|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$291.83
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.11 |
| Max. Negotiated Rate |
$262.65 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: BCBS Trust/PPO |
$241.02
|
| Rate for Payer: BCN Commercial |
$241.02
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cofinity Commercial |
$250.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.46
|
| Rate for Payer: Healthscope Commercial |
$262.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.87
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.81
|
| Rate for Payer: UHC Core |
$243.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.87
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$291.83
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$262.65 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$75.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.20
|
| Rate for Payer: BCBS Complete |
$54.02
|
| Rate for Payer: BCBS MAPPO |
$72.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.91
|
| Rate for Payer: BCN Commercial |
$239.91
|
| Rate for Payer: BCN Medicare Advantage |
$72.96
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cofinity Commercial |
$250.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.96
|
| Rate for Payer: Healthscope Commercial |
$262.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.87
|
| Rate for Payer: Mclaren Medicaid |
$51.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.61
|
| Rate for Payer: Meridian Medicaid |
$54.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.87
|
| Rate for Payer: PACE Senior Care Partners |
$69.31
|
| Rate for Payer: PACE SWMI |
$72.96
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: PHP Medicare Advantage |
$72.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.89
|
| Rate for Payer: Priority Health Medicare |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.11
|
| Rate for Payer: Railroad Medicare Medicare |
$72.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.81
|
| Rate for Payer: UHC Core |
$243.68
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UHC Medicaid |
$51.45
|
| Rate for Payer: UHC Medicare Advantage |
$72.96
|
| Rate for Payer: UHCCP Medicaid |
$51.45
|
| Rate for Payer: VA VA |
$72.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.87
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.54 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: BCBS Trust/PPO |
$189.31
|
| Rate for Payer: BCN Commercial |
$189.31
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.71
|
| Rate for Payer: UHC Core |
$191.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna Medicare |
$59.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.63
|
| Rate for Payer: BCBS Complete |
$42.43
|
| Rate for Payer: BCBS MAPPO |
$57.30
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$188.44
|
| Rate for Payer: BCN Medicare Advantage |
$57.30
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.30
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Mclaren Medicaid |
$40.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.17
|
| Rate for Payer: Meridian Medicaid |
$42.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PACE Senior Care Partners |
$54.44
|
| Rate for Payer: PACE SWMI |
$57.30
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: PHP Medicare Advantage |
$57.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.42
|
| Rate for Payer: Priority Health Medicare |
$57.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.54
|
| Rate for Payer: Railroad Medicare Medicare |
$57.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.71
|
| Rate for Payer: UHC Core |
$191.40
|
| Rate for Payer: UHC Exchange |
$57.30
|
| Rate for Payer: UHC Medicaid |
$40.41
|
| Rate for Payer: UHC Medicare Advantage |
$57.30
|
| Rate for Payer: UHCCP Medicaid |
$40.41
|
| Rate for Payer: VA VA |
$57.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.54 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: BCBS Trust/PPO |
$189.31
|
| Rate for Payer: BCN Commercial |
$189.31
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.71
|
| Rate for Payer: UHC Core |
$191.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna Medicare |
$59.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.63
|
| Rate for Payer: BCBS Complete |
$42.43
|
| Rate for Payer: BCBS MAPPO |
$57.30
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$188.44
|
| Rate for Payer: BCN Medicare Advantage |
$57.30
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.30
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Mclaren Medicaid |
$40.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.17
|
| Rate for Payer: Meridian Medicaid |
$42.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PACE Senior Care Partners |
$54.44
|
| Rate for Payer: PACE SWMI |
$57.30
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: PHP Medicare Advantage |
$57.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.42
|
| Rate for Payer: Priority Health Medicare |
$57.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.54
|
| Rate for Payer: Railroad Medicare Medicare |
$57.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.71
|
| Rate for Payer: UHC Core |
$191.40
|
| Rate for Payer: UHC Exchange |
$57.30
|
