|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.45 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna Medicare |
$102.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.10
|
| Rate for Payer: BCBS Complete |
$72.92
|
| Rate for Payer: BCBS MAPPO |
$98.48
|
| Rate for Payer: BCBS Trust/PPO |
$323.85
|
| Rate for Payer: BCN Commercial |
$323.85
|
| Rate for Payer: BCN Medicare Advantage |
$98.48
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.48
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.45
|
| Rate for Payer: Mclaren Medicaid |
$69.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.41
|
| Rate for Payer: Meridian Medicaid |
$72.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Senior Care Partners |
$93.56
|
| Rate for Payer: PACE SWMI |
$98.48
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: PHP Medicare Advantage |
$98.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$342.72
|
| Rate for Payer: Priority Health Medicare |
$99.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.18
|
| Rate for Payer: Railroad Medicare Medicare |
$98.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.66
|
| Rate for Payer: UHC Core |
$328.93
|
| Rate for Payer: UHC Exchange |
$98.48
|
| Rate for Payer: UHC Medicaid |
$69.45
|
| Rate for Payer: UHC Medicare Advantage |
$98.48
|
| Rate for Payer: UHCCP Medicaid |
$69.45
|
| Rate for Payer: VA VA |
$98.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.45
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.18 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: BCBS Trust/PPO |
$325.35
|
| Rate for Payer: BCN Commercial |
$325.35
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$342.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.66
|
| Rate for Payer: UHC Core |
$328.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.45
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.63
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.45
|
| Rate for Payer: BCN Commercial |
$17.45
|
| Rate for Payer: BCN Medicare Advantage |
$5.31
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.31
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$3.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.04
|
| Rate for Payer: PACE SWMI |
$5.31
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UHC Medicaid |
$3.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.31
|
| Rate for Payer: UHCCP Medicaid |
$3.74
|
| Rate for Payer: VA VA |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCN Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$17.87
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.04
|
| Rate for Payer: UHC Core |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.23
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$5.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.76
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.79
|
| Rate for Payer: BCN Commercial |
$17.79
|
| Rate for Payer: BCN Medicare Advantage |
$5.41
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.41
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.23
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.68
|
| Rate for Payer: Meridian Medicaid |
$4.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PACE Senior Care Partners |
$5.14
|
| Rate for Payer: PACE SWMI |
$5.41
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Medicare Advantage |
$5.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.83
|
| Rate for Payer: Priority Health Medicare |
$5.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.04
|
| Rate for Payer: UHC Core |
$18.07
|
| Rate for Payer: UHC Exchange |
$5.41
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.41
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.23
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$37.66
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.77
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS MAPPO |
$9.41
|
| Rate for Payer: BCBS Trust/PPO |
$30.96
|
| Rate for Payer: BCN Commercial |
$30.96
|
| Rate for Payer: BCN Medicare Advantage |
$9.41
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.41
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.25
|
| Rate for Payer: Mclaren Medicaid |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.89
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Nomi Health Commercial |
$30.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: PACE Senior Care Partners |
$8.94
|
| Rate for Payer: PACE SWMI |
$9.41
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: PHP Medicare Advantage |
$9.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.76
|
| Rate for Payer: Priority Health Medicare |
$9.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.21
|
| Rate for Payer: Railroad Medicare Medicare |
$9.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.14
|
| Rate for Payer: UHC Core |
$31.45
|
| Rate for Payer: UHC Exchange |
$9.41
|
| Rate for Payer: UHC Medicaid |
$6.64
|
| Rate for Payer: UHC Medicare Advantage |
$9.41
|
| Rate for Payer: UHCCP Medicaid |
$6.64
|
| Rate for Payer: VA VA |
$9.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.25
