|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.1 TO 2.0 CM
|
Facility
|
IP
|
$287.22
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.91 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$244.14
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$237.21
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Healthscope Commercial |
$258.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Nomi Health Commercial |
$235.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PHP Commercial |
$244.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.75
|
| Rate for Payer: UHC Core |
$239.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.41
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA >2CM
|
Facility
|
OP
|
$508.32
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.62 |
| Max. Negotiated Rate |
$457.49 |
| Rate for Payer: Aetna Commercial |
$432.07
|
| Rate for Payer: Aetna Medicare |
$132.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$158.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$158.85
|
| Rate for Payer: BCBS Complete |
$94.09
|
| Rate for Payer: BCBS MAPPO |
$127.08
|
| Rate for Payer: BCBS Trust/PPO |
$417.89
|
| Rate for Payer: BCN Commercial |
$417.89
|
| Rate for Payer: BCN Medicare Advantage |
$127.08
|
| Rate for Payer: Cash Price |
$406.66
|
| Rate for Payer: Cofinity Commercial |
$437.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.08
|
| Rate for Payer: Healthscope Commercial |
$457.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.24
|
| Rate for Payer: Mclaren Medicaid |
$89.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.43
|
| Rate for Payer: Meridian Medicaid |
$94.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.07
|
| Rate for Payer: Nomi Health Commercial |
$416.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.24
|
| Rate for Payer: PACE Senior Care Partners |
$120.73
|
| Rate for Payer: PACE SWMI |
$127.08
|
| Rate for Payer: PHP Commercial |
$432.07
|
| Rate for Payer: PHP Medicare Advantage |
$127.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$442.24
|
| Rate for Payer: Priority Health Medicare |
$128.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.79
|
| Rate for Payer: Railroad Medicare Medicare |
$127.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.32
|
| Rate for Payer: UHC Core |
$424.45
|
| Rate for Payer: UHC Exchange |
$127.08
|
| Rate for Payer: UHC Medicaid |
$89.62
|
| Rate for Payer: UHC Medicare Advantage |
$127.08
|
| Rate for Payer: UHCCP Medicaid |
$89.62
|
| Rate for Payer: VA VA |
$127.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.24
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA >2CM
|
Facility
|
IP
|
$508.32
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.79 |
| Max. Negotiated Rate |
$457.49 |
| Rate for Payer: Aetna Commercial |
$432.07
|
| Rate for Payer: BCBS Trust/PPO |
$419.82
|
| Rate for Payer: BCN Commercial |
$419.82
|
| Rate for Payer: Cash Price |
$406.66
|
| Rate for Payer: Cofinity Commercial |
$437.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.66
|
| Rate for Payer: Healthscope Commercial |
$457.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.07
|
| Rate for Payer: Nomi Health Commercial |
$416.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.24
|
| Rate for Payer: PHP Commercial |
$432.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$442.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.32
|
| Rate for Payer: UHC Core |
$424.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.24
|
|
|
HC SHAVE LESION TRUCK, ARM, LEGS 0.6 TO 1.0 CM
|
Facility
|
OP
|
$165.06
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.58
|
| Rate for Payer: BCBS Complete |
$30.55
|
| Rate for Payer: BCBS MAPPO |
$41.27
|
| Rate for Payer: BCBS Trust/PPO |
$135.70
|
| Rate for Payer: BCN Commercial |
$135.70
|
| Rate for Payer: BCN Medicare Advantage |
$41.27
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.27
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.80
|
| Rate for Payer: Mclaren Medicaid |
$29.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.33
|
| Rate for Payer: Meridian Medicaid |
$30.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$135.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PACE Senior Care Partners |
$39.20
|
| Rate for Payer: PACE SWMI |
$41.27
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: PHP Medicare Advantage |
$41.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.60
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.88
|
| Rate for Payer: Railroad Medicare Medicare |
$41.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.25
|
| Rate for Payer: UHC Core |
$137.83
|
| Rate for Payer: UHC Exchange |
$41.27
|
| Rate for Payer: UHC Medicaid |
$29.10
|
| Rate for Payer: UHC Medicare Advantage |
$41.27
|
| Rate for Payer: UHCCP Medicaid |
$29.10
|
| Rate for Payer: VA VA |
$41.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.80
|
|
|
HC SHAVE LESION TRUCK, ARM, LEGS 0.6 TO 1.0 CM
|
Facility
|
IP
|
$165.06
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: BCBS Trust/PPO |
$136.32
|
| Rate for Payer: BCN Commercial |
$136.32
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$135.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.25
|
| Rate for Payer: UHC Core |
$137.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.80
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 0.5 CM OR LESS
|
Facility
|
IP
|
$165.06
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: BCBS Trust/PPO |
$136.32
|
| Rate for Payer: BCN Commercial |
$136.32
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$135.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.25