| Rate for Payer: UHC Medicaid |
$40.41
|
| Rate for Payer: UHC Medicare Advantage |
$57.30
|
| Rate for Payer: UHCCP Medicaid |
$40.41
|
| Rate for Payer: VA VA |
$57.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$158.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$142.86 |
| Rate for Payer: Aetna Commercial |
$134.92
|
| Rate for Payer: Aetna Medicare |
$41.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.60
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS MAPPO |
$39.68
|
| Rate for Payer: BCBS Trust/PPO |
$130.49
|
| Rate for Payer: BCN Commercial |
$130.49
|
| Rate for Payer: BCN Medicare Advantage |
$39.68
|
| Rate for Payer: Cash Price |
$126.98
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.68
|
| Rate for Payer: Healthscope Commercial |
$142.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.05
|
| Rate for Payer: Mclaren Medicaid |
$27.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.67
|
| Rate for Payer: Meridian Medicaid |
$29.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.92
|
| Rate for Payer: Nomi Health Commercial |
$130.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.05
|
| Rate for Payer: PACE Senior Care Partners |
$37.70
|
| Rate for Payer: PACE SWMI |
$39.68
|
| Rate for Payer: PHP Commercial |
$134.92
|
| Rate for Payer: PHP Medicare Advantage |
$39.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.10
|
| Rate for Payer: Priority Health Medicare |
$40.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.48
|
| Rate for Payer: Railroad Medicare Medicare |
$39.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.68
|
| Rate for Payer: UHC Core |
$132.54
|
| Rate for Payer: UHC Exchange |
$39.68
|
| Rate for Payer: UHC Medicaid |
$27.98
|
| Rate for Payer: UHC Medicare Advantage |
$39.68
|
| Rate for Payer: UHCCP Medicaid |
$27.98
|
| Rate for Payer: VA VA |
$39.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.05
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$158.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.48 |
| Max. Negotiated Rate |
$142.86 |
| Rate for Payer: Aetna Commercial |
$134.92
|
| Rate for Payer: BCBS Trust/PPO |
$131.10
|
| Rate for Payer: BCN Commercial |
$131.10
|
| Rate for Payer: Cash Price |
$126.98
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.98
|
| Rate for Payer: Healthscope Commercial |
$142.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.92
|
| Rate for Payer: Nomi Health Commercial |
$130.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.05
|
| Rate for Payer: PHP Commercial |
$134.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.68
|
| Rate for Payer: UHC Core |
$132.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.05
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$208.15
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$187.34 |
| Rate for Payer: Aetna Commercial |
$176.93
|
| Rate for Payer: Aetna Medicare |
$54.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.05
|
| Rate for Payer: BCBS Complete |
$38.53
|
| Rate for Payer: BCBS MAPPO |
$52.04
|
| Rate for Payer: BCBS Trust/PPO |
$171.12
|
| Rate for Payer: BCN Commercial |
$171.12
|
| Rate for Payer: BCN Medicare Advantage |
$52.04
|
| Rate for Payer: Cash Price |
$166.52
|
| Rate for Payer: Cofinity Commercial |
$179.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.04
|
| Rate for Payer: Healthscope Commercial |
$187.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.11
|
| Rate for Payer: Mclaren Medicaid |
$36.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.64
|
| Rate for Payer: Meridian Medicaid |
$38.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.93
|
| Rate for Payer: Nomi Health Commercial |
$170.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.11
|
| Rate for Payer: PACE Senior Care Partners |
$49.44
|
| Rate for Payer: PACE SWMI |
$52.04
|
| Rate for Payer: PHP Commercial |
$176.93
|
| Rate for Payer: PHP Medicare Advantage |
$52.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.09
|
| Rate for Payer: Priority Health Medicare |
$52.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.87
|
| Rate for Payer: Railroad Medicare Medicare |
$52.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.17
|
| Rate for Payer: UHC Core |
$173.81
|
| Rate for Payer: UHC Exchange |
$52.04
|
| Rate for Payer: UHC Medicaid |
$36.70
|
| Rate for Payer: UHC Medicare Advantage |
$52.04
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: VA VA |
$52.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.11
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$208.15
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.87 |
| Max. Negotiated Rate |
$187.34 |
| Rate for Payer: Aetna Commercial |
$176.93
|
| Rate for Payer: BCBS Trust/PPO |
$171.91
|
| Rate for Payer: BCN Commercial |
$171.91
|
| Rate for Payer: Cash Price |
$166.52
|
| Rate for Payer: Cofinity Commercial |
$179.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.52
|
| Rate for Payer: Healthscope Commercial |
$187.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.93
|
| Rate for Payer: Nomi Health Commercial |
$170.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.11
|
| Rate for Payer: PHP Commercial |
$176.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.17
|
| Rate for Payer: UHC Core |
