|
HC PULSE OX SINGLE
|
Facility
|
OP
|
$88.16
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$74.94
|
| Rate for Payer: Aetna Medicare |
$22.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.55
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS MAPPO |
$22.04
|
| Rate for Payer: BCBS Trust/PPO |
$72.48
|
| Rate for Payer: BCN Commercial |
$72.48
|
| Rate for Payer: BCN Medicare Advantage |
$22.04
|
| Rate for Payer: Cash Price |
$70.53
|
| Rate for Payer: Cofinity Commercial |
$75.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.04
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.12
|
| Rate for Payer: Mclaren Medicaid |
$15.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.14
|
| Rate for Payer: Meridian Medicaid |
$16.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.94
|
| Rate for Payer: Nomi Health Commercial |
$72.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.12
|
| Rate for Payer: PACE Senior Care Partners |
$20.94
|
| Rate for Payer: PACE SWMI |
$22.04
|
| Rate for Payer: PHP Commercial |
$74.94
|
| Rate for Payer: PHP Medicare Advantage |
$22.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$22.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.36
|
| Rate for Payer: Railroad Medicare Medicare |
$22.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.58
|
| Rate for Payer: UHC Core |
$73.61
|
| Rate for Payer: UHC Exchange |
$22.04
|
| Rate for Payer: UHC Medicaid |
$15.54
|
| Rate for Payer: UHC Medicare Advantage |
$22.04
|
| Rate for Payer: UHCCP Medicaid |
$15.54
|
| Rate for Payer: VA VA |
$22.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.12
|
|
|
HC PULSERIDER
|
Facility
|
IP
|
$17,410.45
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.67 |
| Max. Negotiated Rate |
$15,669.41 |
| Rate for Payer: Aetna Commercial |
$14,798.88
|
| Rate for Payer: BCBS Trust/PPO |
$14,379.29
|
| Rate for Payer: BCN Commercial |
$14,379.29
|
| Rate for Payer: Cash Price |
$13,928.36
|
| Rate for Payer: Cofinity Commercial |
$14,972.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,928.36
|
| Rate for Payer: Healthscope Commercial |
$15,669.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,057.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,798.88
|
| Rate for Payer: Nomi Health Commercial |
$14,276.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,057.84
|
| Rate for Payer: PHP Commercial |
$14,798.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15,147.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,117.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,321.20
|
| Rate for Payer: UHC Core |
$14,537.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,057.84
|
|
|
HC PULSERIDER
|
Facility
|
OP
|
$17,410.45
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.46 |
| Max. Negotiated Rate |
$15,669.41 |
| Rate for Payer: Aetna Commercial |
$14,798.88
|
| Rate for Payer: Aetna Medicare |
$4,526.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,440.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,440.77
|
| Rate for Payer: BCBS Complete |
$3,222.67
|
| Rate for Payer: BCBS MAPPO |
$4,352.61
|
| Rate for Payer: BCBS Trust/PPO |
$14,313.13
|
| Rate for Payer: BCN Commercial |
$14,313.13
|
| Rate for Payer: BCN Medicare Advantage |
$4,352.61
|
| Rate for Payer: Cash Price |
$13,928.36
|
| Rate for Payer: Cofinity Commercial |
$14,972.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,928.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,352.61
|
| Rate for Payer: Healthscope Commercial |
$15,669.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,057.84
|
| Rate for Payer: Mclaren Medicaid |
$3,069.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,570.24
|
| Rate for Payer: Meridian Medicaid |
$3,222.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,005.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,787.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,798.88
|
| Rate for Payer: Nomi Health Commercial |
$14,276.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,057.84
|
| Rate for Payer: PACE Senior Care Partners |
$4,134.98
|
| Rate for Payer: PACE SWMI |
$4,352.61
|
| Rate for Payer: PHP Commercial |
$14,798.88
|
| Rate for Payer: PHP Medicare Advantage |
$4,352.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,069.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15,147.09
|
| Rate for Payer: Priority Health Medicare |
$4,396.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,117.67
|
| Rate for Payer: Railroad Medicare Medicare |
$4,352.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,321.20
|
| Rate for Payer: UHC Core |
$14,537.73
|
| Rate for Payer: UHC Exchange |
$4,352.61
|
| Rate for Payer: UHC Medicaid |
$3,069.46
|
| Rate for Payer: UHC Medicare Advantage |
$4,352.61
|
| Rate for Payer: UHCCP Medicaid |
$3,069.46
|
| Rate for Payer: VA VA |
$4,352.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,057.84
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
IP
|
$466.40
