|
HC POST-OP
|
Facility
|
OP
|
$18.07
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Aetna Commercial |
$15.36
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$16.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.36
|
| Rate for Payer: Nomi Health Commercial |
$14.82
|
| Rate for Payer: PACE Senior Care Partners |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$15.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.72
|
| Rate for Payer: Priority Health Medicare |
$4.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Core |
$15.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$4.52
|
| Rate for Payer: VA VA |
$4.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.55
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$100.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.69
|
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: BCBS MAPPO |
$96.55
|
| Rate for Payer: BCBS Trust/PPO |
$317.50
|
| Rate for Payer: BCN Commercial |
$300.28
|
| Rate for Payer: BCN Medicare Advantage |
$96.55
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.38
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PACE Senior Care Partners |
$91.72
|
| Rate for Payer: PACE SWMI |
$96.55
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$96.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO |
$336.00
|
| Rate for Payer: Priority Health Medicare |
$97.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.76
|
| Rate for Payer: Railroad Medicare Medicare |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.86
|
| Rate for Payer: UHC Core |
$322.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.55
|
| Rate for Payer: UHC Exchange |
$96.55
|
| Rate for Payer: UHC Medicare Advantage |
$96.55
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
| Rate for Payer: VA VA |
$96.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: BCBS Trust/PPO |
$315.26
|
| Rate for Payer: BCN Commercial |
$298.46
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO |
$336.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.86
|
| Rate for Payer: UHC Core |
$322.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.44
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$17.32
|
| Rate for Payer: BCN Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO |
$18.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.67
|
| Rate for Payer: UHC Core |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.91
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.63
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$16.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.30
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PACE Senior Care Partners |
$5.04
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO |
$18.46
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.67
|
| Rate for Payer: UHC Core |
$17.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.30
|
| Rate for Payer: UHC Exchange |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.30
|
| Rate for Payer: VA VA |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.91
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$36.92
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: Aetna Medicare |
$9.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.54
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$9.23
|
| Rate for Payer: BCBS Trust/PPO |
$30.35
|
| Rate for Payer: BCN Commercial |
$28.71
|
| Rate for Payer: BCN Medicare Advantage |
$9.23
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.23
|
| Rate for Payer: Healthscope Commercial |
$33.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.69
|
| Rate for Payer: Mclaren Medicaid |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.69
|
| Rate for Payer: Meridian Medicaid |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.38
|
| Rate for Payer: Nomi Health Commercial |
$30.27
|
| Rate for Payer: PACE Senior Care Partners |
$8.77
|
| Rate for Payer: PACE SWMI |
$9.23
|
| Rate for Payer: PHP Commercial |
$31.38
|
| Rate for Payer: PHP Medicare Advantage |
$9.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: Priority Health HMO/PPO |
$32.12
|
| Rate for Payer: Priority Health Medicare |
$9.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.49
|
| Rate for Payer: UHC Core |
$30.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.23
|
| Rate for Payer: UHC Exchange |
$9.23
|
| Rate for Payer: UHC Medicare Advantage |
$9.23
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: VA VA |
$9.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.69
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$36.92
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: BCBS Trust/PPO |
$30.14
|
| Rate for Payer: BCN Commercial |
$28.53
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$31.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$33.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.38
|
| Rate for Payer: Nomi Health Commercial |
$30.27
|
| Rate for Payer: PHP Commercial |
$31.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.00
|
| Rate for Payer: Priority Health HMO/PPO |
$32.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.49
|
| Rate for Payer: UHC Core |
$30.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.69
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$7.88
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health HMO/PPO |
$8.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS MAPPO |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCN Commercial |
$7.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.55
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: PACE Senior Care Partners |
$2.42
|
| Rate for Payer: PACE SWMI |
$2.55
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicare Advantage |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health HMO/PPO |
$8.87
|
| Rate for Payer: Priority Health Medicare |
$2.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.55
|
| Rate for Payer: UHC Exchange |
$2.55
|
| Rate for Payer: UHC Medicare Advantage |
$2.55
|
| Rate for Payer: VA VA |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$14.11
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$15.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: Nomi Health Commercial |
$14.17
|
| Rate for Payer: PHP Commercial |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health HMO/PPO |
$15.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.21
|
| Rate for Payer: UHC Core |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.96
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$4.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.40
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS MAPPO |
$4.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCN Commercial |
$13.44
|
| Rate for Payer: BCN Medicare Advantage |
$4.32
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.32
|
| Rate for Payer: Healthscope Commercial |
$15.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: Nomi Health Commercial |
$14.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.10
|
| Rate for Payer: PACE SWMI |
$4.32
|
| Rate for Payer: PHP Commercial |
$14.69
|
| Rate for Payer: PHP Medicare Advantage |
$4.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health HMO/PPO |
$15.03
|
| Rate for Payer: Priority Health Medicare |
$4.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.58
|
| Rate for Payer: Railroad Medicare Medicare |
$4.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.21
|
| Rate for Payer: UHC Core |
$14.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.32
|
| Rate for Payer: UHC Exchange |
$4.32
|
| Rate for Payer: UHC Medicare Advantage |
$4.32
|
| Rate for Payer: VA VA |
$4.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.96
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$101.58 |
| Rate for Payer: Aetna Commercial |
$95.94
|
| Rate for Payer: Aetna Medicare |
$29.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.27
|
| Rate for Payer: BCBS Complete |
$45.15
|
| Rate for Payer: BCBS MAPPO |
$28.22
|
| Rate for Payer: BCBS Trust/PPO |
$92.79
|
| Rate for Payer: BCN Commercial |
$87.76
|
| Rate for Payer: BCN Medicare Advantage |
$28.22
