|
HC THERASKIN 1.75X1.75 PER SQ CM
|
Facility
|
IP
|
$588.13
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$409.34 |
| Max. Negotiated Rate |
$529.32 |
| Rate for Payer: Aetna Commercial |
$499.91
|
| Rate for Payer: BCBS Trust/PPO |
$485.74
|
| Rate for Payer: BCN Commercial |
$485.74
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cofinity Commercial |
$505.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.50
|
| Rate for Payer: Healthscope Commercial |
$529.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.91
|
| Rate for Payer: Nomi Health Commercial |
$482.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.10
|
| Rate for Payer: PHP Commercial |
$499.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.55
|
| Rate for Payer: UHC Core |
$491.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.10
|
|
|
HC THERASKIN 2.5X2.5 PER SQ CM
|
Facility
|
OP
|
$429.46
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$386.51 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Medicare |
$111.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.21
|
| Rate for Payer: BCBS Complete |
$79.49
|
| Rate for Payer: BCBS MAPPO |
$107.36
|
| Rate for Payer: BCBS Trust/PPO |
$353.06
|
| Rate for Payer: BCN Commercial |
$353.06
|
| Rate for Payer: BCN Medicare Advantage |
$107.36
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cofinity Commercial |
$369.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.36
|
| Rate for Payer: Healthscope Commercial |
$386.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.10
|
| Rate for Payer: Mclaren Medicaid |
$75.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.73
|
| Rate for Payer: Meridian Medicaid |
$79.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.04
|
| Rate for Payer: Nomi Health Commercial |
$352.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.10
|
| Rate for Payer: PACE Senior Care Partners |
$102.00
|
| Rate for Payer: PACE SWMI |
$107.36
|
| Rate for Payer: PHP Commercial |
$365.04
|
| Rate for Payer: PHP Medicare Advantage |
$107.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$373.63
|
| Rate for Payer: Priority Health Medicare |
$108.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.90
|
| Rate for Payer: Railroad Medicare Medicare |
$107.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.92
|
| Rate for Payer: UHC Core |
$358.60
|
| Rate for Payer: UHC Exchange |
$107.36
|
| Rate for Payer: UHC Medicaid |
$75.71
|
| Rate for Payer: UHC Medicare Advantage |
$107.36
|
| Rate for Payer: UHCCP Medicaid |
$75.71
|
| Rate for Payer: VA VA |
$107.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.10
|
|
|
HC THERASKIN 2.5X2.5 PER SQ CM
|
Facility
|
IP
|
$429.46
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$386.51 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: BCBS Trust/PPO |
$354.69
|
| Rate for Payer: BCN Commercial |
$354.69
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cofinity Commercial |
$369.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.57
|
| Rate for Payer: Healthscope Commercial |
$386.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.04
|
| Rate for Payer: Nomi Health Commercial |
$352.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.10
|
| Rate for Payer: PHP Commercial |
$365.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$373.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$298.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.92
|
| Rate for Payer: UHC Core |
$358.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.10
|
|
|
HC THERASKIN 2.5X5.1 PER SQ CM
|
Facility
|
IP
|
$187.81
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.72 |
| Max. Negotiated Rate |
$169.03 |
| Rate for Payer: Aetna Commercial |
$159.64
|
| Rate for Payer: BCBS Trust/PPO |
$155.11
|
| Rate for Payer: BCN Commercial |
$155.11
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.25
|
| Rate for Payer: Healthscope Commercial |
$169.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.64
|
| Rate for Payer: Nomi Health Commercial |
$154.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.86
|
| Rate for Payer: PHP Commercial |
$159.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.27
|
| Rate for Payer: UHC Core |
$156.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.86
|
|
|
HC THERASKIN 2.5X5.1 PER SQ CM
|
Facility
|
OP
|
$187.81
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$169.03 |
| Rate for Payer: Aetna Commercial |
$159.64
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.69
|
| Rate for Payer: BCBS Complete |
$34.76
|
| Rate for Payer: BCBS MAPPO |
$46.95
|
| Rate for Payer: BCBS Trust/PPO |
$154.40
|
| Rate for Payer: BCN Commercial |
$154.40
|
| Rate for Payer: BCN Medicare Advantage |
$46.95
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.95
|
| Rate for Payer: Healthscope Commercial |
$169.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.86
|
| Rate for Payer: Mclaren Medicaid |
$33.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.30
|
| Rate for Payer: Meridian Medicaid |
$34.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.64
|
| Rate for Payer: Nomi Health Commercial |
$154.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.86
|
| Rate for Payer: PACE Senior Care Partners |
$44.60
|
| Rate for Payer: PACE SWMI |
$46.95
|
| Rate for Payer: PHP Commercial |
$159.64
|
| Rate for Payer: PHP Medicare Advantage |
$46.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.39
|
| Rate for Payer: Priority Health Medicare |
$47.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.72
|
| Rate for Payer: Railroad Medicare Medicare |