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$324.61 |
| Max. Negotiated Rate |
$419.76 |
| Rate for Payer: Aetna Commercial |
$396.44
|
| Rate for Payer: BCBS Trust/PPO |
$385.20
|
| Rate for Payer: BCN Commercial |
$385.20
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.12
|
| Rate for Payer: Healthscope Commercial |
$419.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.44
|
| Rate for Payer: Nomi Health Commercial |
$382.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.80
|
| Rate for Payer: PHP Commercial |
$396.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$405.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.43
|
| Rate for Payer: UHC Core |
$389.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.80
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
OP
|
$466.40
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$419.76 |
| Rate for Payer: Aetna Commercial |
$396.44
|
| Rate for Payer: Aetna Medicare |
$121.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.75
|
| Rate for Payer: BCBS Complete |
$86.33
|
| Rate for Payer: BCBS MAPPO |
$116.60
|
| Rate for Payer: BCBS Trust/PPO |
$383.43
|
| Rate for Payer: BCN Commercial |
$383.43
|
| Rate for Payer: BCN Medicare Advantage |
$116.60
|
| Rate for Payer: Cash Price |
$373.12
|
| Rate for Payer: Cofinity Commercial |
$401.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.60
|
| Rate for Payer: Healthscope Commercial |
$419.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.80
|
| Rate for Payer: Mclaren Medicaid |
$82.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.43
|
| Rate for Payer: Meridian Medicaid |
$86.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.44
|
| Rate for Payer: Nomi Health Commercial |
$382.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.80
|
| Rate for Payer: PACE Senior Care Partners |
$110.77
|
| Rate for Payer: PACE SWMI |
$116.60
|
| Rate for Payer: PHP Commercial |
$396.44
|
| Rate for Payer: PHP Medicare Advantage |
$116.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$405.77
|
| Rate for Payer: Priority Health Medicare |
$117.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.61
|
| Rate for Payer: Railroad Medicare Medicare |
$116.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.43
|
| Rate for Payer: UHC Core |
$389.44
|
| Rate for Payer: UHC Exchange |
$116.60
|
| Rate for Payer: UHC Medicaid |
$82.23
|
| Rate for Payer: UHC Medicare Advantage |
$116.60
|
| Rate for Payer: UHCCP Medicaid |
$82.23
|
| Rate for Payer: VA VA |
$116.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.80
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$85.22
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.31 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$72.44
|
| Rate for Payer: BCBS Trust/PPO |
$70.38
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cofinity Commercial |
$73.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.18
|
| Rate for Payer: Healthscope Commercial |
$76.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.44
|
| Rate for Payer: Nomi Health Commercial |
$69.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.91
|
| Rate for Payer: PHP Commercial |
$72.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.99
|
| Rate for Payer: UHC Core |
$71.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.91
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$85.22
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$72.44
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.63
|
| Rate for Payer: BCBS Complete |
$15.77
|
| Rate for Payer: BCBS MAPPO |
$21.30
|
| Rate for Payer: BCBS Trust/PPO |
$70.06
|
| Rate for Payer: BCN Commercial |
$70.06
|
| Rate for Payer: BCN Medicare Advantage |
$21.30
|
| Rate for Payer: Cash Price |
$68.18
|
| Rate for Payer: Cofinity Commercial |
$73.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.30
|
| Rate for Payer: Healthscope Commercial |
$76.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.91
|
| Rate for Payer: Mclaren Medicaid |
$15.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.37
|
| Rate for Payer: Meridian Medicaid |
$15.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.44
|
| Rate for Payer: Nomi Health Commercial |
$69.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.91
|
| Rate for Payer: PACE Senior Care Partners |
$20.24
|
| Rate for Payer: PACE SWMI |
$21.30
|
| Rate for Payer: PHP Commercial |
$72.44
|
| Rate for Payer: PHP Medicare Advantage |
$21.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.14
|
| Rate for Payer: Priority Health Medicare |
$21.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.31
|
| Rate for Payer: Railroad Medicare Medicare |
$21.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.99
|
| Rate for Payer: UHC Core |
$71.16
|
| Rate for Payer: UHC Exchange |
$21.30
|
| Rate for Payer: UHC Medicaid |
$15.02
|
| Rate for Payer: UHC Medicare Advantage |
$21.30
|
| Rate for Payer: UHCCP Medicaid |
$15.02
|
| Rate for Payer: VA VA |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.91
