|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: BCBS Trust/PPO |
$634.84
|
| Rate for Payer: BCN Commercial |
$601.01
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC PUNCTURE WITH INJECTION CERVICAL
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
36100269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.71 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$202.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.03
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$194.43
|
| Rate for Payer: BCBS Trust/PPO |
$639.36
|
| Rate for Payer: BCN Commercial |
$604.67
|
| Rate for Payer: BCN Medicare Advantage |
$194.43
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.43
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.15
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Senior Care Partners |
$184.71
|
| Rate for Payer: PACE SWMI |
$194.43
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$194.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Medicare |
$196.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: Railroad Medicare Medicare |
$194.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.43
|
| Rate for Payer: UHC Exchange |
$194.43
|
| Rate for Payer: UHC Medicare Advantage |
$194.43
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$194.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$737.39
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.30 |
| Max. Negotiated Rate |
$663.65 |
| Rate for Payer: Aetna Commercial |
$626.78
|
| Rate for Payer: BCBS Trust/PPO |
$601.93
|
| Rate for Payer: BCN Commercial |
$569.85
|
| Rate for Payer: Cash Price |
$589.91
|
| Rate for Payer: Cofinity Commercial |
$634.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.91
|
| Rate for Payer: Healthscope Commercial |
$663.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.78
|
| Rate for Payer: Nomi Health Commercial |
$604.66
|
| Rate for Payer: PHP Commercial |
$626.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.30
|
| Rate for Payer: Priority Health HMO/PPO |
$641.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.90
|
| Rate for Payer: UHC Core |
$615.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.04
|
|
|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$737.39
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.13 |
| Max. Negotiated Rate |
$663.65 |
| Rate for Payer: Aetna Commercial |
$626.78
|
| Rate for Payer: Aetna Medicare |
$191.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.43
|
| Rate for Payer: BCBS Complete |
$294.96
|
| Rate for Payer: BCBS MAPPO |
$184.35
|
| Rate for Payer: BCBS Trust/PPO |
$606.21
|
| Rate for Payer: BCN Commercial |
$573.32
|
| Rate for Payer: BCN Medicare Advantage |
$184.35
|
| Rate for Payer: Cash Price |
$589.91
|
| Rate for Payer: Cofinity Commercial |
$634.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.35
|
| Rate for Payer: Healthscope Commercial |
$663.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.78
|
| Rate for Payer: Nomi Health Commercial |
$604.66
|
| Rate for Payer: PACE Senior Care Partners |
$175.13
|
| Rate for Payer: PACE SWMI |
$184.35
|
| Rate for Payer: PHP Commercial |
$626.78
|
| Rate for Payer: PHP Medicare Advantage |
$184.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.30
|
| Rate for Payer: Priority Health HMO/PPO |
$641.53
|
| Rate for Payer: Priority Health Medicare |
$186.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.05
|
| Rate for Payer: Railroad Medicare Medicare |
$184.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.90
|
| Rate for Payer: UHC Core |
$615.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.35
|
| Rate for Payer: UHC Exchange |
$184.35
|
| Rate for Payer: UHC Medicare Advantage |
$184.35
|
| Rate for Payer: VA VA |
$184.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.04
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$512.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$332.85 |
| Max. Negotiated Rate |
$460.86 |
| Rate for Payer: Aetna Commercial |
$435.26
|
| Rate for Payer: BCBS Trust/PPO |
$418.00
|
| Rate for Payer: BCN Commercial |
$395.73
|
| Rate for Payer: Cash Price |
$409.66
|
| Rate for Payer: Cofinity Commercial |
$440.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.66
|
| Rate for Payer: Healthscope Commercial |
$460.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.26
|
| Rate for Payer: Nomi Health Commercial |
$419.90
|
| Rate for Payer: PHP Commercial |
$435.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.85
|
| Rate for Payer: Priority Health HMO/PPO |
$445.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.62
|
| Rate for Payer: UHC Core |
$427.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.05
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$512.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$460.86 |
