|
HC SITZ MARKER
|
Facility
|
IP
|
$87.39
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$60.82 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$74.28
|
| Rate for Payer: BCBS Trust/PPO |
$72.18
|
| Rate for Payer: BCN Commercial |
$72.18
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$78.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: PHP Commercial |
$74.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.90
|
| Rate for Payer: UHC Core |
$72.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.54
|
|
|
HC SITZ MARKER
|
Facility
|
OP
|
$87.39
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$74.28
|
| Rate for Payer: Aetna Medicare |
$22.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.31
|
| Rate for Payer: BCBS Complete |
$16.18
|
| Rate for Payer: BCBS MAPPO |
$21.85
|
| Rate for Payer: BCBS Trust/PPO |
$71.84
|
| Rate for Payer: BCN Commercial |
$71.84
|
| Rate for Payer: BCN Medicare Advantage |
$21.85
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.85
|
| Rate for Payer: Healthscope Commercial |
$78.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.54
|
| Rate for Payer: Mclaren Medicaid |
$15.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.94
|
| Rate for Payer: Meridian Medicaid |
$16.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: PACE Senior Care Partners |
$20.76
|
| Rate for Payer: PACE SWMI |
$21.85
|
| Rate for Payer: PHP Commercial |
$74.28
|
| Rate for Payer: PHP Medicare Advantage |
$21.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.03
|
| Rate for Payer: Priority Health Medicare |
$22.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.82
|
| Rate for Payer: Railroad Medicare Medicare |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.90
|
| Rate for Payer: UHC Core |
$72.97
|
| Rate for Payer: UHC Exchange |
$21.85
|
| Rate for Payer: UHC Medicaid |
$15.41
|
| Rate for Payer: UHC Medicare Advantage |
$21.85
|
| Rate for Payer: UHCCP Medicaid |
$15.41
|
| Rate for Payer: VA VA |
$21.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.54
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
OP
|
$5,604.91
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$988.15 |
| Max. Negotiated Rate |
$5,044.42 |
| Rate for Payer: Aetna Commercial |
$4,764.17
|
| Rate for Payer: Aetna Medicare |
$1,457.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,751.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,751.53
|
| Rate for Payer: BCBS Complete |
$1,037.47
|
| Rate for Payer: BCBS MAPPO |
$1,401.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,607.80
|
| Rate for Payer: BCN Commercial |
$4,607.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,401.23
|
| Rate for Payer: Cash Price |
$4,483.93
|
| Rate for Payer: Cofinity Commercial |
$4,820.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,483.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,401.23
|
| Rate for Payer: Healthscope Commercial |
$5,044.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,203.68
|
| Rate for Payer: Mclaren Medicaid |
$988.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,471.29
|
| Rate for Payer: Meridian Medicaid |
$1,037.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,611.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,541.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,764.17
|
| Rate for Payer: Nomi Health Commercial |
$4,596.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,203.68
|
| Rate for Payer: PACE Senior Care Partners |
$1,331.17
|
| Rate for Payer: PACE SWMI |
$1,401.23
|
| Rate for Payer: PHP Commercial |
$4,764.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,401.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,876.27
|
| Rate for Payer: Priority Health Medicare |
$1,415.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,901.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,401.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,932.32
|
| Rate for Payer: UHC Core |
$4,680.10
|
| Rate for Payer: UHC Exchange |
$1,401.23
|
| Rate for Payer: UHC Medicaid |
$988.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,401.23
|
| Rate for Payer: UHCCP Medicaid |
$988.15
|
| Rate for Payer: VA VA |
$1,401.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,203.68
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
IP
|
$5,604.91
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,901.02 |
| Max. Negotiated Rate |
$5,044.42 |
| Rate for Payer: Aetna Commercial |
$4,764.17
|
| Rate for Payer: BCBS Trust/PPO |
$4,629.10
|
| Rate for Payer: BCN Commercial |
$4,629.10
|
| Rate for Payer: Cash Price |
$4,483.93
|
| Rate for Payer: Cofinity Commercial |
$4,820.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,483.93
|
| Rate for Payer: Healthscope Commercial |
$5,044.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,203.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,764.17
|
| Rate for Payer: Nomi Health Commercial |
$4,596.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,203.68
|
| Rate for Payer: PHP Commercial |
$4,764.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,876.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,901.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,932.32
|
| Rate for Payer: UHC Core |
$4,680.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,203.68
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
OP
|
$278.14
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna Medicare |
$72.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.92
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$69.53
|
| Rate for Payer: BCBS Trust/PPO |
$228.66
|
| Rate for Payer: BCN Commercial |
$228.66
|
| Rate for Payer: BCN Medicare Advantage |
$69.53
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Mclaren Medicaid |
$49.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.01
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PACE Senior Care Partners |
$66.06
|
| Rate for Payer: PACE SWMI |
$69.53
