|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,935.71 |
| Max. Negotiated Rate |
$4,064.83 |
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,686.80
|
| Rate for Payer: BCN Commercial |
$3,490.34
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$3,884.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Healthscope Commercial |
$4,064.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,387.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: Nomi Health Commercial |
$3,703.51
|
| Rate for Payer: PHP Commercial |
$3,839.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: Priority Health HMO/PPO |
$3,929.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,026.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,974.50
|
| Rate for Payer: UHC Core |
$3,771.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,387.36
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,516.48
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,072.66 |
| Max. Negotiated Rate |
$4,064.83 |
| Rate for Payer: Aetna Commercial |
$3,839.01
|
| Rate for Payer: Aetna Medicare |
$1,174.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,411.40
|
| Rate for Payer: BCBS Complete |
$1,806.59
|
| Rate for Payer: BCBS MAPPO |
$1,129.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,713.00
|
| Rate for Payer: BCN Commercial |
$3,511.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,129.12
|
| Rate for Payer: Cash Price |
$3,613.18
|
| Rate for Payer: Cofinity Commercial |
$3,884.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,613.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,129.12
|
| Rate for Payer: Healthscope Commercial |
$4,064.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,387.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,298.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,839.01
|
| Rate for Payer: Nomi Health Commercial |
$3,703.51
|
| Rate for Payer: PACE Senior Care Partners |
$1,072.66
|
| Rate for Payer: PACE SWMI |
$1,129.12
|
| Rate for Payer: PHP Commercial |
$3,839.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,129.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.71
|
| Rate for Payer: Priority Health HMO/PPO |
$3,929.34
|
| Rate for Payer: Priority Health Medicare |
$1,140.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,026.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,129.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,974.50
|
| Rate for Payer: UHC Core |
$3,771.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,129.12
|
| Rate for Payer: UHC Exchange |
$1,129.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,129.12
|
| Rate for Payer: VA VA |
$1,129.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,387.36
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: Meridian Medicaid |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: UHCCP Medicaid |
$13.48
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO |
$38.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$11.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.71
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: BCBS MAPPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$36.06
|
| Rate for Payer: BCN Commercial |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.96
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: PACE Senior Care Partners |
$10.42
|
| Rate for Payer: PACE SWMI |
$10.96
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO |
$38.16
|
| Rate for Payer: Priority Health Medicare |
$11.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.39
|
| Rate for Payer: Railroad Medicare Medicare |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.96
|
| Rate for Payer: UHC Exchange |
$10.96
|
| Rate for Payer: UHC Medicare Advantage |
$10.96
|
| Rate for Payer: VA VA |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.45 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: Aetna Medicare |
$107.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.54
|
| Rate for Payer: BCBS Complete |
$165.81
|
| Rate for Payer: BCBS MAPPO |
$103.63
|
| Rate for Payer: BCBS Trust/PPO |
$340.79
|
| Rate for Payer: BCN Commercial |
$322.30
|
| Rate for Payer: BCN Medicare Advantage |
$103.63
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.63
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: Nomi Health Commercial |
$339.91
|
| Rate for Payer: PACE Senior Care Partners |
$98.45
|
| Rate for Payer: PACE SWMI |
$103.63
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: PHP Medicare Advantage |
$103.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health HMO/PPO |
$360.64
|
| Rate for Payer: Priority Health Medicare |
$104.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.74
|
| Rate for Payer: Railroad Medicare Medicare |
$103.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.79
|
| Rate for Payer: UHC Core |
$346.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.63
|
