|
HC WMC FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.02 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna Medicare |
$97.45
|
| Rate for Payer: Aetna Medicare |
$79.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.60
|
| Rate for Payer: BCBS Complete |
$122.36
|
| Rate for Payer: BCBS Complete |
$149.93
|
| Rate for Payer: BCBS MAPPO |
$93.70
|
| Rate for Payer: BCBS MAPPO |
$76.48
|
| Rate for Payer: BCBS Trust/PPO |
$291.42
|
| Rate for Payer: BCBS Trust/PPO |
$237.85
|
| Rate for Payer: BCN Commercial |
$291.42
|
| Rate for Payer: BCN Commercial |
$237.85
|
| Rate for Payer: BCN Medicare Advantage |
$76.48
|
| Rate for Payer: BCN Medicare Advantage |
$93.70
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cash Price |
$244.73
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Cofinity Commercial |
$263.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.48
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Healthscope Commercial |
$275.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.02
|
| Rate for Payer: PACE Senior Care Partners |
$89.02
|
| Rate for Payer: PACE Senior Care Partners |
$72.65
|
| Rate for Payer: PACE SWMI |
$76.48
|
| Rate for Payer: PACE SWMI |
$93.70
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: PHP Medicare Advantage |
$76.48
|
| Rate for Payer: PHP Medicare Advantage |
$93.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.14
|
| Rate for Payer: Priority Health Medicare |
$76.48
|
| Rate for Payer: Priority Health Medicare |
$93.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.57
|
| Rate for Payer: Railroad Medicare Medicare |
$76.48
|
| Rate for Payer: Railroad Medicare Medicare |
$93.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.20
|
| Rate for Payer: UHC Core |
$312.97
|
| Rate for Payer: UHC Core |
$255.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.70
|
| Rate for Payer: UHC Medicare Advantage |
$96.52
|
| Rate for Payer: UHC Medicare Advantage |
$78.77
|
| Rate for Payer: VA VA |
$76.48
|
| Rate for Payer: VA VA |
$93.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.12
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: Aetna Medicare |
$2,014.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,420.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,420.91
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,936.72
|
| Rate for Payer: BCBS Trust/PPO |
$6,023.21
|
| Rate for Payer: BCN Commercial |
$6,023.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,936.72
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,936.72
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,810.18
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,033.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,227.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,584.86
|
| Rate for Payer: PACE Senior Care Partners |
$1,839.89
|
| Rate for Payer: PACE SWMI |
$1,936.72
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,936.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,422.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,739.80
|
| Rate for Payer: Priority Health Medicare |
$1,936.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,724.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,936.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,817.27
|
| Rate for Payer: UHC Core |
$6,468.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,936.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,994.83
|
| Rate for Payer: VA VA |
$1,936.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,810.18
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,724.83 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: BCBS Trust/PPO |
$5,986.80
|
| Rate for Payer: BCN Commercial |
$5,986.80
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,810.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,584.86
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,422.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,739.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,724.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,817.27
|
| Rate for Payer: UHC Core |
$6,468.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,810.18
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$255.37
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.65 |
| Max. Negotiated Rate |
$229.83 |
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna Medicare |
$66.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.80
|
| Rate for Payer: BCBS Complete |
$102.15
|
| Rate for Payer: BCBS MAPPO |
$63.84
|
| Rate for Payer: BCBS Trust/PPO |
$198.55
|
| Rate for Payer: BCN Commercial |
$198.55
|
| Rate for Payer: BCN Medicare Advantage |
$63.84
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$219.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.84
|
| Rate for Payer: Healthscope Commercial |
$229.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: PACE Senior Care Partners |
$60.65
|
| Rate for Payer: PACE SWMI |
$63.84
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: PHP Medicare Advantage |
$63.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.17
|
| Rate for Payer: Priority Health Medicare |
$63.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.75
|
| Rate for Payer: Railroad Medicare Medicare |
$63.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.73
|
| Rate for Payer: UHC Core |
$213.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.84
|
| Rate for Payer: UHC Medicare Advantage |
$65.76
|
| Rate for Payer: VA VA |
$63.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.53
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$255.37
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$155.75 |
| Max. Negotiated Rate |
$229.83 |
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: BCBS Trust/PPO |
$197.35
|
| Rate for Payer: BCN Commercial |
$197.35
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$219.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Healthscope Commercial |
$229.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.73
|
| Rate for Payer: UHC Core |
$213.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.53
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.26 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Aetna Commercial |
$373.15
|
| Rate for Payer: Aetna Medicare |
$114.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.19
|
| Rate for Payer: BCBS Complete |