$173.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.11
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
OP
|
$138.72
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna Medicare |
$36.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.35
|
| Rate for Payer: BCBS Complete |
$25.68
|
| Rate for Payer: BCBS MAPPO |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$114.04
|
| Rate for Payer: BCN Commercial |
$114.04
|
| Rate for Payer: BCN Medicare Advantage |
$34.68
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.68
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Mclaren Medicaid |
$24.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.41
|
| Rate for Payer: Meridian Medicaid |
$25.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Nomi Health Commercial |
$113.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PACE Senior Care Partners |
$32.95
|
| Rate for Payer: PACE SWMI |
$34.68
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: PHP Medicare Advantage |
$34.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.69
|
| Rate for Payer: Priority Health Medicare |
$35.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.55
|
| Rate for Payer: Railroad Medicare Medicare |
$34.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.07
|
| Rate for Payer: UHC Core |
$115.83
|
| Rate for Payer: UHC Exchange |
$34.68
|
| Rate for Payer: UHC Medicaid |
$24.46
|
| Rate for Payer: UHC Medicare Advantage |
$34.68
|
| Rate for Payer: UHCCP Medicaid |
$24.46
|
| Rate for Payer: VA VA |
$34.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
IP
|
$138.72
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: BCBS Trust/PPO |
$114.57
|
| Rate for Payer: BCN Commercial |
$114.57
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Nomi Health Commercial |
$113.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.07
|
| Rate for Payer: UHC Core |
$115.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$169.49
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$117.97 |
| Max. Negotiated Rate |
$152.54 |
| Rate for Payer: Aetna Commercial |
$144.07
|
| Rate for Payer: BCBS Trust/PPO |
$139.98
|
| Rate for Payer: BCN Commercial |
$139.98
|
| Rate for Payer: Cash Price |
$135.59
|
| Rate for Payer: Cofinity Commercial |
$145.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.59
|
| Rate for Payer: Healthscope Commercial |
$152.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.07
|
| Rate for Payer: Nomi Health Commercial |
$138.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.12
|
| Rate for Payer: PHP Commercial |
$144.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.15
|
| Rate for Payer: UHC Core |
$141.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.12
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$169.49
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$152.54 |
| Rate for Payer: Aetna Commercial |
$144.07
|
| Rate for Payer: Aetna Medicare |
$44.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.97
|
| Rate for Payer: BCBS Complete |
$31.37
|
| Rate for Payer: BCBS MAPPO |
$42.37
|
| Rate for Payer: BCBS Trust/PPO |
$139.34
|
| Rate for Payer: BCN Commercial |
$139.34
|
| Rate for Payer: BCN Medicare Advantage |
$42.37
|
| Rate for Payer: Cash Price |
$135.59
|
| Rate for Payer: Cofinity Commercial |
$145.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.37
|
| Rate for Payer: Healthscope Commercial |
$152.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.12
|
| Rate for Payer: Mclaren Medicaid |
$29.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.49
|
| Rate for Payer: Meridian Medicaid |
$31.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.07
|
| Rate for Payer: Nomi Health Commercial |
$138.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.12
|
| Rate for Payer: PACE Senior Care Partners |
$40.25
|
| Rate for Payer: PACE SWMI |
$42.37
|
| Rate for Payer: PHP Commercial |
$144.07
|
| Rate for Payer: PHP Medicare Advantage |
$42.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.46
|
| Rate for Payer: Priority Health Medicare |
$42.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.97
|
| Rate for Payer: Railroad Medicare Medicare |
$42.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.15
|
| Rate for Payer: UHC Core |
$141.52
|
| Rate for Payer: UHC Exchange |
$42.37
|
| Rate for Payer: UHC Medicaid |
$29.88
|
| Rate for Payer: UHC Medicare Advantage |
$42.37
|
| Rate for Payer: UHCCP Medicaid |
$29.88
|
| Rate for Payer: VA VA |
$42.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.12
|
|
|
HC PV JAK2V617F
|
Facility
|
IP
|
$336.10
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$233.93 |
| Max. Negotiated Rate |
$302.49 |
| Rate for Payer: Aetna Commercial |
$285.69
|
| Rate for Payer: BCBS Trust/PPO |
$277.58
|
| Rate for Payer: BCN Commercial |
$277.58
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cofinity Commercial |
$289.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.88
|
| Rate for Payer: Healthscope Commercial |
$302.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.69
|
| Rate for Payer: Nomi Health Commercial |
$275.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.07
|
| Rate for Payer: PHP Commercial |
$285.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.77
|
| Rate for Payer: UHC Core |