| Rate for Payer: Aetna Commercial |
$435.26
|
| Rate for Payer: Aetna Medicare |
$133.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.02
|
| Rate for Payer: BCBS Complete |
$204.83
|
| Rate for Payer: BCBS MAPPO |
$128.02
|
| Rate for Payer: BCBS Trust/PPO |
$420.97
|
| Rate for Payer: BCN Commercial |
$398.13
|
| Rate for Payer: BCN Medicare Advantage |
$128.02
|
| Rate for Payer: Cash Price |
$409.66
|
| Rate for Payer: Cofinity Commercial |
$440.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.02
|
| Rate for Payer: Healthscope Commercial |
$460.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.26
|
| Rate for Payer: Nomi Health Commercial |
$419.90
|
| Rate for Payer: PACE Senior Care Partners |
$121.62
|
| Rate for Payer: PACE SWMI |
$128.02
|
| Rate for Payer: PHP Commercial |
$435.26
|
| Rate for Payer: PHP Medicare Advantage |
$128.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.85
|
| Rate for Payer: Priority Health HMO/PPO |
$445.50
|
| Rate for Payer: Priority Health Medicare |
$129.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.09
|
| Rate for Payer: Railroad Medicare Medicare |
$128.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.62
|
| Rate for Payer: UHC Core |
$427.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.02
|
| Rate for Payer: UHC Exchange |
$128.02
|
| Rate for Payer: UHC Medicare Advantage |
$128.02
|
| Rate for Payer: VA VA |
$128.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.05
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$324.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$291.88 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: BCBS Trust/PPO |
$264.73
|
| Rate for Payer: BCN Commercial |
$250.63
|
| Rate for Payer: Cash Price |
$259.45
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.45
|
| Rate for Payer: Healthscope Commercial |
$291.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health HMO/PPO |
$282.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.39
|
| Rate for Payer: UHC Core |
$270.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.23
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$324.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$291.88 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Aetna Medicare |
$84.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.35
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS MAPPO |
$81.08
|
| Rate for Payer: BCBS Trust/PPO |
$266.62
|
| Rate for Payer: BCN Commercial |
$252.15
|
| Rate for Payer: BCN Medicare Advantage |
$81.08
|
| Rate for Payer: Cash Price |
$259.45
|
| Rate for Payer: Cofinity Commercial |
$278.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.08
|
| Rate for Payer: Healthscope Commercial |
$291.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: PACE Senior Care Partners |
$77.02
|
| Rate for Payer: PACE SWMI |
$81.08
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: PHP Medicare Advantage |
$81.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health HMO/PPO |
$282.15
|
| Rate for Payer: Priority Health Medicare |
$81.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.29
|
| Rate for Payer: Railroad Medicare Medicare |
$81.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.39
|
| Rate for Payer: UHC Core |
$270.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.08
|
| Rate for Payer: UHC Exchange |
$81.08
|
| Rate for Payer: UHC Medicare Advantage |
$81.08
|
| Rate for Payer: VA VA |
$81.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.23
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$270.94
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$243.85 |
| Rate for Payer: Aetna Commercial |
$230.30
|
| Rate for Payer: Aetna Medicare |
$70.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.67
|
| Rate for Payer: BCBS Complete |
$108.38
|
| Rate for Payer: BCBS MAPPO |
$67.74
|
| Rate for Payer: BCBS Trust/PPO |
$222.74
|
| Rate for Payer: BCN Commercial |
$210.66
|
| Rate for Payer: BCN Medicare Advantage |
$67.74
|
| Rate for Payer: Cash Price |
$216.75
|
| Rate for Payer: Cofinity Commercial |
$233.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.74
|
| Rate for Payer: Healthscope Commercial |
$243.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.30
|
| Rate for Payer: Nomi Health Commercial |
$222.17
|
| Rate for Payer: PACE Senior Care Partners |
$64.35
|
| Rate for Payer: PACE SWMI |
$67.74
|
| Rate for Payer: PHP Commercial |
$230.30
|
| Rate for Payer: PHP Medicare Advantage |
$67.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.11
|
| Rate for Payer: Priority Health HMO/PPO |
$235.72
|
| Rate for Payer: Priority Health Medicare |
$68.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.53
|
| Rate for Payer: Railroad Medicare Medicare |
$67.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.43