| Rate for Payer: UHC Exchange |
$103.63
|
| Rate for Payer: UHC Medicare Advantage |
$103.63
|
| Rate for Payer: VA VA |
$103.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.90
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$414.53
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$269.44 |
| Max. Negotiated Rate |
$373.08 |
| Rate for Payer: Aetna Commercial |
$352.35
|
| Rate for Payer: BCBS Trust/PPO |
$338.38
|
| Rate for Payer: BCN Commercial |
$320.35
|
| Rate for Payer: Cash Price |
$331.62
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.62
|
| Rate for Payer: Healthscope Commercial |
$373.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.35
|
| Rate for Payer: Nomi Health Commercial |
$339.91
|
| Rate for Payer: PHP Commercial |
$352.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.44
|
| Rate for Payer: Priority Health HMO/PPO |
$360.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.79
|
| Rate for Payer: UHC Core |
$346.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.90
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$948.26
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$853.43 |
| Rate for Payer: Aetna Commercial |
$806.02
|
| Rate for Payer: Aetna Medicare |
$246.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.33
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$237.06
|
| Rate for Payer: BCBS Trust/PPO |
$779.56
|
| Rate for Payer: BCN Commercial |
$737.27
|
| Rate for Payer: BCN Medicare Advantage |
$237.06
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cofinity Commercial |
$815.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.06
|
| Rate for Payer: Healthscope Commercial |
$853.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.20
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.92
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.02
|
| Rate for Payer: Nomi Health Commercial |
$777.57
|
| Rate for Payer: PACE Senior Care Partners |
$225.21
|
| Rate for Payer: PACE SWMI |
$237.06
|
| Rate for Payer: PHP Commercial |
$806.02
|
| Rate for Payer: PHP Medicare Advantage |
$237.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.37
|
| Rate for Payer: Priority Health HMO/PPO |
$824.99
|
| Rate for Payer: Priority Health Medicare |
$239.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$635.33
|
| Rate for Payer: Railroad Medicare Medicare |
$237.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.47
|
| Rate for Payer: UHC Core |
$791.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.06
|
| Rate for Payer: UHC Exchange |
$237.06
|
| Rate for Payer: UHC Medicare Advantage |
$237.06
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$237.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.20
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$948.26
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$616.37 |
| Max. Negotiated Rate |
$853.43 |
| Rate for Payer: Aetna Commercial |
$806.02
|
| Rate for Payer: BCBS Trust/PPO |
$774.06
|
| Rate for Payer: BCN Commercial |
$732.82
|
| Rate for Payer: Cash Price |
$758.61
|
| Rate for Payer: Cofinity Commercial |
$815.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.61
|
| Rate for Payer: Healthscope Commercial |
$853.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.02
|
| Rate for Payer: Nomi Health Commercial |
$777.57
|
| Rate for Payer: PHP Commercial |
$806.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.37
|
| Rate for Payer: Priority Health HMO/PPO |
$824.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$635.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.47
|
| Rate for Payer: UHC Core |
$791.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.20
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.29 |
| Max. Negotiated Rate |
$194.37 |
| Rate for Payer: Aetna Commercial |
$183.57
|
| Rate for Payer: Aetna Medicare |
$56.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.49
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$53.99
|
| Rate for Payer: BCBS Trust/PPO |
$177.55
|
| Rate for Payer: BCN Commercial |
$167.92
|
| Rate for Payer: BCN Medicare Advantage |
$53.99
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$185.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.99
|
| Rate for Payer: Healthscope Commercial |
$194.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.98
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.69
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: Nomi Health Commercial |
$177.10
|
| Rate for Payer: PACE Senior Care Partners |
$51.29
|
| Rate for Payer: PACE SWMI |
$53.99
|
| Rate for Payer: PHP Commercial |
$183.57
|
| Rate for Payer: PHP Medicare Advantage |
$53.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: Priority Health HMO/PPO |
$187.89
|
| Rate for Payer: Priority Health Medicare |
$54.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.70
|
| Rate for Payer: Railroad Medicare Medicare |