$280.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.07
|
|
|
HC PV JAK2V617F
|
Facility
|
OP
|
$336.10
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$302.49 |
| Rate for Payer: Aetna Commercial |
$285.69
|
| Rate for Payer: Aetna Medicare |
$87.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.03
|
| Rate for Payer: BCBS Complete |
$62.21
|
| Rate for Payer: BCBS MAPPO |
$84.03
|
| Rate for Payer: BCBS Trust/PPO |
$276.31
|
| Rate for Payer: BCN Commercial |
$276.31
|
| Rate for Payer: BCN Medicare Advantage |
$84.03
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cofinity Commercial |
$289.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.03
|
| Rate for Payer: Healthscope Commercial |
$302.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.07
|
| Rate for Payer: Mclaren Medicaid |
$59.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.23
|
| Rate for Payer: Meridian Medicaid |
$62.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.69
|
| Rate for Payer: Nomi Health Commercial |
$275.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.07
|
| Rate for Payer: PACE Senior Care Partners |
$79.82
|
| Rate for Payer: PACE SWMI |
$84.03
|
| Rate for Payer: PHP Commercial |
$285.69
|
| Rate for Payer: PHP Medicare Advantage |
$84.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.41
|
| Rate for Payer: Priority Health Medicare |
$84.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.93
|
| Rate for Payer: Railroad Medicare Medicare |
$84.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.77
|
| Rate for Payer: UHC Core |
$280.64
|
| Rate for Payer: UHC Exchange |
$84.03
|
| Rate for Payer: UHC Medicaid |
$59.25
|
| Rate for Payer: UHC Medicare Advantage |
$84.03
|
| Rate for Payer: UHCCP Medicaid |
$59.25
|
| Rate for Payer: VA VA |
$84.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.07
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$96.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$87.08 |
| Rate for Payer: Aetna Commercial |
$82.25
|
| Rate for Payer: Aetna Medicare |
$25.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.24
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS MAPPO |
$24.19
|
| Rate for Payer: BCBS Trust/PPO |
$79.55
|
| Rate for Payer: BCN Commercial |
$79.55
|
| Rate for Payer: BCN Medicare Advantage |
$24.19
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$83.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.19
|
| Rate for Payer: Healthscope Commercial |
$87.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.57
|
| Rate for Payer: Mclaren Medicaid |
$17.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.40
|
| Rate for Payer: Meridian Medicaid |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Nomi Health Commercial |
$79.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| Rate for Payer: PACE Senior Care Partners |
$22.98
|
| Rate for Payer: PACE SWMI |
$24.19
|
| Rate for Payer: PHP Commercial |
$82.25
|
| Rate for Payer: PHP Medicare Advantage |
$24.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.18
|
| Rate for Payer: Priority Health Medicare |
$24.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.34
|
| Rate for Payer: Railroad Medicare Medicare |
$24.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.15
|
| Rate for Payer: UHC Core |
$80.79
|
| Rate for Payer: UHC Exchange |
$24.19
|
| Rate for Payer: UHC Medicaid |
$17.06
|
| Rate for Payer: UHC Medicare Advantage |
$24.19
|
| Rate for Payer: UHCCP Medicaid |
$17.06
|
| Rate for Payer: VA VA |
$24.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.57
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$96.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$87.08 |
| Rate for Payer: Aetna Commercial |
$82.25
|
| Rate for Payer: BCBS Trust/PPO |
$79.91
|
| Rate for Payer: BCN Commercial |
$79.91
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$83.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Healthscope Commercial |
$87.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Nomi Health Commercial |
$79.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| Rate for Payer: PHP Commercial |
$82.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.15
|
| Rate for Payer: UHC Core |
$80.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.57
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS MAPPO |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.27
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.93
|
| Rate for Payer: Meridian Medicaid |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.27
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Medicare |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: UHCCP Medicaid |
$9.35
|
| Rate for Payer: VA VA |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
OP
|
$95.77
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$86.19 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$24.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.93
|
| Rate for Payer: BCBS Complete |
$17.73
|
| Rate for Payer: BCBS MAPPO |
$23.94
|
| Rate for Payer: BCBS Trust/PPO |
$78.73
|
| Rate for Payer: BCN Commercial |
$78.73
|
| Rate for Payer: BCN Medicare Advantage |
$23.94
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cofinity Commercial |