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: PHP Medicare Advantage |
$69.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.98
|
| Rate for Payer: Priority Health Medicare |
$70.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: Railroad Medicare Medicare |
$69.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.76
|
| Rate for Payer: UHC Core |
$232.25
|
| Rate for Payer: UHC Exchange |
$69.53
|
| Rate for Payer: UHC Medicaid |
$49.04
|
| Rate for Payer: UHC Medicare Advantage |
$69.53
|
| Rate for Payer: UHCCP Medicaid |
$49.04
|
| Rate for Payer: VA VA |
$69.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
IP
|
$278.14
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.59 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: BCBS Trust/PPO |
$229.72
|
| Rate for Payer: BCN Commercial |
$229.72
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.76
|
| Rate for Payer: UHC Core |
$232.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.81
|
| Rate for Payer: UHC Core |
$15.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$4.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$15.70
|
| Rate for Payer: BCN Commercial |
$15.70
|
| Rate for Payer: BCN Medicare Advantage |
$4.78
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.78
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Senior Care Partners |
$4.54
|
| Rate for Payer: PACE SWMI |
$4.78
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.62
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.81
|
| Rate for Payer: UHC Core |
$15.95
|
| Rate for Payer: UHC Exchange |
$4.78
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.78
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,962.71 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.02
|
| Rate for Payer: BCN Commercial |
$2,329.02
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.16 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$733.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.24
|
| Rate for Payer: BCBS Complete |
$521.98
|
| Rate for Payer: BCBS MAPPO |
$705.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,318.31
|
| Rate for Payer: BCN Commercial |
$2,318.31
|
| Rate for Payer: BCN Medicare Advantage |
$705.00
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.00
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Mclaren Medicaid |
$497.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.24
|
| Rate for Payer: Meridian Medicaid |
$521.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$810.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$775.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Senior Care Partners |
$669.75
|
| Rate for Payer: PACE SWMI |
$705.00
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$705.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Medicare |
$712.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: Railroad Medicare Medicare |
$705.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: UHC Exchange |
$705.00
|
| Rate for Payer: UHC Medicaid |
$497.16
|
| Rate for Payer: UHC Medicare Advantage |
$705.00
|
| Rate for Payer: UHCCP Medicaid |
$497.16
|
| Rate for Payer: VA VA |
$705.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC SMALLPOX 0.3ML PERQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
63600213
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Medicaid |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicaid |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: UHCCP Medicaid |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC SMALLPOX 0.3ML PERQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
63600213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC SMALLPOX & MONKEYPOX 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Medicaid |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicaid |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: UHCCP Medicaid |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC SMALLPOX & MONKEYPOX 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC SMART NEEDLE
|
Facility
|
IP
|
$510.33
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$355.19 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: BCBS Trust/PPO |
$421.48
|
| Rate for Payer: BCN Commercial |
$421.48
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$418.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$443.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.09
|
| Rate for Payer: UHC Core |
$426.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC SMART NEEDLE
|
Facility
|
OP
|
$510.33
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.97 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna Medicare |
$132.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.48
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS MAPPO |
$127.58
|
| Rate for Payer: BCBS Trust/PPO |
$419.54
|
| Rate for Payer: BCN Commercial |
$419.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.58
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.58
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Mclaren Medicaid |
$89.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.96
|
| Rate for Payer: Meridian Medicaid |
$94.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$418.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PACE Senior Care Partners |
$121.20
|
| Rate for Payer: PACE SWMI |
$127.58
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: PHP Medicare Advantage |
$127.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$443.99
|
| Rate for Payer: Priority Health Medicare |
$128.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.19
|
| Rate for Payer: Railroad Medicare Medicare |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.09
|
| Rate for Payer: UHC Core |
$426.13
|
| Rate for Payer: UHC Exchange |
$127.58
|
| Rate for Payer: UHC Medicaid |
$89.97
|
| Rate for Payer: UHC Medicare Advantage |
$127.58
|
| Rate for Payer: UHCCP Medicaid |
$89.97
|
| Rate for Payer: VA VA |