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$37.66
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: BCBS Trust/PPO |
$31.10
|
| Rate for Payer: BCN Commercial |
$31.10
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Nomi Health Commercial |
$30.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.14
|
| Rate for Payer: UHC Core |
$31.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.25
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.40
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.59
|
| Rate for Payer: BCN Commercial |
$8.59
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.40
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.25
|
| Rate for Payer: BCBS Complete |
$1.93
|
| Rate for Payer: BCBS MAPPO |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: BCN Medicare Advantage |
$2.60
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Mclaren Medicaid |
$1.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.73
|
| Rate for Payer: Meridian Medicaid |
$1.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PACE Senior Care Partners |
$2.47
|
| Rate for Payer: PACE SWMI |
$2.60
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: UHC Exchange |
$2.60
|
| Rate for Payer: UHC Medicaid |
$1.83
|
| Rate for Payer: UHC Medicare Advantage |
$2.60
|
| Rate for Payer: UHCCP Medicaid |
$1.83
|
| Rate for Payer: VA VA |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$17.63
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$14.56
|
| Rate for Payer: BCN Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Healthscope Commercial |
$15.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.99
|
| Rate for Payer: Nomi Health Commercial |
$14.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.22
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.51
|
| Rate for Payer: UHC Core |
$14.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.22
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$17.63
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.51
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$14.49
|
| Rate for Payer: BCN Commercial |
$14.49
|
| Rate for Payer: BCN Medicare Advantage |
$4.41
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.41
|
| Rate for Payer: Healthscope Commercial |
$15.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.22
|
| Rate for Payer: Mclaren Medicaid |
$3.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.63
|
| Rate for Payer: Meridian Medicaid |
$3.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.99
|
| Rate for Payer: Nomi Health Commercial |
$14.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.22
|
| Rate for Payer: PACE Senior Care Partners |
$4.19
|
| Rate for Payer: PACE SWMI |
$4.41
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: PHP Medicare Advantage |
$4.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.34
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.27
|
| Rate for Payer: Railroad Medicare Medicare |
$4.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.51
|
| Rate for Payer: UHC Core |
$14.72
|
| Rate for Payer: UHC Exchange |
$4.41
|
| Rate for Payer: UHC Medicaid |
$3.11
|
| Rate for Payer: UHC Medicare Advantage |
$4.41
|
| Rate for Payer: UHCCP Medicaid |
$3.11
|
| Rate for Payer: VA VA |
$4.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.22
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$115.13
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$103.62 |
| Rate for Payer: Aetna Commercial |
$97.86
|
| Rate for Payer: Aetna Medicare |
$29.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.98
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS MAPPO |
$28.78
|
| Rate for Payer: BCBS Trust/PPO |
$94.65
|
| Rate for Payer: BCN Commercial |
$94.65
|
| Rate for Payer: BCN Medicare Advantage |
$28.78
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Commercial |
$99.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$103.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.35
|
| Rate for Payer: Mclaren Medicaid |
$20.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.22
|
| Rate for Payer: Meridian Medicaid |
$21.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.35
|
| Rate for Payer: PACE Senior Care Partners |
$27.34
|
| Rate for Payer: PACE SWMI |
$28.78
|
| Rate for Payer: PHP Commercial |
$97.86
|
| Rate for Payer: PHP Medicare Advantage |
$28.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.16
|
| Rate for Payer: Priority Health Medicare |
$29.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.13
|
| Rate for Payer: Railroad Medicare Medicare |
$28.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.31
|
| Rate for Payer: UHC Core |
$96.13
|
| Rate for Payer: UHC Exchange |
$28.78
|
| Rate for Payer: UHC Medicaid |
$20.30
|
| Rate for Payer: UHC Medicare Advantage |
$28.78
|
| Rate for Payer: UHCCP Medicaid |
$20.30
|
| Rate for Payer: VA VA |
$28.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.35
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$115.13
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.13 |
| Max. Negotiated Rate |
$103.62 |
| Rate for Payer: Aetna Commercial |
$97.86
|