$82.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$86.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.83
|
| Rate for Payer: Mclaren Medicaid |
$16.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.14
|
| Rate for Payer: Meridian Medicaid |
$17.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.83
|
| Rate for Payer: PACE Senior Care Partners |
$22.75
|
| Rate for Payer: PACE SWMI |
$23.94
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: PHP Medicare Advantage |
$23.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.32
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.66
|
| Rate for Payer: Railroad Medicare Medicare |
$23.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Core |
$79.97
|
| Rate for Payer: UHC Exchange |
$23.94
|
| Rate for Payer: UHC Medicaid |
$16.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.94
|
| Rate for Payer: UHCCP Medicaid |
$16.88
|
| Rate for Payer: VA VA |
$23.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.83
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
IP
|
$95.77
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.66 |
| Max. Negotiated Rate |
$86.19 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: BCBS Trust/PPO |
$79.10
|
| Rate for Payer: BCN Commercial |
$79.10
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cofinity Commercial |
$82.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.62
|
| Rate for Payer: Healthscope Commercial |
$86.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.40
|
| Rate for Payer: Nomi Health Commercial |
$78.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.83
|
| Rate for Payer: PHP Commercial |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Core |
$79.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.83
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$347.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.34 |
| Max. Negotiated Rate |
$313.14 |
| Rate for Payer: Aetna Commercial |
$295.74
|
| Rate for Payer: Aetna Medicare |
$90.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.73
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$86.98
|
| Rate for Payer: BCBS Trust/PPO |
$286.03
|
| Rate for Payer: BCN Commercial |
$286.03
|
| Rate for Payer: BCN Medicare Advantage |
$86.98
|
| Rate for Payer: Cash Price |
$278.34
|
| Rate for Payer: Cofinity Commercial |
$299.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.98
|
| Rate for Payer: Healthscope Commercial |
$313.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.95
|
| Rate for Payer: Mclaren Medicaid |
$61.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.33
|
| Rate for Payer: Meridian Medicaid |
$64.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.74
|
| Rate for Payer: Nomi Health Commercial |
$285.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.95
|
| Rate for Payer: PACE Senior Care Partners |
$82.63
|
| Rate for Payer: PACE SWMI |
$86.98
|
| Rate for Payer: PHP Commercial |
$295.74
|
| Rate for Payer: PHP Medicare Advantage |
$86.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.70
|
| Rate for Payer: Priority Health Medicare |
$87.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.16
|
| Rate for Payer: Railroad Medicare Medicare |
$86.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.18
|
| Rate for Payer: UHC Core |
$290.52
|
| Rate for Payer: UHC Exchange |
$86.98
|
| Rate for Payer: UHC Medicaid |
$61.34
|
| Rate for Payer: UHC Medicare Advantage |
$86.98
|
| Rate for Payer: UHCCP Medicaid |
$61.34
|
| Rate for Payer: VA VA |
$86.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.95
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$347.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.16 |
| Max. Negotiated Rate |
$313.14 |
| Rate for Payer: Aetna Commercial |
$295.74
|
| Rate for Payer: BCBS Trust/PPO |
$287.36
|
| Rate for Payer: BCN Commercial |
$287.36
|
| Rate for Payer: Cash Price |
$278.34
|
| Rate for Payer: Cofinity Commercial |
$299.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.34
|
| Rate for Payer: Healthscope Commercial |
$313.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.74
|
| Rate for Payer: Nomi Health Commercial |
$285.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.95
|
| Rate for Payer: PHP Commercial |
$295.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.18
|
| Rate for Payer: UHC Core |
$290.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.95
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$354.27
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.57 |
| Max. Negotiated Rate |
$318.84 |
| Rate for Payer: Aetna Commercial |
$301.13
|
| Rate for Payer: BCBS Trust/PPO |
$292.59
|
| Rate for Payer: BCN Commercial |
$292.59
|
| Rate for Payer: Cash Price |
$283.42
|
| Rate for Payer: Cofinity Commercial |
$304.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.42
|
| Rate for Payer: Healthscope Commercial |
$318.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.13
|
| Rate for Payer: Nomi Health Commercial |
$290.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.70
|
| Rate for Payer: PHP Commercial |
$301.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$308.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.76
|
| Rate for Payer: UHC Core |
$295.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.70
|
|