$53.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.05
|
| Rate for Payer: UHC Core |
$180.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.99
|
| Rate for Payer: UHC Exchange |
$53.99
|
| Rate for Payer: UHC Medicare Advantage |
$53.99
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$53.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.98
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$215.97
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.38 |
| Max. Negotiated Rate |
$194.37 |
| Rate for Payer: Aetna Commercial |
$183.57
|
| Rate for Payer: BCBS Trust/PPO |
$176.30
|
| Rate for Payer: BCN Commercial |
$166.90
|
| Rate for Payer: Cash Price |
$172.78
|
| Rate for Payer: Cofinity Commercial |
$185.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.78
|
| Rate for Payer: Healthscope Commercial |
$194.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.57
|
| Rate for Payer: Nomi Health Commercial |
$177.10
|
| Rate for Payer: PHP Commercial |
$183.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.38
|
| Rate for Payer: Priority Health HMO/PPO |
$187.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.05
|
| Rate for Payer: UHC Core |
$180.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.98
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Aetna Commercial |
$523.97
|
| Rate for Payer: Aetna Medicare |
$160.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.64
|
| Rate for Payer: BCBS Complete |
$246.58
|
| Rate for Payer: BCBS MAPPO |
$154.11
|
| Rate for Payer: BCBS Trust/PPO |
$506.78
|
| Rate for Payer: BCN Commercial |
$479.28
|
| Rate for Payer: BCN Medicare Advantage |
$154.11
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$530.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.11
|
| Rate for Payer: Healthscope Commercial |
$554.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$505.48
|
| Rate for Payer: PACE Senior Care Partners |
$146.40
|
| Rate for Payer: PACE SWMI |
$154.11
|
| Rate for Payer: PHP Commercial |
$523.97
|
| Rate for Payer: PHP Medicare Advantage |
$154.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: Priority Health HMO/PPO |
$536.30
|
| Rate for Payer: Priority Health Medicare |
$155.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.01
|
| Rate for Payer: Railroad Medicare Medicare |
$154.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.47
|
| Rate for Payer: UHC Core |
$514.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.11
|
| Rate for Payer: UHC Exchange |
$154.11
|
| Rate for Payer: UHC Medicare Advantage |
$154.11
|
| Rate for Payer: VA VA |
$154.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.33
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$616.44
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$400.69 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Aetna Commercial |
$523.97
|
| Rate for Payer: BCBS Trust/PPO |
$503.20
|
| Rate for Payer: BCN Commercial |
$476.38
|
| Rate for Payer: Cash Price |
$493.15
|
| Rate for Payer: Cofinity Commercial |
$530.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.15
|
| Rate for Payer: Healthscope Commercial |
$554.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.97
|
| Rate for Payer: Nomi Health Commercial |
$505.48
|
| Rate for Payer: PHP Commercial |
$523.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.69
|
| Rate for Payer: Priority Health HMO/PPO |
$536.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.47
|
| Rate for Payer: UHC Core |
$514.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.33
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
OP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$296.07 |
| Rate for Payer: Aetna Commercial |
$279.62
|
| Rate for Payer: Aetna Medicare |
$85.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.80
|
| Rate for Payer: BCBS Complete |
$131.59
|
| Rate for Payer: BCBS MAPPO |
$82.24
|
| Rate for Payer: BCBS Trust/PPO |
$270.45
|
| Rate for Payer: BCN Commercial |
$255.77
|
| Rate for Payer: BCN Medicare Advantage |
$82.24
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$282.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.24
|
| Rate for Payer: Healthscope Commercial |
$296.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: Nomi Health Commercial |
$269.76
|
| Rate for Payer: PACE Senior Care Partners |
$78.13
|
| Rate for Payer: PACE SWMI |
$82.24
|
| Rate for Payer: PHP Commercial |
$279.62
|
| Rate for Payer: PHP Medicare Advantage |
$82.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: Priority Health HMO/PPO |
$286.20
|
| Rate for Payer: Priority Health Medicare |
$83.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.41
|
| Rate for Payer: Railroad Medicare Medicare |
$82.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.49
|
| Rate for Payer: UHC Core |
$274.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.24
|
| Rate for Payer: UHC Exchange |
$82.24
|
| Rate for Payer: UHC Medicare Advantage |
$82.24
|