$127.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC SMITH SM ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC SMITH SM ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$9.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$8.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.49
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.97
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.52
|
| Rate for Payer: PACE SWMI |
$8.97
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Medicare |
$9.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: UHC Exchange |
$8.97
|
| Rate for Payer: UHC Medicaid |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.97
|
| Rate for Payer: UHCCP Medicaid |
$6.32
|
| Rate for Payer: VA VA |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
IP
|
$125.22
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna Commercial |
$106.44
|
| Rate for Payer: BCBS Trust/PPO |
$103.42
|
| Rate for Payer: BCN Commercial |
$103.42
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.44
|
| Rate for Payer: Nomi Health Commercial |
$102.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.19
|
| Rate for Payer: UHC Core |
$104.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
OP
|
$125.22
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna Commercial |
$106.44
|
| Rate for Payer: Aetna Medicare |
$32.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.13
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$31.30
|
| Rate for Payer: BCBS Trust/PPO |
$102.94
|
| Rate for Payer: BCN Commercial |
$102.94
|
| Rate for Payer: BCN Medicare Advantage |
$31.30
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Mclaren Medicaid |
$22.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.87
|
| Rate for Payer: Meridian Medicaid |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.44
|
| Rate for Payer: Nomi Health Commercial |
$102.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Senior Care Partners |
$29.74
|
| Rate for Payer: PACE SWMI |
$31.30
|
| Rate for Payer: PHP Commercial |
$106.44
|
| Rate for Payer: PHP Medicare Advantage |
$31.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$31.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$31.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.19
|
| Rate for Payer: UHC Core |
$104.56
|
| Rate for Payer: UHC Exchange |
$31.30
|
| Rate for Payer: UHC Medicaid |
$22.08
|
| Rate for Payer: UHC Medicare Advantage |
$31.30
|
| Rate for Payer: UHCCP Medicaid |
$22.08
|
| Rate for Payer: VA VA |
$31.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
IP
|
$125.22
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna Commercial |
$106.44
|
| Rate for Payer: BCBS Trust/PPO |
$103.42
|
| Rate for Payer: BCN Commercial |
$103.42
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.44
|
| Rate for Payer: Nomi Health Commercial |
$102.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.19
|
| Rate for Payer: UHC Core |
$104.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
OP
|
$125.22
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Aetna Commercial |
$106.44
|
| Rate for Payer: Aetna Medicare |
$32.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.13
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$31.30
|
| Rate for Payer: BCBS Trust/PPO |
$102.94
|
| Rate for Payer: BCN Commercial |
$102.94
|
| Rate for Payer: BCN Medicare Advantage |
$31.30
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Mclaren Medicaid |
$22.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.87
|
| Rate for Payer: Meridian Medicaid |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.44
|
| Rate for Payer: Nomi Health Commercial |
$102.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Senior Care Partners |
$29.74
|
| Rate for Payer: PACE SWMI |
$31.30
|
| Rate for Payer: PHP Commercial |
$106.44
|
| Rate for Payer: PHP Medicare Advantage |
$31.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.94
|
| Rate for Payer: Priority Health Medicare |
$31.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.15
|
| Rate for Payer: Railroad Medicare Medicare |
$31.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.19
|
| Rate for Payer: UHC Core |
$104.56
|
| Rate for Payer: UHC Exchange |
$31.30
|
| Rate for Payer: UHC Medicaid |
$22.08
|
| Rate for Payer: UHC Medicare Advantage |
$31.30
|
| Rate for Payer: UHCCP Medicaid |
$22.08
|
| Rate for Payer: VA VA |
$31.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
OP
|
$21.58
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.74
|
| Rate for Payer: BCBS Complete |
$3.99
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.74
|
| Rate for Payer: BCN Commercial |
$17.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.18
|
| Rate for Payer: Mclaren Medicaid |
$3.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: Meridian Medicaid |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.34
|
| Rate for Payer: Nomi Health Commercial |
$17.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.18
|
| Rate for Payer: PACE Senior Care Partners |
$5.13
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.77
|
| Rate for Payer: Priority Health Medicare |
$5.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.99
|
| Rate for Payer: UHC Core |
$18.02
|
| Rate for Payer: UHC Exchange |
$5.39
|
| Rate for Payer: UHC Medicaid |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$5.39
|
| Rate for Payer: UHCCP Medicaid |
$3.80
|
| Rate for Payer: VA VA |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.18
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
IP
|
$21.58
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.82
|
| Rate for Payer: BCN Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.34
|
| Rate for Payer: Nomi Health Commercial |
$17.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.18
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.99
|
| Rate for Payer: UHC Core |
$18.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.18
|
|
|
HC SMRNP
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
