|
HC PULSE OX SINGLE
|
Facility
|
OP
|
$86.43
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: Aetna Medicare |
$22.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.01
|
| Rate for Payer: BCBS Complete |
$34.57
|
| Rate for Payer: BCBS MAPPO |
$21.61
|
| Rate for Payer: BCBS Trust/PPO |
$71.05
|
| Rate for Payer: BCN Commercial |
$67.20
|
| Rate for Payer: BCN Medicare Advantage |
$21.61
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.61
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: Nomi Health Commercial |
$70.87
|
| Rate for Payer: PACE Senior Care Partners |
$20.53
|
| Rate for Payer: PACE SWMI |
$21.61
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: PHP Medicare Advantage |
$21.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health HMO/PPO |
$75.19
|
| Rate for Payer: Priority Health Medicare |
$21.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.91
|
| Rate for Payer: Railroad Medicare Medicare |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.06
|
| Rate for Payer: UHC Core |
$72.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.61
|
| Rate for Payer: UHC Exchange |
$21.61
|
| Rate for Payer: UHC Medicare Advantage |
$21.61
|
| Rate for Payer: VA VA |
$21.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.82
|
|
|
HC PULSE OX SINGLE
|
Facility
|
IP
|
$86.43
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$77.79 |
| Rate for Payer: Aetna Commercial |
$73.47
|
| Rate for Payer: BCBS Trust/PPO |
$70.55
|
| Rate for Payer: BCN Commercial |
$66.79
|
| Rate for Payer: Cash Price |
$69.14
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.14
|
| Rate for Payer: Healthscope Commercial |
$77.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.47
|
| Rate for Payer: Nomi Health Commercial |
$70.87
|
| Rate for Payer: PHP Commercial |
$73.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.18
|
| Rate for Payer: Priority Health HMO/PPO |
$75.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.06
|
| Rate for Payer: UHC Core |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.82
|
|
|
HC PULSERIDER
|
Facility
|
OP
|
$17,069.07
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,053.90 |
| Max. Negotiated Rate |
$15,362.16 |
| Rate for Payer: Aetna Commercial |
$14,508.71
|
| Rate for Payer: Aetna Medicare |
$4,437.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,334.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,334.08
|
| Rate for Payer: BCBS Complete |
$6,827.63
|
| Rate for Payer: BCBS MAPPO |
$4,267.27
|
| Rate for Payer: BCBS Trust/PPO |
$14,032.48
|
| Rate for Payer: BCN Commercial |
$13,271.20
|
| Rate for Payer: BCN Medicare Advantage |
$4,267.27
|
| Rate for Payer: Cash Price |
$13,655.26
|
| Rate for Payer: Cofinity Commercial |
$14,679.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,655.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,267.27
|
| Rate for Payer: Healthscope Commercial |
$15,362.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,801.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,480.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,907.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,508.71
|
| Rate for Payer: Nomi Health Commercial |
$13,996.64
|
| Rate for Payer: PACE Senior Care Partners |
$4,053.90
|
| Rate for Payer: PACE SWMI |
$4,267.27
|
| Rate for Payer: PHP Commercial |
$14,508.71
|
| Rate for Payer: PHP Medicare Advantage |
$4,267.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,094.90
|
| Rate for Payer: Priority Health HMO/PPO |
$14,850.09
|
| Rate for Payer: Priority Health Medicare |
$4,309.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,436.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4,267.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,020.78
|
| Rate for Payer: UHC Core |
$14,252.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,267.27
|
| Rate for Payer: UHC Exchange |
$4,267.27
|
| Rate for Payer: UHC Medicare Advantage |
$4,267.27
|
| Rate for Payer: VA VA |
$4,267.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,801.80
|
|
|
HC PULSERIDER
|
Facility
|
IP
|
$17,069.07
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,094.90 |
| Max. Negotiated Rate |
$15,362.16 |
| Rate for Payer: Aetna Commercial |
$14,508.71
|
| Rate for Payer: BCBS Trust/PPO |
$13,933.48
|
| Rate for Payer: BCN Commercial |
$13,190.98
|
| Rate for Payer: Cash Price |
$13,655.26
|
| Rate for Payer: Cofinity Commercial |
$14,679.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,655.26
|
| Rate for Payer: Healthscope Commercial |
$15,362.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,801.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,508.71
|
| Rate for Payer: Nomi Health Commercial |
$13,996.64
|
| Rate for Payer: PHP Commercial |
$14,508.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,094.90
|
| Rate for Payer: Priority Health HMO/PPO |
$14,850.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,436.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,020.78
|
| Rate for Payer: UHC Core |
$14,252.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,801.80
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
OP
|
$457.25
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$411.52 |
| Rate for Payer: Aetna Commercial |
$388.66
|
| Rate for Payer: Aetna Medicare |
$118.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.89
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$114.31
|
| Rate for Payer: BCBS Trust/PPO |
$375.91
|
| Rate for Payer: BCN Commercial |
$355.51
|
| Rate for Payer: BCN Medicare Advantage |
$114.31
|
| Rate for Payer: Cash Price |
$365.80
|
| Rate for Payer: Cofinity Commercial |
$393.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.31
|
| Rate for Payer: Healthscope Commercial |
$411.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.66
|
| Rate for Payer: Nomi Health Commercial |
$374.94
|
| Rate for Payer: PACE Senior Care Partners |
$108.60
|
| Rate for Payer: PACE SWMI |
$114.31
|
| Rate for Payer: PHP Commercial |
$388.66
|
| Rate for Payer: PHP Medicare Advantage |
$114.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.21
|
| Rate for Payer: Priority Health HMO/PPO |
$397.81
|
| Rate for Payer: Priority Health Medicare |
$115.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.36
|
| Rate for Payer: Railroad Medicare Medicare |
$114.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.38
|