|
| Rate for Payer: UHC Core |
$137.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.80
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 0.5 CM OR LESS
|
Facility
|
OP
|
$165.06
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.58
|
| Rate for Payer: BCBS Complete |
$30.55
|
| Rate for Payer: BCBS MAPPO |
$41.27
|
| Rate for Payer: BCBS Trust/PPO |
$135.70
|
| Rate for Payer: BCN Commercial |
$135.70
|
| Rate for Payer: BCN Medicare Advantage |
$41.27
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.27
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.80
|
| Rate for Payer: Mclaren Medicaid |
$29.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.33
|
| Rate for Payer: Meridian Medicaid |
$30.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$135.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PACE Senior Care Partners |
$39.20
|
| Rate for Payer: PACE SWMI |
$41.27
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: PHP Medicare Advantage |
$41.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.60
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.88
|
| Rate for Payer: Railroad Medicare Medicare |
$41.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.25
|
| Rate for Payer: UHC Core |
$137.83
|
| Rate for Payer: UHC Exchange |
$41.27
|
| Rate for Payer: UHC Medicaid |
$29.10
|
| Rate for Payer: UHC Medicare Advantage |
$41.27
|
| Rate for Payer: UHCCP Medicaid |
$29.10
|
| Rate for Payer: VA VA |
$41.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.80
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$165.06
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.58
|
| Rate for Payer: BCBS Complete |
$30.55
|
| Rate for Payer: BCBS MAPPO |
$41.27
|
| Rate for Payer: BCBS Trust/PPO |
$135.70
|
| Rate for Payer: BCN Commercial |
$135.70
|
| Rate for Payer: BCN Medicare Advantage |
$41.27
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.27
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.80
|
| Rate for Payer: Mclaren Medicaid |
$29.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.33
|
| Rate for Payer: Meridian Medicaid |
$30.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$135.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PACE Senior Care Partners |
$39.20
|
| Rate for Payer: PACE SWMI |
$41.27
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: PHP Medicare Advantage |
$41.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.60
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.88
|
| Rate for Payer: Railroad Medicare Medicare |
$41.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.25
|
| Rate for Payer: UHC Core |
$137.83
|
| Rate for Payer: UHC Exchange |
$41.27
|
| Rate for Payer: UHC Medicaid |
$29.10
|
| Rate for Payer: UHC Medicare Advantage |
$41.27
|
| Rate for Payer: UHCCP Medicaid |
$29.10
|
| Rate for Payer: VA VA |
$41.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.80
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
IP
|
$165.06
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: BCBS Trust/PPO |
$136.32
|
| Rate for Payer: BCN Commercial |
$136.32
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$135.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.25
|
| Rate for Payer: UHC Core |
$137.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.80
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
OP
|
$150.05
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna Medicare |
$39.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.89
|
| Rate for Payer: BCBS Complete |
$27.77
|
| Rate for Payer: BCBS MAPPO |
$37.51
|
| Rate for Payer: BCBS Trust/PPO |
$123.36
|
| Rate for Payer: BCN Commercial |
$123.36
|
| Rate for Payer: BCN Medicare Advantage |
$37.51
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Mclaren Medicaid |
$26.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.39
|
| Rate for Payer: Meridian Medicaid |
$27.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PACE Senior Care Partners |
$35.64
|
| Rate for Payer: PACE SWMI |
$37.51
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: PHP Medicare Advantage |
$37.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.54
|
| Rate for Payer: Priority Health Medicare |
$37.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.43
|
| Rate for Payer: Railroad Medicare Medicare |
$37.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.04
|
| Rate for Payer: UHC Core |
$125.29
|
| Rate for Payer: UHC Exchange |
$37.51
|
| Rate for Payer: UHC Medicaid |
$26.45
|
| Rate for Payer: UHC Medicare Advantage |
$37.51
|
| Rate for Payer: UHCCP Medicaid |
$26.45
|
| Rate for Payer: VA VA |
$37.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: BCBS Trust/PPO |
$123.93
|
| Rate for Payer: BCN Commercial |
$123.93
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.04
|
| Rate for Payer: UHC Core |
$125.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC SHEEP SORREL IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC SHEEP SORREL IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC SHINGLES VACCINE
|
Facility
|
OP
|
$282.49
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$254.24 |
| Rate for Payer: Aetna Commercial |
$240.12
|
| Rate for Payer: Aetna Medicare |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.28
|
| Rate for Payer: BCBS Complete |
$52.29
|
| Rate for Payer: BCBS MAPPO |
$70.62
|
| Rate for Payer: BCBS Trust/PPO |
$232.24
|
| Rate for Payer: BCN Commercial |
$232.24
|
| Rate for Payer: BCN Medicare Advantage |
$70.62
|
| Rate for Payer: Cash Price |
$225.99
|
| Rate for Payer: Cofinity Commercial |