$175.60
|
| Rate for Payer: BCBS MAPPO |
$109.75
|
| Rate for Payer: BCBS Trust/PPO |
$341.32
|
| Rate for Payer: BCN Commercial |
$341.32
|
| Rate for Payer: BCN Medicare Advantage |
$109.75
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$377.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.75
|
| Rate for Payer: Healthscope Commercial |
$395.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.15
|
| Rate for Payer: PACE Senior Care Partners |
$104.26
|
| Rate for Payer: PACE SWMI |
$109.75
|
| Rate for Payer: PHP Commercial |
$373.15
|
| Rate for Payer: PHP Medicare Advantage |
$109.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.93
|
| Rate for Payer: Priority Health Medicare |
$109.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.75
|
| Rate for Payer: Railroad Medicare Medicare |
$109.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.32
|
| Rate for Payer: UHC Core |
$366.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.75
|
| Rate for Payer: UHC Medicare Advantage |
$113.04
|
| Rate for Payer: VA VA |
$109.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.25
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Aetna Commercial |
$373.15
|
| Rate for Payer: BCBS Trust/PPO |
$339.26
|
| Rate for Payer: BCN Commercial |
$339.26
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$377.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.20
|
| Rate for Payer: Healthscope Commercial |
$395.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.15
|
| Rate for Payer: PHP Commercial |
$373.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.32
|
| Rate for Payer: UHC Core |
$366.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.25
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$236.16
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.03 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: BCBS Trust/PPO |
$182.50
|
| Rate for Payer: BCN Commercial |
$182.50
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$203.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.82
|
| Rate for Payer: UHC Core |
$197.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.12
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$236.16
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna Medicare |
$61.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.80
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS MAPPO |
$59.04
|
| Rate for Payer: BCBS Trust/PPO |
$183.61
|
| Rate for Payer: BCN Commercial |
$183.61
|
| Rate for Payer: BCN Medicare Advantage |
$59.04
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$203.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.04
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.74
|
| Rate for Payer: PACE Senior Care Partners |
$56.09
|
| Rate for Payer: PACE SWMI |
$59.04
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: PHP Medicare Advantage |
$59.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.46
|
| Rate for Payer: Priority Health Medicare |
$59.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.03
|
| Rate for Payer: Railroad Medicare Medicare |
$59.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.82
|
| Rate for Payer: UHC Core |
$197.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.04
|
| Rate for Payer: UHC Medicare Advantage |
$60.81
|
| Rate for Payer: VA VA |
$59.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.12
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,145.36
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$698.56 |
| Max. Negotiated Rate |
$1,030.82 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: BCBS Trust/PPO |
$885.13
|
| Rate for Payer: BCN Commercial |
$885.13
|
| Rate for Payer: Cash Price |
$916.29
|
| Rate for Payer: Cofinity Commercial |
$985.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.29
|
| Rate for Payer: Healthscope Commercial |
$1,030.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$973.56
|
| Rate for Payer: PHP Commercial |
$973.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$996.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$698.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.92
|
| Rate for Payer: UHC Core |
$956.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.02
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,145.36
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.02 |
| Max. Negotiated Rate |
$1,030.82 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: Aetna Medicare |
$297.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$357.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$357.92
|
| Rate for Payer: BCBS Complete |
$458.14
|
| Rate for Payer: BCBS MAPPO |
$286.34
|
| Rate for Payer: BCBS Trust/PPO |
$890.52
|
| Rate for Payer: BCN Commercial |
$890.52
|
| Rate for Payer: BCN Medicare Advantage |
$286.34
|
| Rate for Payer: Cash Price |
$916.29
|
| Rate for Payer: Cofinity Commercial |
$985.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.34
|
| Rate for Payer: Healthscope Commercial |
$1,030.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$300.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$973.56
|
| Rate for Payer: PACE Senior Care Partners |
$272.02
|
| Rate for Payer: PACE SWMI |
$286.34
|
| Rate for Payer: PHP Commercial |
$973.56
|
| Rate for Payer: PHP Medicare Advantage |
$286.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$996.46
|
| Rate for Payer: Priority Health Medicare |
$286.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$698.56
|
| Rate for Payer: Railroad Medicare Medicare |
$286.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.92
|
| Rate for Payer: UHC Core |
$956.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.34
|
| Rate for Payer: UHC Medicare Advantage |
$294.93
|
| Rate for Payer: VA VA |
$286.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.02
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$708.47
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.10 |
| Max. Negotiated Rate |
$637.62 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: BCBS Trust/PPO |
$547.51
|
| Rate for Payer: BCN Commercial |
$547.51
|
| Rate for Payer: Cash Price |
$566.78
|
| Rate for Payer: Cofinity Commercial |
$609.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.78
|
| Rate for Payer: Healthscope Commercial |
$637.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.20
|
| Rate for Payer: PHP Commercial |