| Rate for Payer: VA VA |
$82.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.73
|
|
|
HC NUSHIELD 2X3 PER SQ CM
|
Facility
|
IP
|
$328.97
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.83 |
| Max. Negotiated Rate |
$296.07 |
| Rate for Payer: Aetna Commercial |
$279.62
|
| Rate for Payer: BCBS Trust/PPO |
$268.54
|
| Rate for Payer: BCN Commercial |
$254.23
|
| Rate for Payer: Cash Price |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$282.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.18
|
| Rate for Payer: Healthscope Commercial |
$296.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.62
|
| Rate for Payer: Nomi Health Commercial |
$269.76
|
| Rate for Payer: PHP Commercial |
$279.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.83
|
| Rate for Payer: Priority Health HMO/PPO |
$286.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.49
|
| Rate for Payer: UHC Core |
$274.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.73
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.77 |
| Max. Negotiated Rate |
$277.99 |
| Rate for Payer: Aetna Commercial |
$262.55
|
| Rate for Payer: BCBS Trust/PPO |
$252.14
|
| Rate for Payer: BCN Commercial |
$238.70
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$265.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$277.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: PHP Commercial |
$262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health HMO/PPO |
$268.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.81
|
| Rate for Payer: UHC Core |
$257.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.66
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$277.99 |
| Rate for Payer: Aetna Commercial |
$262.55
|
| Rate for Payer: Aetna Medicare |
$80.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.53
|
| Rate for Payer: BCBS Complete |
$123.55
|
| Rate for Payer: BCBS MAPPO |
$77.22
|
| Rate for Payer: BCBS Trust/PPO |
$253.93
|
| Rate for Payer: BCN Commercial |
$240.15
|
| Rate for Payer: BCN Medicare Advantage |
$77.22
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$265.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.22
|
| Rate for Payer: Healthscope Commercial |
$277.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: PACE Senior Care Partners |
$73.36
|
| Rate for Payer: PACE SWMI |
$77.22
|
| Rate for Payer: PHP Commercial |
$262.55
|
| Rate for Payer: PHP Medicare Advantage |
$77.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health HMO/PPO |
$268.73
|
| Rate for Payer: Priority Health Medicare |
$77.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.95
|
| Rate for Payer: Railroad Medicare Medicare |
$77.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.81
|
| Rate for Payer: UHC Core |
$257.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.22
|
| Rate for Payer: UHC Exchange |
$77.22
|
| Rate for Payer: UHC Medicare Advantage |
$77.22
|
| Rate for Payer: VA VA |
$77.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.66
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.78 |
| Max. Negotiated Rate |
$268.23 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Aetna Medicare |
$77.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.13
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS MAPPO |
$74.51
|
| Rate for Payer: BCBS Trust/PPO |
$245.01
|
| Rate for Payer: BCN Commercial |
$231.72
|
| Rate for Payer: BCN Medicare Advantage |
$74.51
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$256.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.51
|
| Rate for Payer: Healthscope Commercial |
$268.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: PACE Senior Care Partners |
$70.78
|
| Rate for Payer: PACE SWMI |
$74.51
|
| Rate for Payer: PHP Commercial |
$253.33
|
| Rate for Payer: PHP Medicare Advantage |
$74.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health HMO/PPO |
$259.29
|
| Rate for Payer: Priority Health Medicare |
$75.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.68
|
| Rate for Payer: Railroad Medicare Medicare |
$74.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.27
|
| Rate for Payer: UHC Core |
$248.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.51
|
| Rate for Payer: UHC Exchange |
$74.51
|
| Rate for Payer: UHC Medicare Advantage |
$74.51
|
| Rate for Payer: VA VA |
$74.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.52
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.72 |
| Max. Negotiated Rate |
$268.23 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: BCBS Trust/PPO |
$243.28
|
| Rate for Payer: BCN Commercial |
$230.32
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$256.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$268.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: PHP Commercial |
$253.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health HMO/PPO |
$259.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.27
|