| Rate for Payer: BCBS Trust/PPO |
$95.09
|
| Rate for Payer: BCN Commercial |
$95.09
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Commercial |
$99.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$103.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.35
|
| Rate for Payer: PHP Commercial |
$97.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.31
|
| Rate for Payer: UHC Core |
$96.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.35
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$31.06
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: BCBS Trust/PPO |
$25.65
|
| Rate for Payer: BCN Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.85
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.40
|
| Rate for Payer: Nomi Health Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PHP Commercial |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.33
|
| Rate for Payer: UHC Core |
$25.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.30
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$31.06
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.71
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: BCBS MAPPO |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$25.53
|
| Rate for Payer: BCN Commercial |
$25.53
|
| Rate for Payer: BCN Medicare Advantage |
$7.76
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.30
|
| Rate for Payer: Mclaren Medicaid |
$5.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.15
|
| Rate for Payer: Meridian Medicaid |
$5.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.40
|
| Rate for Payer: Nomi Health Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PACE Senior Care Partners |
$7.38
|
| Rate for Payer: PACE SWMI |
$7.76
|
| Rate for Payer: PHP Commercial |
$26.40
|
| Rate for Payer: PHP Medicare Advantage |
$7.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.02
|
| Rate for Payer: Priority Health Medicare |
$7.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.33
|
| Rate for Payer: UHC Core |
$25.94
|
| Rate for Payer: UHC Exchange |
$7.76
|
| Rate for Payer: UHC Medicaid |
$5.48
|
| Rate for Payer: UHC Medicare Advantage |
$7.76
|
| Rate for Payer: UHCCP Medicaid |
$5.48
|
| Rate for Payer: VA VA |
$7.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.30
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$40.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$36.54 |
| Rate for Payer: Aetna Commercial |
$34.51
|
| Rate for Payer: Aetna Medicare |
$10.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.69
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS MAPPO |
$10.15
|
| Rate for Payer: BCBS Trust/PPO |
$33.38
|
| Rate for Payer: BCN Commercial |
$33.38
|
| Rate for Payer: BCN Medicare Advantage |
$10.15
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.15
|
| Rate for Payer: Healthscope Commercial |
$36.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.45
|
| Rate for Payer: Mclaren Medicaid |
$7.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.66
|
| Rate for Payer: Meridian Medicaid |
$7.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$33.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.45
|
| Rate for Payer: PACE Senior Care Partners |
$9.64
|
| Rate for Payer: PACE SWMI |
$10.15
|
| Rate for Payer: PHP Commercial |
$34.51
|
| Rate for Payer: PHP Medicare Advantage |
$10.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.32
|
| Rate for Payer: Priority Health Medicare |
$10.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.26
|
| Rate for Payer: Railroad Medicare Medicare |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.73
|
| Rate for Payer: UHC Core |
$33.90
|
| Rate for Payer: UHC Exchange |
$10.15
|
| Rate for Payer: UHC Medicaid |
$7.16
|
| Rate for Payer: UHC Medicare Advantage |
$10.15
|
| Rate for Payer: UHCCP Medicaid |
$7.16
|
| Rate for Payer: VA VA |
$10.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.45
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$36.54 |
| Rate for Payer: Aetna Commercial |
$34.51
|
| Rate for Payer: BCBS Trust/PPO |
$33.53
|
| Rate for Payer: BCN Commercial |
$33.53
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$36.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$33.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.45
|
| Rate for Payer: PHP Commercial |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.73
|
| Rate for Payer: UHC Core |
$33.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.45
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$52.07 |
| Rate for Payer: Aetna Commercial |
$49.18
|
| Rate for Payer: BCBS Trust/PPO |
$47.79
|
| Rate for Payer: BCN Commercial |
$47.79
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Healthscope Commercial |
$52.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Nomi Health Commercial |
$47.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: PHP Commercial |
$49.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.92
|
| Rate for Payer: UHC Core |
$48.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.40
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$52.07 |
| Rate for Payer: Aetna Commercial |
$49.18
|