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna Medicare |
$84.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.72
|
| Rate for Payer: BCBS Complete |
$60.25
|
| Rate for Payer: BCBS MAPPO |
$81.38
|
| Rate for Payer: BCBS Trust/PPO |
$267.59
|
| Rate for Payer: BCN Commercial |
$267.59
|
| Rate for Payer: BCN Medicare Advantage |
$81.38
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.38
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Mclaren Medicaid |
$57.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.44
|
| Rate for Payer: Meridian Medicaid |
$60.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Nomi Health Commercial |
$266.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PACE Senior Care Partners |
$77.31
|
| Rate for Payer: PACE SWMI |
$81.38
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: PHP Medicare Advantage |
$81.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.19
|
| Rate for Payer: Priority Health Medicare |
$82.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.55
|
| Rate for Payer: Railroad Medicare Medicare |
$81.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.44
|
| Rate for Payer: UHC Core |
$271.79
|
| Rate for Payer: UHC Exchange |
$81.38
|
| Rate for Payer: UHC Medicaid |
$57.39
|
| Rate for Payer: UHC Medicare Advantage |
$81.38
|
| Rate for Payer: UHCCP Medicaid |
$57.39
|
| Rate for Payer: VA VA |
$81.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.55 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: BCBS Trust/PPO |
$268.83
|
| Rate for Payer: BCN Commercial |
$268.83
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Nomi Health Commercial |
$266.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$283.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.44
|
| Rate for Payer: UHC Core |
$271.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
OP
|
$971.03
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$873.93 |
| Rate for Payer: Aetna Commercial |
$825.38
|
| Rate for Payer: Aetna Medicare |
$252.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.45
|
| Rate for Payer: BCBS Complete |
$179.74
|
| Rate for Payer: BCBS MAPPO |
$242.76
|
| Rate for Payer: BCBS Trust/PPO |
$798.28
|
| Rate for Payer: BCN Commercial |
$798.28
|
| Rate for Payer: BCN Medicare Advantage |
$242.76
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cofinity Commercial |
$835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.76
|
| Rate for Payer: Healthscope Commercial |
$873.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.27
|
| Rate for Payer: Mclaren Medicaid |
$171.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.90
|
| Rate for Payer: Meridian Medicaid |
$179.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$267.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.38
|
| Rate for Payer: Nomi Health Commercial |
$796.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.27
|
| Rate for Payer: PACE Senior Care Partners |
$230.62
|
| Rate for Payer: PACE SWMI |
$242.76
|
| Rate for Payer: PHP Commercial |
$825.38
|
| Rate for Payer: PHP Medicare Advantage |
$242.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$844.80
|
| Rate for Payer: Priority Health Medicare |
$245.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$675.84
|
| Rate for Payer: Railroad Medicare Medicare |
$242.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.51
|
| Rate for Payer: UHC Core |
$810.81
|
| Rate for Payer: UHC Exchange |
$242.76
|
| Rate for Payer: UHC Medicaid |
$171.19
|
| Rate for Payer: UHC Medicare Advantage |
$242.76
|
| Rate for Payer: UHCCP Medicaid |
$171.19
|
| Rate for Payer: VA VA |
$242.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.27
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
IP
|
$971.03
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.84 |
| Max. Negotiated Rate |
$873.93 |
| Rate for Payer: Aetna Commercial |
$825.38
|
| Rate for Payer: BCBS Trust/PPO |
$801.97
|
| Rate for Payer: BCN Commercial |
$801.97
|
| Rate for Payer: Cash Price |
$776.82
|
| Rate for Payer: Cofinity Commercial |
$835.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.82
|
| Rate for Payer: Healthscope Commercial |
$873.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.38
|
| Rate for Payer: Nomi Health Commercial |
$796.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.27
|
| Rate for Payer: PHP Commercial |
$825.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$844.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$675.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.51
|
| Rate for Payer: UHC Core |
$810.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.27
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
IP
|
$280.80
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.44 |
| Max. Negotiated Rate |
$252.72 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: BCBS Trust/PPO |
$231.91
|
| Rate for Payer: BCN Commercial |
$231.91
|
| Rate for Payer: Cash Price |