$242.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.62
|
| Rate for Payer: Healthscope Commercial |
$254.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.87
|
| Rate for Payer: Mclaren Medicaid |
$49.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.15
|
| Rate for Payer: Meridian Medicaid |
$52.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.12
|
| Rate for Payer: Nomi Health Commercial |
$231.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.87
|
| Rate for Payer: PACE Senior Care Partners |
$67.09
|
| Rate for Payer: PACE SWMI |
$70.62
|
| Rate for Payer: PHP Commercial |
$240.12
|
| Rate for Payer: PHP Medicare Advantage |
$70.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.77
|
| Rate for Payer: Priority Health Medicare |
$71.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.61
|
| Rate for Payer: Railroad Medicare Medicare |
$70.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.59
|
| Rate for Payer: UHC Core |
$235.88
|
| Rate for Payer: UHC Exchange |
$70.62
|
| Rate for Payer: UHC Medicaid |
$49.80
|
| Rate for Payer: UHC Medicare Advantage |
$70.62
|
| Rate for Payer: UHCCP Medicaid |
$49.80
|
| Rate for Payer: VA VA |
$70.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.87
|
|
|
HC SHINGLES VACCINE
|
Facility
|
IP
|
$282.49
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.61 |
| Max. Negotiated Rate |
$254.24 |
| Rate for Payer: Aetna Commercial |
$240.12
|
| Rate for Payer: BCBS Trust/PPO |
$233.31
|
| Rate for Payer: BCN Commercial |
$233.31
|
| Rate for Payer: Cash Price |
$225.99
|
| Rate for Payer: Cofinity Commercial |
$242.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.99
|
| Rate for Payer: Healthscope Commercial |
$254.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.12
|
| Rate for Payer: Nomi Health Commercial |
$231.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.87
|
| Rate for Payer: PHP Commercial |
$240.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.59
|
| Rate for Payer: UHC Core |
$235.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.87
|
|
|
HC SHRIMP IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC SHRIMP IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.06
|
| Rate for Payer: BCBS Complete |
$23.14
|
| Rate for Payer: BCBS MAPPO |
$31.25
|
| Rate for Payer: BCBS Trust/PPO |
$102.76
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$102.76
|
| Rate for Payer: BCN Medicare Advantage |
$31.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Mclaren Medicaid |
$22.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.81
|
| Rate for Payer: Meridian Medicaid |
$23.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: PACE Senior Care Partners |
$29.69
|
| Rate for Payer: PACE SWMI |
$31.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: PHP Medicare Advantage |
$31.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.75
|
| Rate for Payer: Priority Health Medicare |
$31.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.00
|
| Rate for Payer: Railroad Medicare Medicare |
$31.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: UHC Exchange |
$31.25
|
| Rate for Payer: UHC Medicaid |
$22.04
|
| Rate for Payer: UHC Medicare Advantage |
$31.25
|
| Rate for Payer: UHCCP Medicaid |
$22.04
|
| Rate for Payer: VA VA |
$31.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$103.24
|
| Rate for Payer: BCN Commercial |
$103.24
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$371.65
|
| Rate for Payer: BCN Commercial |
$371.65
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC SICKLE CELL CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500009
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$83.30
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$369.94
|
| Rate for Payer: BCN Commercial |
$369.94
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$79.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: Meridian Medicaid |
$83.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$113.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.20
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Exchange |
$112.50
|
| Rate for Payer: UHC Medicaid |
$79.33
|
| Rate for Payer: UHC Medicare Advantage |
$112.50
|
| Rate for Payer: UHCCP Medicaid |
$79.33
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.94
|
| Rate for Payer: BCN Commercial |
$61.94
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC SICKLE CELL CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500012
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.44
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.66
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$61.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Medicare |
$18.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: UHC Exchange |
$18.75
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.75
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$55.53
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$246.63
|
| Rate for Payer: BCN Commercial |
$246.63
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Mclaren Medicaid |
$52.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: Meridian Medicaid |
$55.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Exchange |
$75.00
|
| Rate for Payer: UHC Medicaid |
$52.89
|
| Rate for Payer: UHC Medicare Advantage |
$75.00
|
| Rate for Payer: UHCCP Medicaid |
$52.89
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC SICKLE CELLS CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500010
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$247.77
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