| Rate for Payer: Aetna Medicare |
$15.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.08
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$14.46
|
| Rate for Payer: BCBS Trust/PPO |
$47.57
|
| Rate for Payer: BCN Commercial |
$47.57
|
| Rate for Payer: BCN Medicare Advantage |
$14.46
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.46
|
| Rate for Payer: Healthscope Commercial |
$52.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.40
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.19
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Nomi Health Commercial |
$47.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: PACE Senior Care Partners |
$13.74
|
| Rate for Payer: PACE SWMI |
$14.46
|
| Rate for Payer: PHP Commercial |
$49.18
|
| Rate for Payer: PHP Medicare Advantage |
$14.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.34
|
| Rate for Payer: Priority Health Medicare |
$14.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.27
|
| Rate for Payer: Railroad Medicare Medicare |
$14.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.92
|
| Rate for Payer: UHC Core |
$48.31
|
| Rate for Payer: UHC Exchange |
$14.46
|
| Rate for Payer: UHC Medicaid |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$14.46
|
| Rate for Payer: UHCCP Medicaid |
$10.20
|
| Rate for Payer: VA VA |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.40
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna Commercial |
$88.95
|
| Rate for Payer: BCBS Trust/PPO |
$86.43
|
| Rate for Payer: BCN Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$94.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Nomi Health Commercial |
$85.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: PHP Commercial |
$88.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.09
|
| Rate for Payer: UHC Core |
$87.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.49
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna Commercial |
$88.95
|
| Rate for Payer: Aetna Medicare |
$27.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.70
|
| Rate for Payer: BCBS Complete |
$19.37
|
| Rate for Payer: BCBS MAPPO |
$26.16
|
| Rate for Payer: BCBS Trust/PPO |
$86.03
|
| Rate for Payer: BCN Commercial |
$86.03
|
| Rate for Payer: BCN Medicare Advantage |
$26.16
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$94.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.49
|
| Rate for Payer: Mclaren Medicaid |
$18.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.47
|
| Rate for Payer: Meridian Medicaid |
$19.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Nomi Health Commercial |
$85.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: PACE Senior Care Partners |
$24.85
|
| Rate for Payer: PACE SWMI |
$26.16
|
| Rate for Payer: PHP Commercial |
$88.95
|
| Rate for Payer: PHP Medicare Advantage |
$26.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.05
|
| Rate for Payer: Priority Health Medicare |
$26.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.84
|
| Rate for Payer: Railroad Medicare Medicare |
$26.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.09
|
| Rate for Payer: UHC Core |
$87.38
|
| Rate for Payer: UHC Exchange |
$26.16
|
| Rate for Payer: UHC Medicaid |
$18.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.16
|
| Rate for Payer: UHCCP Medicaid |
$18.45
|
| Rate for Payer: VA VA |
$26.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.49
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.37
|
| Rate for Payer: BCBS Complete |
$3.77
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$16.76
|
| Rate for Payer: BCN Commercial |
$16.76
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: Mclaren Medicaid |
$3.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.35
|
| Rate for Payer: Meridian Medicaid |
$3.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Nomi Health Commercial |
$16.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.74
|
| Rate for Payer: Priority Health Medicare |
$5.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.94
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Exchange |
$5.10
|
| Rate for Payer: UHC Medicaid |
$3.59
|
| Rate for Payer: UHC Medicare Advantage |
$5.10
|
| Rate for Payer: UHCCP Medicaid |
$3.59
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: BCBS Trust/PPO |
$16.84
|
| Rate for Payer: BCN Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Nomi Health Commercial |
$16.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.94
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.29
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$26.19
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: BCBS Trust/PPO |
$21.63
|
| Rate for Payer: BCN Commercial |
$21.63
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Cofinity Commercial |
$22.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$23.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.26
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.64
|
| Rate for Payer: PHP Commercial |
$22.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.05
|
| Rate for Payer: UHC Core |
$21.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.64
|
|