| Rate for Payer: UHC Core |
$248.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.52
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: BCBS Trust/PPO |
$189.10
|
| Rate for Payer: BCN Commercial |
$179.02
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health HMO/PPO |
$201.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.85
|
| Rate for Payer: UHC Core |
$193.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$60.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.39
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: BCBS MAPPO |
$57.91
|
| Rate for Payer: BCBS Trust/PPO |
$190.44
|
| Rate for Payer: BCN Commercial |
$180.11
|
| Rate for Payer: BCN Medicare Advantage |
$57.91
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.91
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: PACE Senior Care Partners |
$55.02
|
| Rate for Payer: PACE SWMI |
$57.91
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Medicare Advantage |
$57.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health HMO/PPO |
$201.54
|
| Rate for Payer: Priority Health Medicare |
$58.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.21
|
| Rate for Payer: Railroad Medicare Medicare |
$57.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.85
|
| Rate for Payer: UHC Core |
$193.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.91
|
| Rate for Payer: UHC Exchange |
$57.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.91
|
| Rate for Payer: VA VA |
$57.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.67 |
| Max. Negotiated Rate |
$146.31 |
| Rate for Payer: Aetna Commercial |
$138.18
|
| Rate for Payer: BCBS Trust/PPO |
$132.71
|
| Rate for Payer: BCN Commercial |
$125.63
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$139.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$146.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: PHP Commercial |
$138.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health HMO/PPO |
$141.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.06
|
| Rate for Payer: UHC Core |
$135.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.93
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$146.31 |
| Rate for Payer: Aetna Commercial |
$138.18
|
| Rate for Payer: Aetna Medicare |
$42.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.80
|
| Rate for Payer: BCBS Complete |
$65.03
|
| Rate for Payer: BCBS MAPPO |
$40.64
|
| Rate for Payer: BCBS Trust/PPO |
$133.65
|
| Rate for Payer: BCN Commercial |
$126.40
|
| Rate for Payer: BCN Medicare Advantage |
$40.64
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$139.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.64
|
| Rate for Payer: Healthscope Commercial |
$146.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: PACE Senior Care Partners |
$38.61
|
| Rate for Payer: PACE SWMI |
$40.64
|
| Rate for Payer: PHP Commercial |
$138.18
|
| Rate for Payer: PHP Medicare Advantage |
$40.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health HMO/PPO |
$141.44
|
| Rate for Payer: Priority Health Medicare |
$41.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.92
|
| Rate for Payer: Railroad Medicare Medicare |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.06
|
| Rate for Payer: UHC Core |
$135.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.64
|
| Rate for Payer: UHC Exchange |
$40.64
|
| Rate for Payer: UHC Medicare Advantage |
$40.64
|
| Rate for Payer: VA VA |
$40.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.93
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$129.54 |
| Rate for Payer: Aetna Commercial |
$122.34
|
| Rate for Payer: Aetna Medicare |
$37.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.98
|
| Rate for Payer: BCBS Complete |
$57.57
|
| Rate for Payer: BCBS MAPPO |
$35.98
|
| Rate for Payer: BCBS Trust/PPO |
$118.32
|
| Rate for Payer: BCN Commercial |
$111.91
|
| Rate for Payer: BCN Medicare Advantage |
$35.98
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$123.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.98
|
| Rate for Payer: Healthscope Commercial |
$129.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: Nomi Health Commercial |
$118.02
|
| Rate for Payer: PACE Senior Care Partners |
$34.18
|
| Rate for Payer: PACE SWMI |
$35.98
|
| Rate for Payer: PHP Commercial |
$122.34
|
| Rate for Payer: PHP Medicare Advantage |
$35.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: Priority Health HMO/PPO |
$125.22
|
| Rate for Payer: Priority Health Medicare |
$36.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.43
|
| Rate for Payer: Railroad Medicare Medicare |
$35.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.66
|
| Rate for Payer: UHC Core |
$120.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.98
|
| Rate for Payer: UHC Exchange |
$35.98
|
| Rate for Payer: UHC Medicare Advantage |
$35.98
|
| Rate for Payer: VA VA |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.95
|
|