$602.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$616.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$432.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.45
|
| Rate for Payer: UHC Core |
$591.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.35
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$708.47
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.26 |
| Max. Negotiated Rate |
$637.62 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: Aetna Medicare |
$184.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: BCBS Complete |
$283.39
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$550.84
|
| Rate for Payer: BCN Commercial |
$550.84
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$566.78
|
| Rate for Payer: Cofinity Commercial |
$609.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$637.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.20
|
| Rate for Payer: PACE Senior Care Partners |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$602.20
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$616.37
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$432.10
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.45
|
| Rate for Payer: UHC Core |
$591.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.12
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.35
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$525.44
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.79 |
| Max. Negotiated Rate |
$472.90 |
| Rate for Payer: Aetna Commercial |
$446.62
|
| Rate for Payer: Aetna Medicare |
$136.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.20
|
| Rate for Payer: BCBS Complete |
$210.18
|
| Rate for Payer: BCBS MAPPO |
$131.36
|
| Rate for Payer: BCBS Trust/PPO |
$408.53
|
| Rate for Payer: BCN Commercial |
$408.53
|
| Rate for Payer: BCN Medicare Advantage |
$131.36
|
| Rate for Payer: Cash Price |
$420.35
|
| Rate for Payer: Cofinity Commercial |
$451.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.36
|
| Rate for Payer: Healthscope Commercial |
$472.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.62
|
| Rate for Payer: PACE Senior Care Partners |
$124.79
|
| Rate for Payer: PACE SWMI |
$131.36
|
| Rate for Payer: PHP Commercial |
$446.62
|
| Rate for Payer: PHP Medicare Advantage |
$131.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.13
|
| Rate for Payer: Priority Health Medicare |
$131.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.47
|
| Rate for Payer: Railroad Medicare Medicare |
$131.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.39
|
| Rate for Payer: UHC Core |
$438.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.36
|
| Rate for Payer: UHC Medicare Advantage |
$135.30
|
| Rate for Payer: VA VA |
$131.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.08
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$525.44
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.47 |
| Max. Negotiated Rate |
$472.90 |
| Rate for Payer: Aetna Commercial |
$446.62
|
| Rate for Payer: BCBS Trust/PPO |
$406.06
|
| Rate for Payer: BCN Commercial |
$406.06
|
| Rate for Payer: Cash Price |
$420.35
|
| Rate for Payer: Cofinity Commercial |
$451.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.35
|
| Rate for Payer: Healthscope Commercial |
$472.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.62
|
| Rate for Payer: PHP Commercial |
$446.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.39
|
| Rate for Payer: UHC Core |
$438.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.08
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$413.27
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: Aetna Medicare |
$107.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.15
|
| Rate for Payer: BCBS Complete |
$165.31
|
| Rate for Payer: BCBS MAPPO |
$103.32
|
| Rate for Payer: BCBS Trust/PPO |
$321.32
|
| Rate for Payer: BCN Commercial |
$321.32
|
| Rate for Payer: BCN Medicare Advantage |
$103.32
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.32
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PACE Senior Care Partners |
$98.15
|
| Rate for Payer: PACE SWMI |
$103.32
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: PHP Medicare Advantage |
$103.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.54
|
| Rate for Payer: Priority Health Medicare |
$103.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.05
|
| Rate for Payer: Railroad Medicare Medicare |
$103.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.68
|
| Rate for Payer: UHC Core |
$345.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.32
|
| Rate for Payer: UHC Medicare Advantage |
$106.42
|
| Rate for Payer: VA VA |
$103.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.95
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$413.27
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.05 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: BCBS Trust/PPO |
$319.38
|
| Rate for Payer: BCN Commercial |
$319.38
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.68
|
| Rate for Payer: UHC Core |
$345.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.95
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$119.67
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.99 |
| Max. Negotiated Rate |
$107.70 |
| Rate for Payer: Aetna Commercial |
$101.72
|
| Rate for Payer: BCBS Trust/PPO |
$92.48
|
| Rate for Payer: BCN Commercial |
$92.48
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cofinity Commercial |
$102.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.74
|
| Rate for Payer: Healthscope Commercial |
$107.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.72
|
| Rate for Payer: PHP Commercial |
$101.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.31
|
| Rate for Payer: UHC Core |
$99.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.75
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$119.67
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$107.70 |
| Rate for Payer: Aetna Commercial |
$101.72
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.40
|
| Rate for Payer: BCBS Complete |
$47.87
|
| Rate for Payer: BCBS MAPPO |
$29.92
|
| Rate for Payer: BCBS Trust/PPO |
$93.04
|
| Rate for Payer: BCN Commercial |
$93.04
|
| Rate for Payer: BCN Medicare Advantage |
$29.92
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cofinity Commercial |
$102.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$107.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.72