|
| Rate for Payer: UHC Core |
$226.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.74
|
| Rate for Payer: UHC Exchange |
$67.74
|
| Rate for Payer: UHC Medicare Advantage |
$67.74
|
| Rate for Payer: VA VA |
$67.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.20
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$270.94
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.11 |
| Max. Negotiated Rate |
$243.85 |
| Rate for Payer: Aetna Commercial |
$230.30
|
| Rate for Payer: BCBS Trust/PPO |
$221.17
|
| Rate for Payer: BCN Commercial |
$209.38
|
| Rate for Payer: Cash Price |
$216.75
|
| Rate for Payer: Cofinity Commercial |
$233.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.75
|
| Rate for Payer: Healthscope Commercial |
$243.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.30
|
| Rate for Payer: Nomi Health Commercial |
$222.17
|
| Rate for Payer: PHP Commercial |
$230.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.11
|
| Rate for Payer: Priority Health HMO/PPO |
$235.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.43
|
| Rate for Payer: UHC Core |
$226.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.20
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$114.44
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$235.21
|
| Rate for Payer: BCN Commercial |
$222.45
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$72.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.69
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Exchange |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$71.53
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$286.11
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.97 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: BCBS Trust/PPO |
$233.55
|
| Rate for Payer: BCN Commercial |
$221.11
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.97
|
| Rate for Payer: Priority Health HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$58.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.23
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: BCBS MAPPO |
$56.18
|
| Rate for Payer: BCBS Trust/PPO |
$184.75
|
| Rate for Payer: BCN Commercial |
$174.73
|
| Rate for Payer: BCN Medicare Advantage |
$56.18
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.18
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: PACE Senior Care Partners |
$53.37
|
| Rate for Payer: PACE SWMI |
$56.18
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: PHP Medicare Advantage |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Medicare |
$56.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.57
|
| Rate for Payer: Railroad Medicare Medicare |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.18
|
| Rate for Payer: UHC Exchange |
$56.18
|
| Rate for Payer: UHC Medicare Advantage |
$56.18
|
| Rate for Payer: VA VA |
$56.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: BCBS Trust/PPO |
$183.45
|
| Rate for Payer: BCN Commercial |
$173.67
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$58.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.23
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: BCBS MAPPO |
$56.18
|
| Rate for Payer: BCBS Trust/PPO |
$184.75
|
| Rate for Payer: BCN Commercial |
$174.73
|
| Rate for Payer: BCN Medicare Advantage |
$56.18
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.18
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: PACE Senior Care Partners |
$53.37
|
| Rate for Payer: PACE SWMI |
$56.18
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: PHP Medicare Advantage |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Medicare |
$56.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.57
|
| Rate for Payer: Railroad Medicare Medicare |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.18
|
| Rate for Payer: UHC Exchange |
$56.18
|
| Rate for Payer: UHC Medicare Advantage |
$56.18
|
| Rate for Payer: VA VA |
$56.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: BCBS Trust/PPO |
$183.45
|
| Rate for Payer: BCN Commercial |
$173.67
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$155.62
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$140.06 |
| Rate for Payer: Aetna Commercial |
$132.28
|
| Rate for Payer: BCBS Trust/PPO |
$127.03
|
| Rate for Payer: BCN Commercial |
$120.26
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$133.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.50
|
| Rate for Payer: Healthscope Commercial |
$140.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.28
|
| Rate for Payer: Nomi Health Commercial |
$127.61
|
| Rate for Payer: PHP Commercial |
$132.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.15
|
| Rate for Payer: Priority Health HMO/PPO |
$135.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.95
|