$46.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.27
|
| Rate for Payer: UHC Core |
$156.82
|
| Rate for Payer: UHC Exchange |
$46.95
|
| Rate for Payer: UHC Medicaid |
$33.11
|
| Rate for Payer: UHC Medicare Advantage |
$46.95
|
| Rate for Payer: UHCCP Medicaid |
$33.11
|
| Rate for Payer: VA VA |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.86
|
|
|
HC THERASKIN 5.1X7.6 PER SQ CM
|
Facility
|
OP
|
$86.24
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$77.62 |
| Rate for Payer: Aetna Commercial |
$73.30
|
| Rate for Payer: Aetna Medicare |
$22.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.95
|
| Rate for Payer: BCBS Complete |
$15.96
|
| Rate for Payer: BCBS MAPPO |
$21.56
|
| Rate for Payer: BCBS Trust/PPO |
$70.90
|
| Rate for Payer: BCN Commercial |
$70.90
|
| Rate for Payer: BCN Medicare Advantage |
$21.56
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cofinity Commercial |
$74.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.56
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.68
|
| Rate for Payer: Mclaren Medicaid |
$15.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.64
|
| Rate for Payer: Meridian Medicaid |
$15.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.30
|
| Rate for Payer: Nomi Health Commercial |
$70.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.68
|
| Rate for Payer: PACE Senior Care Partners |
$20.48
|
| Rate for Payer: PACE SWMI |
$21.56
|
| Rate for Payer: PHP Commercial |
$73.30
|
| Rate for Payer: PHP Medicare Advantage |
$21.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.03
|
| Rate for Payer: Priority Health Medicare |
$21.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.02
|
| Rate for Payer: Railroad Medicare Medicare |
$21.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.89
|
| Rate for Payer: UHC Core |
$72.01
|
| Rate for Payer: UHC Exchange |
$21.56
|
| Rate for Payer: UHC Medicaid |
$15.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.56
|
| Rate for Payer: UHCCP Medicaid |
$15.20
|
| Rate for Payer: VA VA |
$21.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.68
|
|
|
HC THERASKIN 5.1X7.6 PER SQ CM
|
Facility
|
IP
|
$86.24
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$77.62 |
| Rate for Payer: Aetna Commercial |
$73.30
|
| Rate for Payer: BCBS Trust/PPO |
$71.23
|
| Rate for Payer: BCN Commercial |
$71.23
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cofinity Commercial |
$74.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.99
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.30
|
| Rate for Payer: Nomi Health Commercial |
$70.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.68
|
| Rate for Payer: PHP Commercial |
$73.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.89
|
| Rate for Payer: UHC Core |
$72.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.68
|
|
|
HC THERASKIN 7.6X15.24 PER SQ CM
|
Facility
|
OP
|
$60.62
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$54.56 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna Medicare |
$15.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.94
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS MAPPO |
$15.15
|
| Rate for Payer: BCBS Trust/PPO |
$49.84
|
| Rate for Payer: BCN Commercial |
$49.84
|
| Rate for Payer: BCN Medicare Advantage |
$15.15
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$52.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.15
|
| Rate for Payer: Healthscope Commercial |
$54.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.47
|
| Rate for Payer: Mclaren Medicaid |
$10.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.91
|
| Rate for Payer: Meridian Medicaid |
$11.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.53
|
| Rate for Payer: Nomi Health Commercial |
$49.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.47
|
| Rate for Payer: PACE Senior Care Partners |
$14.40
|
| Rate for Payer: PACE SWMI |
$15.15
|
| Rate for Payer: PHP Commercial |
$51.53
|
| Rate for Payer: PHP Medicare Advantage |
$15.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.74
|
| Rate for Payer: Priority Health Medicare |
$15.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.19
|
| Rate for Payer: Railroad Medicare Medicare |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.35
|
| Rate for Payer: UHC Core |
$50.62
|
| Rate for Payer: UHC Exchange |
$15.15
|
| Rate for Payer: UHC Medicaid |
$10.69
|
| Rate for Payer: UHC Medicare Advantage |
$15.15
|
| Rate for Payer: UHCCP Medicaid |
$10.69
|
| Rate for Payer: VA VA |
$15.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.47
|
|
|
HC THERASKIN 7.6X15.24 PER SQ CM
|
Facility
|
IP
|
$60.62
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$54.56 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: BCBS Trust/PPO |
$50.07
|
| Rate for Payer: BCN Commercial |
$50.07
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$52.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$54.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.53
|
| Rate for Payer: Nomi Health Commercial |
$49.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.47
|
| Rate for Payer: PHP Commercial |
$51.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.35
|
| Rate for Payer: UHC Core |
$50.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.47
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$89.43
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$80.49 |
| Rate for Payer: Aetna Commercial |
$76.02
|
| Rate for Payer: BCBS Trust/PPO |
$73.86
|
| Rate for Payer: BCN Commercial |
$73.86
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cofinity Commercial |
