Rate for Payer: PHP Commercial |
$153.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.86
|
| Rate for Payer: UHC Core |
$150.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.39
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
OP
|
$82.89
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: Aetna Commercial |
$70.46
|
| Rate for Payer: Aetna Medicare |
$21.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.90
|
| Rate for Payer: BCBS Complete |
$33.16
|
| Rate for Payer: BCBS MAPPO |
$20.72
|
| Rate for Payer: BCBS Trust/PPO |
$64.45
|
| Rate for Payer: BCN Commercial |
$64.45
|
| Rate for Payer: BCN Medicare Advantage |
$20.72
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cofinity Commercial |
$71.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$74.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.46
|
| Rate for Payer: PACE Senior Care Partners |
$19.69
|
| Rate for Payer: PACE SWMI |
$20.72
|
| Rate for Payer: PHP Commercial |
$70.46
|
| Rate for Payer: PHP Medicare Advantage |
$20.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.11
|
| Rate for Payer: Priority Health Medicare |
$20.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.55
|
| Rate for Payer: Railroad Medicare Medicare |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.94
|
| Rate for Payer: UHC Core |
$69.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.72
|
| Rate for Payer: UHC Medicare Advantage |
$21.34
|
| Rate for Payer: VA VA |
$20.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.17
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
IP
|
$82.89
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.55 |
| Max. Negotiated Rate |
$74.60 |
| Rate for Payer: Aetna Commercial |
$70.46
|
| Rate for Payer: BCBS Trust/PPO |
$64.06
|
| Rate for Payer: BCN Commercial |
$64.06
|
| Rate for Payer: Cash Price |
$66.31
|
| Rate for Payer: Cofinity Commercial |
$71.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.31
|
| Rate for Payer: Healthscope Commercial |
$74.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.46
|
| Rate for Payer: PHP Commercial |
$70.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.94
|
| Rate for Payer: UHC Core |
$69.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.17
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
IP
|
$412.78
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.75 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: BCBS Trust/PPO |
$319.00
|
| Rate for Payer: BCN Commercial |
$319.00
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.25
|
| Rate for Payer: UHC Core |
$344.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
OP
|
$412.78
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.04 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: Aetna Medicare |
$107.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.99
|
| Rate for Payer: BCBS Complete |
$165.11
|
| Rate for Payer: BCBS MAPPO |
$103.20
|
| Rate for Payer: BCBS Trust/PPO |
$320.94
|
| Rate for Payer: BCN Commercial |
$320.94
|
| Rate for Payer: BCN Medicare Advantage |
$103.20
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.20
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PACE Senior Care Partners |
$98.04
|
| Rate for Payer: PACE SWMI |
$103.20
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: PHP Medicare Advantage |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.12
|
| Rate for Payer: Priority Health Medicare |
$103.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.75
|
| Rate for Payer: Railroad Medicare Medicare |
$103.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.25
|
| Rate for Payer: UHC Core |
$344.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.20
|
| Rate for Payer: UHC Medicare Advantage |
$106.29
|
| Rate for Payer: VA VA |
$103.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna Medicare |
$22.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.86
|
| Rate for Payer: BCBS Complete |
$20.51
|
| Rate for Payer: BCBS MAPPO |
$21.49
|
| Rate for Payer: BCBS Trust/PPO |
$66.83
|
| Rate for Payer: BCN Commercial |
$66.83
|
| Rate for Payer: BCN Medicare Advantage |
$21.49
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.49
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.47
|
| Rate for Payer: Mclaren Medicaid |
$19.53
|
| Rate for Payer: Meridian Medicaid |
$20.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PACE Senior Care Partners |
$20.42
|
| Rate for Payer: PACE SWMI |
$21.49
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: PHP Medicare Advantage |
$21.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.79
|
| Rate for Payer: Priority Health Medicare |
$21.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.43
|
| Rate for Payer: Railroad Medicare Medicare |
$21.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.64
|
| Rate for Payer: UHC Core |
$71.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.49
|
| Rate for Payer: UHC Medicare Advantage |
$22.13
|
| Rate for Payer: VA VA |
$21.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.47
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: BCBS Trust/PPO |
$66.43
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.07
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.64
|
| Rate for Payer: UHC Core |
$71.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.47
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: BCBS Trust/PPO |
$46.51
|
| Rate for Payer: BCN Commercial |
$46.51
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.96
|
| Rate for Payer: UHC Core |
$50.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$16.45
|
| Rate for Payer: BCBS MAPPO |
$15.04
|
| Rate for Payer: BCBS Trust/PPO |
$46.79
|
| Rate for Payer: BCN Commercial |
$46.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.04
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Mclaren Medicaid |
$15.67
|
| Rate for Payer: Meridian Medicaid |
$16.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PACE Senior Care Partners |
$14.29
|
| Rate for Payer: PACE SWMI |
$15.04
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: PHP Medicare Advantage |
$15.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.36
|
| Rate for Payer: Priority Health Medicare |
$15.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.96
|
| Rate for Payer: UHC Core |
$50.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.04
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: VA VA |
$15.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$15.70
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$14.95
|
| Rate for Payer: Meridian Medicaid |
$15.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$20.62
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCCCP Commercial |
$26.49
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$19.64
|
| Rate for Payer: Meridian Medicaid |
$20.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