| Rate for Payer: UHC Core |
$129.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.72
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$155.62
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$140.06 |
| Rate for Payer: Aetna Commercial |
$132.28
|
| Rate for Payer: Aetna Medicare |
$40.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.63
|
| Rate for Payer: BCBS Complete |
$62.25
|
| Rate for Payer: BCBS MAPPO |
$38.90
|
| Rate for Payer: BCBS Trust/PPO |
$127.94
|
| Rate for Payer: BCN Commercial |
$120.99
|
| Rate for Payer: BCN Medicare Advantage |
$38.90
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$133.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.90
|
| Rate for Payer: Healthscope Commercial |
$140.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.28
|
| Rate for Payer: Nomi Health Commercial |
$127.61
|
| Rate for Payer: PACE Senior Care Partners |
$36.96
|
| Rate for Payer: PACE SWMI |
$38.90
|
| Rate for Payer: PHP Commercial |
$132.28
|
| Rate for Payer: PHP Medicare Advantage |
$38.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.15
|
| Rate for Payer: Priority Health HMO/PPO |
$135.39
|
| Rate for Payer: Priority Health Medicare |
$39.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.27
|
| Rate for Payer: Railroad Medicare Medicare |
$38.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.95
|
| Rate for Payer: UHC Core |
$129.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.90
|
| Rate for Payer: UHC Exchange |
$38.90
|
| Rate for Payer: UHC Medicare Advantage |
$38.90
|
| Rate for Payer: VA VA |
$38.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.72
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$204.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.65 |
| Max. Negotiated Rate |
$183.66 |
| Rate for Payer: Aetna Commercial |
$173.46
|
| Rate for Payer: BCBS Trust/PPO |
$166.58
|
| Rate for Payer: BCN Commercial |
$157.71
|
| Rate for Payer: Cash Price |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$175.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.26
|
| Rate for Payer: Healthscope Commercial |
$183.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.46
|
| Rate for Payer: Nomi Health Commercial |
$167.34
|
| Rate for Payer: PHP Commercial |
$173.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.65
|
| Rate for Payer: Priority Health HMO/PPO |
$177.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.58
|
| Rate for Payer: UHC Core |
$170.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.05
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$204.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$183.66 |
| Rate for Payer: Aetna Commercial |
$173.46
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.77
|
| Rate for Payer: BCBS Complete |
$81.63
|
| Rate for Payer: BCBS MAPPO |
$51.02
|
| Rate for Payer: BCBS Trust/PPO |
$167.77
|
| Rate for Payer: BCN Commercial |
$158.66
|
| Rate for Payer: BCN Medicare Advantage |
$51.02
|
| Rate for Payer: Cash Price |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$175.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.02
|
| Rate for Payer: Healthscope Commercial |
$183.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.46
|
| Rate for Payer: Nomi Health Commercial |
$167.34
|
| Rate for Payer: PACE Senior Care Partners |
$48.47
|
| Rate for Payer: PACE SWMI |
$51.02
|
| Rate for Payer: PHP Commercial |
$173.46
|
| Rate for Payer: PHP Medicare Advantage |
$51.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.65
|
| Rate for Payer: Priority Health HMO/PPO |
$177.54
|
| Rate for Payer: Priority Health Medicare |
$51.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.73
|
| Rate for Payer: Railroad Medicare Medicare |
$51.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.58
|
| Rate for Payer: UHC Core |
$170.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.02
|
| Rate for Payer: UHC Exchange |
$51.02
|
| Rate for Payer: UHC Medicare Advantage |
$51.02
|
| Rate for Payer: VA VA |
$51.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.05
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna Commercial |
$115.60
|
| Rate for Payer: BCBS Trust/PPO |
$111.02
|
| Rate for Payer: BCN Commercial |
$105.10
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$116.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.80
|
| Rate for Payer: Healthscope Commercial |
$122.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.60
|
| Rate for Payer: Nomi Health Commercial |
$111.52
|
| Rate for Payer: PHP Commercial |
$115.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health HMO/PPO |
$118.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.68
|
| Rate for Payer: UHC Core |
$113.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.00
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna Commercial |