$224.64
|
| Rate for Payer: Cofinity Commercial |
$241.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.64
|
| Rate for Payer: Healthscope Commercial |
$252.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.68
|
| Rate for Payer: Nomi Health Commercial |
$230.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.60
|
| Rate for Payer: PHP Commercial |
$238.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$244.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.10
|
| Rate for Payer: UHC Core |
$234.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.60
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$280.80
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.51 |
| Max. Negotiated Rate |
$252.72 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$51.98
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$230.85
|
| Rate for Payer: BCN Commercial |
$230.85
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$224.64
|
| Rate for Payer: Cofinity Commercial |
$241.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$252.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.60
|
| Rate for Payer: Mclaren Medicaid |
$49.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$51.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.68
|
| Rate for Payer: Nomi Health Commercial |
$230.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.60
|
| Rate for Payer: PACE Senior Care Partners |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$238.68
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$244.30
|
| Rate for Payer: Priority Health Medicare |
$70.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.44
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.10
|
| Rate for Payer: UHC Core |
$234.47
|
| Rate for Payer: UHC Exchange |
$70.20
|
| Rate for Payer: UHC Medicaid |
$49.51
|
| Rate for Payer: UHC Medicare Advantage |
$70.20
|
| Rate for Payer: UHCCP Medicaid |
$49.51
|
| Rate for Payer: VA VA |
$70.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.60
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.85 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$206.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.89
|
| Rate for Payer: BCBS Complete |
$146.83
|
| Rate for Payer: BCBS MAPPO |
$198.31
|
| Rate for Payer: BCBS Trust/PPO |
$652.14
|
| Rate for Payer: BCN Commercial |
$652.14
|
| Rate for Payer: BCN Medicare Advantage |
$198.31
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.31
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Mclaren Medicaid |
$139.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.23
|
| Rate for Payer: Meridian Medicaid |
$146.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Senior Care Partners |
$188.40
|
| Rate for Payer: PACE SWMI |
$198.31
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$198.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Medicare |
$200.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: Railroad Medicare Medicare |
$198.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: UHC Exchange |
$198.31
|
| Rate for Payer: UHC Medicaid |
$139.85
|
| Rate for Payer: UHC Medicare Advantage |
$198.31
|
| Rate for Payer: UHCCP Medicaid |
$139.85
|
| Rate for Payer: VA VA |
$198.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.11 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: BCBS Trust/PPO |
$655.15
|
| Rate for Payer: BCN Commercial |
$655.15
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$139.85 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$206.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.89
|
| Rate for Payer: BCBS Complete |
$146.83
|
| Rate for Payer: BCBS MAPPO |
$198.31
|
| Rate for Payer: BCBS Trust/PPO |
$652.14
|
| Rate for Payer: BCN Commercial |
$652.14
|
| Rate for Payer: BCN Medicare Advantage |
$198.31
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.31
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Mclaren Medicaid |
$139.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.23
|
| Rate for Payer: Meridian Medicaid |
$146.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Senior Care Partners |
$188.40
|
| Rate for Payer: PACE SWMI |
$198.31
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$198.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Medicare |
$200.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: Railroad Medicare Medicare |
$198.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: UHC Exchange |
$198.31
|
| Rate for Payer: UHC Medicaid |
$139.85
|
| Rate for Payer: UHC Medicare Advantage |
$198.31
|
| Rate for Payer: UHCCP Medicaid |
$139.85
|
| Rate for Payer: VA VA |
$198.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.11 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: BCBS Trust/PPO |
$655.15
|
| Rate for Payer: BCN Commercial |
$655.15
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$752.14
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$676.93 |
| Rate for Payer: Aetna Commercial |
$639.32
|
| Rate for Payer: Aetna Medicare |