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$97.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.22
|
| Rate for Payer: Healthscope Commercial |
$101.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: Nomi Health Commercial |
$92.55
|
| Rate for Payer: PACE Senior Care Partners |
$26.81
|
| Rate for Payer: PACE SWMI |
$28.22
|
| Rate for Payer: PHP Commercial |
$95.94
|
| Rate for Payer: PHP Medicare Advantage |
$28.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: Priority Health HMO/PPO |
$98.20
|
| Rate for Payer: Priority Health Medicare |
$28.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.62
|
| Rate for Payer: Railroad Medicare Medicare |
$28.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.33
|
| Rate for Payer: UHC Core |
$94.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.22
|
| Rate for Payer: UHC Exchange |
$28.22
|
| Rate for Payer: UHC Medicare Advantage |
$28.22
|
| Rate for Payer: VA VA |
$28.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.65
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$101.58 |
| Rate for Payer: Aetna Commercial |
$95.94
|
| Rate for Payer: BCBS Trust/PPO |
$92.14
|
| Rate for Payer: BCN Commercial |
$87.23
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$97.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$101.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: Nomi Health Commercial |
$92.55
|
| Rate for Payer: PHP Commercial |
$95.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: Priority Health HMO/PPO |
$98.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.33
|
| Rate for Payer: UHC Core |
$94.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.65
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: BCBS Trust/PPO |
$24.86
|
| Rate for Payer: BCN Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$27.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: Nomi Health Commercial |
$24.97
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health HMO/PPO |
$26.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.80
|
| Rate for Payer: UHC Core |
$25.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.84
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna Medicare |
$7.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.52
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCBS Trust/PPO |
$25.03
|
| Rate for Payer: BCN Commercial |
$23.67
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$27.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: Nomi Health Commercial |
$24.97
|
| Rate for Payer: PACE Senior Care Partners |
$7.23
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health HMO/PPO |
$26.49
|
| Rate for Payer: Priority Health Medicare |
$7.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.40
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.80
|
| Rate for Payer: UHC Core |
$25.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.61
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicare Advantage |
$7.61
|
| Rate for Payer: VA VA |
$7.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.84
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: BCBS Trust/PPO |
$32.49
|
| Rate for Payer: BCN Commercial |
$30.76
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health HMO/PPO |
$34.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.02
|
| Rate for Payer: UHC Core |
$33.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.44
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: BCBS MAPPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$30.94
|
| Rate for Payer: BCN Medicare Advantage |
$9.95
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.95
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: PACE Senior Care Partners |
$9.45
|
| Rate for Payer: PACE SWMI |
$9.95
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health HMO/PPO |
$34.63
|
| Rate for Payer: Priority Health Medicare |
$10.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.67
|
| Rate for Payer: Railroad Medicare Medicare |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.02
|
| Rate for Payer: UHC Core |
$33.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.95
|
| Rate for Payer: UHC Exchange |
$9.95
|
| Rate for Payer: UHC Medicare Advantage |
$9.95
|
| Rate for Payer: VA VA |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna Medicare |
$14.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.73
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: BCBS MAPPO |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$46.64
|
| Rate for Payer: BCN Commercial |
$44.11
|
| Rate for Payer: BCN Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: Nomi Health Commercial |
$46.52
|
| Rate for Payer: PACE Senior Care Partners |
$13.47
|
| Rate for Payer: PACE SWMI |
$14.18
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: PHP Medicare Advantage |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health HMO/PPO |
$49.36
|
| Rate for Payer: Priority Health Medicare |
$14.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.92
|
| Rate for Payer: UHC Core |
$47.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.18
|
| Rate for Payer: UHC Exchange |
$14.18
|
| Rate for Payer: UHC Medicare Advantage |
$14.18
|
| Rate for Payer: VA VA |
$14.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.55
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: BCBS Trust/PPO |
$46.31
|
| Rate for Payer: BCN Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: Nomi Health Commercial |
$46.52
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health HMO/PPO |
$49.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.92
|
| Rate for Payer: UHC Core |
$47.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.55
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: BCBS Trust/PPO |
$83.75
|
| Rate for Payer: BCN Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: Nomi Health Commercial |
$84.13
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health HMO/PPO |
$89.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.29
|
| Rate for Payer: UHC Core |
$85.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.95
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$26.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.06
|
| Rate for Payer: BCBS Complete |
$41.04
|
| Rate for Payer: BCBS MAPPO |
$25.65
|
| Rate for Payer: BCBS Trust/PPO |
$84.35
|
| Rate for Payer: BCN Commercial |
$79.77
|
| Rate for Payer: BCN Medicare Advantage |
$25.65
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.65
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: Nomi Health Commercial |
$84.13
|
| Rate for Payer: PACE Senior Care Partners |
$24.37
|
| Rate for Payer: PACE SWMI |
$25.65
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: PHP Medicare Advantage |
$25.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health HMO/PPO |
$89.26
|
| Rate for Payer: Priority Health Medicare |
$25.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.74
|
| Rate for Payer: Railroad Medicare Medicare |
$25.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.29
|
| Rate for Payer: UHC Core |
$85.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.65
|
| Rate for Payer: UHC Exchange |
$25.65
|
| Rate for Payer: UHC Medicare Advantage |
$25.65
|
| Rate for Payer: VA VA |
$25.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.95
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$16.32
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: Nomi Health Commercial |
$16.39
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health HMO/PPO |
$17.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.59
|
| Rate for Payer: UHC Core |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.43
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: Nomi Health Commercial |
$16.39
|
| Rate for Payer: PACE Senior Care Partners |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health HMO/PPO |
$17.39
|
| Rate for Payer: Priority Health Medicare |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.59
|
| Rate for Payer: UHC Core |
$16.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Exchange |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: VA VA |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