$115.60
|
| Rate for Payer: Aetna Medicare |
$35.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.50
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS MAPPO |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$111.81
|
| Rate for Payer: BCN Commercial |
$105.74
|
| Rate for Payer: BCN Medicare Advantage |
$34.00
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$116.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.00
|
| Rate for Payer: Healthscope Commercial |
$122.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.60
|
| Rate for Payer: Nomi Health Commercial |
$111.52
|
| Rate for Payer: PACE Senior Care Partners |
$32.30
|
| Rate for Payer: PACE SWMI |
$34.00
|
| Rate for Payer: PHP Commercial |
$115.60
|
| Rate for Payer: PHP Medicare Advantage |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health HMO/PPO |
$118.32
|
| Rate for Payer: Priority Health Medicare |
$34.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.12
|
| Rate for Payer: Railroad Medicare Medicare |
$34.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.68
|
| Rate for Payer: UHC Core |
$113.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.00
|
| Rate for Payer: UHC Exchange |
$34.00
|
| Rate for Payer: UHC Medicare Advantage |
$34.00
|
| Rate for Payer: VA VA |
$34.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.00
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$166.17
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$149.55 |
| Rate for Payer: Aetna Commercial |
$141.24
|
| Rate for Payer: Aetna Medicare |
$43.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.93
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$41.54
|
| Rate for Payer: BCBS Trust/PPO |
$136.61
|
| Rate for Payer: BCN Commercial |
$129.20
|
| Rate for Payer: BCN Medicare Advantage |
$41.54
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Commercial |
$142.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.54
|
| Rate for Payer: Healthscope Commercial |
$149.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.63
|
| Rate for Payer: Mclaren Medicaid |
$91.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.62
|
| Rate for Payer: Meridian Medicaid |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.24
|
| Rate for Payer: Nomi Health Commercial |
$136.26
|
| Rate for Payer: PACE Senior Care Partners |
$39.47
|
| Rate for Payer: PACE SWMI |
$41.54
|
| Rate for Payer: PHP Commercial |
$141.24
|
| Rate for Payer: PHP Medicare Advantage |
$41.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.01
|
| Rate for Payer: Priority Health HMO/PPO |
$144.57
|
| Rate for Payer: Priority Health Medicare |
$41.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.33
|
| Rate for Payer: Railroad Medicare Medicare |
$41.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.23
|
| Rate for Payer: UHC Core |
$138.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.54
|
| Rate for Payer: UHC Exchange |
$41.54
|
| Rate for Payer: UHC Medicare Advantage |
$41.54
|
| Rate for Payer: UHCCP Medicaid |
$91.31
|
| Rate for Payer: VA VA |
$41.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.63
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$166.17
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$149.55 |
| Rate for Payer: Aetna Commercial |
$141.24
|
| Rate for Payer: BCBS Trust/PPO |
$135.64
|
| Rate for Payer: BCN Commercial |
$128.42
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Commercial |
$142.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Healthscope Commercial |
$149.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.24
|
| Rate for Payer: Nomi Health Commercial |
$136.26
|
| Rate for Payer: PHP Commercial |
$141.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.01
|
| Rate for Payer: Priority Health HMO/PPO |
$144.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.23
|
| Rate for Payer: UHC Core |
$138.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.63
|
|
|
HC PV JAK2V617F
|
Facility
|
IP
|
$329.51
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$214.18 |
| Max. Negotiated Rate |
$296.56 |
| Rate for Payer: Aetna Commercial |
$280.08
|
| Rate for Payer: BCBS Trust/PPO |
$268.98
|
| Rate for Payer: BCN Commercial |
$254.65
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$283.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.61
|
| Rate for Payer: Healthscope Commercial |
$296.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.08
|
| Rate for Payer: Nomi Health Commercial |
$270.20
|
| Rate for Payer: PHP Commercial |
$280.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.18
|
| Rate for Payer: Priority Health HMO/PPO |
$286.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.97
|
| Rate for Payer: UHC Core |
$275.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.13
|
|