$195.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$235.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$235.04
|
| Rate for Payer: BCBS Complete |
$139.22
|
| Rate for Payer: BCBS MAPPO |
$188.03
|
| Rate for Payer: BCBS Trust/PPO |
$618.33
|
| Rate for Payer: BCN Commercial |
$618.33
|
| Rate for Payer: BCN Medicare Advantage |
$188.03
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cofinity Commercial |
$646.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.03
|
| Rate for Payer: Healthscope Commercial |
$676.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.11
|
| Rate for Payer: Mclaren Medicaid |
$132.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.44
|
| Rate for Payer: Meridian Medicaid |
$139.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.32
|
| Rate for Payer: Nomi Health Commercial |
$616.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.11
|
| Rate for Payer: PACE Senior Care Partners |
$178.63
|
| Rate for Payer: PACE SWMI |
$188.03
|
| Rate for Payer: PHP Commercial |
$639.32
|
| Rate for Payer: PHP Medicare Advantage |
$188.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$654.36
|
| Rate for Payer: Priority Health Medicare |
$189.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.49
|
| Rate for Payer: Railroad Medicare Medicare |
$188.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.88
|
| Rate for Payer: UHC Core |
$628.04
|
| Rate for Payer: UHC Exchange |
$188.03
|
| Rate for Payer: UHC Medicaid |
$132.60
|
| Rate for Payer: UHC Medicare Advantage |
$188.03
|
| Rate for Payer: UHCCP Medicaid |
$132.60
|
| Rate for Payer: VA VA |
$188.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.11
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$752.14
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$523.49 |
| Max. Negotiated Rate |
$676.93 |
| Rate for Payer: Aetna Commercial |
$639.32
|
| Rate for Payer: BCBS Trust/PPO |
$621.19
|
| Rate for Payer: BCN Commercial |
$621.19
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cofinity Commercial |
$646.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.71
|
| Rate for Payer: Healthscope Commercial |
$676.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.32
|
| Rate for Payer: Nomi Health Commercial |
$616.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.11
|
| Rate for Payer: PHP Commercial |
$639.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$654.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.88
|
| Rate for Payer: UHC Core |
$628.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.11
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$522.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$363.53 |
| Max. Negotiated Rate |
$470.08 |
| Rate for Payer: Aetna Commercial |
$443.96
|
| Rate for Payer: BCBS Trust/PPO |
$431.38
|
| Rate for Payer: BCN Commercial |
$431.38
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cofinity Commercial |
$449.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.85
|
| Rate for Payer: Healthscope Commercial |
$470.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.96
|
| Rate for Payer: Nomi Health Commercial |
$428.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.73
|
| Rate for Payer: PHP Commercial |
$443.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$454.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.63
|
| Rate for Payer: UHC Core |
$436.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.73
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$522.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$470.08 |
| Rate for Payer: Aetna Commercial |
$443.96
|
| Rate for Payer: Aetna Medicare |
$135.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.22
|
| Rate for Payer: BCBS Complete |
$96.68
|
| Rate for Payer: BCBS MAPPO |
$130.58
|
| Rate for Payer: BCBS Trust/PPO |
$429.39
|
| Rate for Payer: BCN Commercial |
$429.39
|
| Rate for Payer: BCN Medicare Advantage |
$130.58
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cofinity Commercial |
$449.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.58
|
| Rate for Payer: Healthscope Commercial |
$470.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.73
|
| Rate for Payer: Mclaren Medicaid |
$92.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.11
|
| Rate for Payer: Meridian Medicaid |
$96.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.96
|
| Rate for Payer: Nomi Health Commercial |
$428.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.73
|
| Rate for Payer: PACE Senior Care Partners |
$124.05
|
| Rate for Payer: PACE SWMI |
$130.58
|
| Rate for Payer: PHP Commercial |
$443.96
|
| Rate for Payer: PHP Medicare Advantage |
$130.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$454.41
|
| Rate for Payer: Priority Health Medicare |
$131.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.53
|
| Rate for Payer: Railroad Medicare Medicare |
$130.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.63
|
| Rate for Payer: UHC Core |