| Rate for Payer: UHC Core |
$381.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.31
|
| Rate for Payer: UHC Exchange |
$114.31
|
| Rate for Payer: UHC Medicare Advantage |
$114.31
|
| Rate for Payer: VA VA |
$114.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.94
|
|
|
HC PUMP CENTRFUGAL
|
Facility
|
IP
|
$457.25
|
|
| Hospital Charge Code |
27000382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$297.21 |
| Max. Negotiated Rate |
$411.52 |
| Rate for Payer: Aetna Commercial |
$388.66
|
| Rate for Payer: BCBS Trust/PPO |
$373.25
|
| Rate for Payer: BCN Commercial |
$353.36
|
| Rate for Payer: Cash Price |
$365.80
|
| Rate for Payer: Cofinity Commercial |
$393.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.80
|
| Rate for Payer: Healthscope Commercial |
$411.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.66
|
| Rate for Payer: Nomi Health Commercial |
$374.94
|
| Rate for Payer: PHP Commercial |
$388.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.21
|
| Rate for Payer: Priority Health HMO/PPO |
$397.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.38
|
| Rate for Payer: UHC Core |
$381.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.94
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$83.55
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Commercial |
$71.02
|
| Rate for Payer: BCBS Trust/PPO |
$68.20
|
| Rate for Payer: BCN Commercial |
$64.57
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$71.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.84
|
| Rate for Payer: Healthscope Commercial |
$75.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.02
|
| Rate for Payer: Nomi Health Commercial |
$68.51
|
| Rate for Payer: PHP Commercial |
$71.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health HMO/PPO |
$72.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.52
|
| Rate for Payer: UHC Core |
$69.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.66
|
|
|
HC PUNCH BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$83.55
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
76100151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Commercial |
$71.02
|
| Rate for Payer: Aetna Medicare |
$21.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.11
|
| Rate for Payer: BCBS Complete |
$33.42
|
| Rate for Payer: BCBS MAPPO |
$20.89
|
| Rate for Payer: BCBS Trust/PPO |
$68.69
|
| Rate for Payer: BCN Commercial |
$64.96
|
| Rate for Payer: BCN Medicare Advantage |
$20.89
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$71.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.89
|
| Rate for Payer: Healthscope Commercial |
$75.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.02
|
| Rate for Payer: Nomi Health Commercial |
$68.51
|
| Rate for Payer: PACE Senior Care Partners |
$19.84
|
| Rate for Payer: PACE SWMI |
$20.89
|
| Rate for Payer: PHP Commercial |
$71.02
|
| Rate for Payer: PHP Medicare Advantage |
$20.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health HMO/PPO |
$72.69
|
| Rate for Payer: Priority Health Medicare |
$21.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.98
|
| Rate for Payer: Railroad Medicare Medicare |
$20.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.52
|
| Rate for Payer: UHC Core |
$69.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.89
|
| Rate for Payer: UHC Exchange |
$20.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.89
|
| Rate for Payer: VA VA |
$20.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.66
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$319.12
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.43 |
| Max. Negotiated Rate |
$287.21 |
| Rate for Payer: Aetna Commercial |
$271.25
|
| Rate for Payer: BCBS Trust/PPO |
$260.50
|
| Rate for Payer: BCN Commercial |
$246.62
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$274.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.30
|
| Rate for Payer: Healthscope Commercial |
$287.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.25
|
| Rate for Payer: Nomi Health Commercial |
$261.68
|
| Rate for Payer: PHP Commercial |
$271.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.43
|
| Rate for Payer: Priority Health HMO/PPO |
$277.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.83
|
| Rate for Payer: UHC Core |
$266.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.34
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$319.12
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
76100150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: Aetna Commercial |
$271.25
|
| Rate for Payer: Aetna Medicare |
$82.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.72
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$79.78
|
| Rate for Payer: BCBS Trust/PPO |
$262.35
|
| Rate for Payer: BCN Commercial |
$248.12
|
| Rate for Payer: BCN Medicare Advantage |
$79.78
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$274.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.78
|
| Rate for Payer: Healthscope Commercial |
$287.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.34
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.77
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.25
|
| Rate for Payer: Nomi Health Commercial |
$261.68
|
| Rate for Payer: PACE Senior Care Partners |
$75.79
|
| Rate for Payer: PACE SWMI |
$79.78
|
| Rate for Payer: PHP Commercial |
$271.25
|
| Rate for Payer: PHP Medicare Advantage |
$79.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.43
|
| Rate for Payer: Priority Health HMO/PPO |
$277.63
|
| Rate for Payer: Priority Health Medicare |
$80.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.81
|
| Rate for Payer: Railroad Medicare Medicare |
$79.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.83
|
| Rate for Payer: UHC Core |
$266.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.78
|
| Rate for Payer: UHC Exchange |
$79.78
|
| Rate for Payer: UHC Medicare Advantage |
$79.78
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$79.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.34
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
OP
|
$951.99
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.10 |
| Max. Negotiated Rate |
$856.79 |
| Rate for Payer: Aetna Commercial |
$809.19
|
| Rate for Payer: Aetna Medicare |
$247.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.50
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$238.00