|
| Rate for Payer: PACE Senior Care Partners |
$28.42
|
| Rate for Payer: PACE SWMI |
$29.92
|
| Rate for Payer: PHP Commercial |
$101.72
|
| Rate for Payer: PHP Medicare Advantage |
$29.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.11
|
| Rate for Payer: Priority Health Medicare |
$29.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.99
|
| Rate for Payer: Railroad Medicare Medicare |
$29.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.31
|
| Rate for Payer: UHC Core |
$99.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$30.82
|
| Rate for Payer: VA VA |
$29.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.75
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$245.38
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: Aetna Medicare |
$63.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.68
|
| Rate for Payer: BCBS Complete |
$98.15
|
| Rate for Payer: BCBS MAPPO |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$190.78
|
| Rate for Payer: BCN Commercial |
$190.78
|
| Rate for Payer: BCN Medicare Advantage |
$61.34
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PACE Senior Care Partners |
$58.28
|
| Rate for Payer: PACE SWMI |
$61.34
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: PHP Medicare Advantage |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.48
|
| Rate for Payer: Priority Health Medicare |
$61.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.66
|
| Rate for Payer: Railroad Medicare Medicare |
$61.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.93
|
| Rate for Payer: UHC Core |
$204.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.34
|
| Rate for Payer: UHC Medicare Advantage |
$63.19
|
| Rate for Payer: VA VA |
$61.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$245.38
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$149.66 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: BCBS Trust/PPO |
$189.63
|
| Rate for Payer: BCN Commercial |
$189.63
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.93
|
| Rate for Payer: UHC Core |
$204.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
OP
|
$6.80
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna Medicare |
$1.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.12
|
| Rate for Payer: BCBS Complete |
$4.02
|
| Rate for Payer: BCBS MAPPO |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: BCN Medicare Advantage |
$1.70
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$5.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$6.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.10
|
| Rate for Payer: Mclaren Medicaid |
$3.83
|
| Rate for Payer: Meridian Medicaid |
$4.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.78
|
| Rate for Payer: PACE Senior Care Partners |
$1.62
|
| Rate for Payer: PACE SWMI |
$1.70
|
| Rate for Payer: PHP Commercial |
$5.78
|
| Rate for Payer: PHP Medicare Advantage |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.92
|
| Rate for Payer: Priority Health Medicare |
$1.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.98
|
| Rate for Payer: UHC Core |
$5.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.70
|
| Rate for Payer: UHC Medicare Advantage |
$1.75
|
| Rate for Payer: VA VA |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.10
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
IP
|
$6.80
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: BCBS Trust/PPO |
$5.26
|
| Rate for Payer: BCN Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$5.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.44
|
| Rate for Payer: Healthscope Commercial |
$6.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.78
|
| Rate for Payer: PHP Commercial |
$5.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.98
|
| Rate for Payer: UHC Core |
$5.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.10
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
IP
|
$1,385.01
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$844.72 |
| Max. Negotiated Rate |
$1,246.51 |
| Rate for Payer: Aetna Commercial |
$1,177.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.34
|
| Rate for Payer: BCN Commercial |
$1,070.34
|
| Rate for Payer: Cash Price |
$1,108.01
|
| Rate for Payer: Cofinity Commercial |
$1,191.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.01
|
| Rate for Payer: Healthscope Commercial |
$1,246.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.26
|
| Rate for Payer: PHP Commercial |
$1,177.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,204.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$844.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.81
|
| Rate for Payer: UHC Core |
$1,156.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.76
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
OP
|
$1,385.01
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.94 |
| Max. Negotiated Rate |
$1,246.51 |
| Rate for Payer: Aetna Commercial |
$1,177.26
|
| Rate for Payer: Aetna Medicare |
$360.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$432.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$432.82
|
| Rate for Payer: BCBS Complete |
$554.00
|
| Rate for Payer: BCBS MAPPO |
$346.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,076.85
|
| Rate for Payer: BCN Commercial |
$1,076.85
|
| Rate for Payer: BCN Medicare Advantage |
$346.25
|
| Rate for Payer: Cash Price |
$1,108.01
|
| Rate for Payer: Cofinity Commercial |
$1,191.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.25
|
| Rate for Payer: Healthscope Commercial |
$1,246.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$363.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.26
|
| Rate for Payer: PACE Senior Care Partners |
$328.94
|
| Rate for Payer: PACE SWMI |
$346.25
|
| Rate for Payer: PHP Commercial |
$1,177.26
|
| Rate for Payer: PHP Medicare Advantage |
$346.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,204.96
|
| Rate for Payer: Priority Health Medicare |
$346.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$844.72
|
| Rate for Payer: Railroad Medicare Medicare |
$346.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.81
|
| Rate for Payer: UHC Core |
$1,156.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.25
|
| Rate for Payer: UHC Medicare Advantage |
$356.64
|
| Rate for Payer: VA VA |
$346.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.76
|
|