$436.13
|
| Rate for Payer: UHC Exchange |
$130.58
|
| Rate for Payer: UHC Medicaid |
$92.08
|
| Rate for Payer: UHC Medicare Advantage |
$130.58
|
| Rate for Payer: UHCCP Medicaid |
$92.08
|
| Rate for Payer: VA VA |
$130.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.73
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$330.80
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$297.72 |
| Rate for Payer: Aetna Commercial |
$281.18
|
| Rate for Payer: Aetna Medicare |
$86.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.38
|
| Rate for Payer: BCBS Complete |
$61.23
|
| Rate for Payer: BCBS MAPPO |
$82.70
|
| Rate for Payer: BCBS Trust/PPO |
$271.95
|
| Rate for Payer: BCN Commercial |
$271.95
|
| Rate for Payer: BCN Medicare Advantage |
$82.70
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cofinity Commercial |
$284.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.70
|
| Rate for Payer: Healthscope Commercial |
$297.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.10
|
| Rate for Payer: Mclaren Medicaid |
$58.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.83
|
| Rate for Payer: Meridian Medicaid |
$61.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.18
|
| Rate for Payer: Nomi Health Commercial |
$271.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.10
|
| Rate for Payer: PACE Senior Care Partners |
$78.56
|
| Rate for Payer: PACE SWMI |
$82.70
|
| Rate for Payer: PHP Commercial |
$281.18
|
| Rate for Payer: PHP Medicare Advantage |
$82.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$287.80
|
| Rate for Payer: Priority Health Medicare |
$83.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.24
|
| Rate for Payer: Railroad Medicare Medicare |
$82.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.10
|
| Rate for Payer: UHC Core |
$276.22
|
| Rate for Payer: UHC Exchange |
$82.70
|
| Rate for Payer: UHC Medicaid |
$58.32
|
| Rate for Payer: UHC Medicare Advantage |
$82.70
|
| Rate for Payer: UHCCP Medicaid |
$58.32
|
| Rate for Payer: VA VA |
$82.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.10
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$330.80
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.24 |
| Max. Negotiated Rate |
$297.72 |
| Rate for Payer: Aetna Commercial |
$281.18
|
| Rate for Payer: BCBS Trust/PPO |
$273.21
|
| Rate for Payer: BCN Commercial |
$273.21
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cofinity Commercial |
$284.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.64
|
| Rate for Payer: Healthscope Commercial |
$297.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.18
|
| Rate for Payer: Nomi Health Commercial |
$271.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.10
|
| Rate for Payer: PHP Commercial |
$281.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$287.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.10
|
| Rate for Payer: UHC Core |
$276.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.10
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$276.36
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: Aetna Medicare |
$71.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.36
|
| Rate for Payer: BCBS Complete |
$51.15
|
| Rate for Payer: BCBS MAPPO |
$69.09
|
| Rate for Payer: BCBS Trust/PPO |
$227.20
|
| Rate for Payer: BCN Commercial |
$227.20
|
| Rate for Payer: BCN Medicare Advantage |
$69.09
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.09
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.27
|
| Rate for Payer: Mclaren Medicaid |
$48.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.54
|
| Rate for Payer: Meridian Medicaid |
$51.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Nomi Health Commercial |
$226.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PACE Senior Care Partners |
$65.64
|
| Rate for Payer: PACE SWMI |
$69.09
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: PHP Medicare Advantage |
$69.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.43
|
| Rate for Payer: Priority Health Medicare |
$69.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.35
|
| Rate for Payer: Railroad Medicare Medicare |
$69.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.20
|
| Rate for Payer: UHC Core |
$230.76
|
| Rate for Payer: UHC Exchange |
$69.09
|
| Rate for Payer: UHC Medicaid |
$48.72
|
| Rate for Payer: UHC Medicare Advantage |
$69.09
|
| Rate for Payer: UHCCP Medicaid |
$48.72
|
| Rate for Payer: VA VA |
$69.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.27
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$276.36
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.35 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: BCBS Trust/PPO |
$228.25
|
| Rate for Payer: BCN Commercial |
$228.25
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Nomi Health Commercial |
$226.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.20
|
| Rate for Payer: UHC Core |
$230.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.27
|
|