|
| Rate for Payer: BCBS Trust/PPO |
$782.63
|
| Rate for Payer: BCN Commercial |
$740.17
|
| Rate for Payer: BCN Medicare Advantage |
$238.00
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cofinity Commercial |
$818.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.00
|
| Rate for Payer: Healthscope Commercial |
$856.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$713.99
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.90
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.19
|
| Rate for Payer: Nomi Health Commercial |
$780.63
|
| Rate for Payer: PACE Senior Care Partners |
$226.10
|
| Rate for Payer: PACE SWMI |
$238.00
|
| Rate for Payer: PHP Commercial |
$809.19
|
| Rate for Payer: PHP Medicare Advantage |
$238.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health HMO/PPO |
$828.23
|
| Rate for Payer: Priority Health Medicare |
$240.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$637.83
|
| Rate for Payer: Railroad Medicare Medicare |
$238.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$837.75
|
| Rate for Payer: UHC Core |
$794.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.00
|
| Rate for Payer: UHC Exchange |
$238.00
|
| Rate for Payer: UHC Medicare Advantage |
$238.00
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$238.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.99
|
|
|
HC PUNCTURE ASPIRATION, HYDROCELE
|
Facility
|
IP
|
$951.99
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
76100259
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.79 |
| Max. Negotiated Rate |
$856.79 |
| Rate for Payer: Aetna Commercial |
$809.19
|
| Rate for Payer: BCBS Trust/PPO |
$777.11
|
| Rate for Payer: BCN Commercial |
$735.70
|
| Rate for Payer: Cash Price |
$761.59
|
| Rate for Payer: Cofinity Commercial |
$818.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$761.59
|
| Rate for Payer: Healthscope Commercial |
$856.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$713.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$809.19
|
| Rate for Payer: Nomi Health Commercial |
$780.63
|
| Rate for Payer: PHP Commercial |
$809.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health HMO/PPO |
$828.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$637.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$837.75
|
| Rate for Payer: UHC Core |
$794.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$713.99
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
IP
|
$275.29
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.94 |
| Max. Negotiated Rate |
$247.76 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: BCBS Trust/PPO |
$224.72
|
| Rate for Payer: BCN Commercial |
$212.74
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$236.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.23
|
| Rate for Payer: Healthscope Commercial |
$247.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.00
|
| Rate for Payer: Nomi Health Commercial |
$225.74
|
| Rate for Payer: PHP Commercial |
$234.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.94
|
| Rate for Payer: Priority Health HMO/PPO |
$239.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.26
|
| Rate for Payer: UHC Core |
$229.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.47
|
|
|
HC PUNCTURE ASPIRATION OF ABSCESS
|
Facility
|
OP
|
$275.29
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
36100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.38 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$71.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.03
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$68.82
|
| Rate for Payer: BCBS Trust/PPO |
$226.32
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: BCN Medicare Advantage |
$68.82
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cash Price |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$236.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.82
|
| Rate for Payer: Healthscope Commercial |
$247.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.47
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.26
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.00
|
| Rate for Payer: Nomi Health Commercial |
$225.74
|
| Rate for Payer: PACE Senior Care Partners |
$65.38
|
| Rate for Payer: PACE SWMI |
$68.82
|
| Rate for Payer: PHP Commercial |
$234.00
|
| Rate for Payer: PHP Medicare Advantage |
$68.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.94
|
| Rate for Payer: Priority Health HMO/PPO |
$239.50
|
| Rate for Payer: Priority Health Medicare |
$69.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.44
|
| Rate for Payer: Railroad Medicare Medicare |
$68.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.26
|
| Rate for Payer: UHC Core |
$229.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.82
|
| Rate for Payer: UHC Exchange |
$68.82
|
| Rate for Payer: UHC Medicare Advantage |
$68.82
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$68.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.47
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
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 |
$224.11
|
| 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 |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.15
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$213.42
|
| 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 |
$213.42
|
| Rate for Payer: VA VA |
$194.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC PUNCTURE CERVICAL
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
36100268
|
|
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 |
$224.11
|
| 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 |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.15
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$213.42
|
| 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 |
$213.42
|
| Rate for Payer: VA VA |
$194.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
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 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
|
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 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 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 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 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 |
$203.21
|
| 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 |
$203.21
|
|