$76.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.54
|
| Rate for Payer: Healthscope Commercial |
$80.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.02
|
| Rate for Payer: Nomi Health Commercial |
$73.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.07
|
| Rate for Payer: PHP Commercial |
$76.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.70
|
| Rate for Payer: UHC Core |
$74.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.07
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$89.43
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$80.49 |
| Rate for Payer: Aetna Commercial |
$76.02
|
| Rate for Payer: Aetna Medicare |
$23.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.95
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$22.36
|
| Rate for Payer: BCBS Trust/PPO |
$73.52
|
| Rate for Payer: BCN Commercial |
$73.52
|
| Rate for Payer: BCN Medicare Advantage |
$22.36
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cofinity Commercial |
$76.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.36
|
| Rate for Payer: Healthscope Commercial |
$80.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.07
|
| Rate for Payer: Mclaren Medicaid |
$15.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.48
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.02
|
| Rate for Payer: Nomi Health Commercial |
$73.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.07
|
| Rate for Payer: PACE Senior Care Partners |
$21.24
|
| Rate for Payer: PACE SWMI |
$22.36
|
| Rate for Payer: PHP Commercial |
$76.02
|
| Rate for Payer: PHP Medicare Advantage |
$22.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.80
|
| Rate for Payer: Priority Health Medicare |
$22.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.24
|
| Rate for Payer: Railroad Medicare Medicare |
$22.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.70
|
| Rate for Payer: UHC Core |
$74.67
|
| Rate for Payer: UHC Exchange |
$22.36
|
| Rate for Payer: UHC Medicaid |
$15.77
|
| Rate for Payer: UHC Medicare Advantage |
$22.36
|
| Rate for Payer: UHCCP Medicaid |
$15.77
|
| Rate for Payer: VA VA |
$22.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.07
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$62.61
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna Medicare |
$16.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.57
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS MAPPO |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$51.47
|
| Rate for Payer: BCN Commercial |
$51.47
|
| Rate for Payer: BCN Medicare Advantage |
$15.65
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.65
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Mclaren Medicaid |
$11.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.44
|
| Rate for Payer: Meridian Medicaid |
$11.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PACE Senior Care Partners |
$14.87
|
| Rate for Payer: PACE SWMI |
$15.65
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: PHP Medicare Advantage |
$15.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.47
|
| Rate for Payer: Priority Health Medicare |
$15.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.58
|
| Rate for Payer: Railroad Medicare Medicare |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.10
|
| Rate for Payer: UHC Core |
$52.28
|
| Rate for Payer: UHC Exchange |
$15.65
|
| Rate for Payer: UHC Medicaid |
$11.04
|
| Rate for Payer: UHC Medicare Advantage |
$15.65
|
| Rate for Payer: UHCCP Medicaid |
$11.04
|
| Rate for Payer: VA VA |
$15.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$62.61
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$51.71
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.10
|
| Rate for Payer: UHC Core |
$52.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.73
|
| Rate for Payer: BCN Commercial |
$65.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.87
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS MAPPO |
$19.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.43
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.90
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.90
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Mclaren Medicaid |
$14.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.89
|
| Rate for Payer: Meridian Medicaid |
$14.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.90
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$19.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Medicare |
$20.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: Railroad Medicare Medicare |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: UHC Exchange |
$19.90
|
| Rate for Payer: UHC Medicaid |
$14.03
|
| Rate for Payer: UHC Medicare Advantage |
$19.90
|
| Rate for Payer: UHCCP Medicaid |
$14.03
|
| Rate for Payer: VA VA |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.73
|
| Rate for Payer: BCN Commercial |
$65.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.87
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS MAPPO |
$19.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.43
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.90
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.90
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Mclaren Medicaid |
$14.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.89
|
| Rate for Payer: Meridian Medicaid |
$14.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.90
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$19.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Medicare |
$20.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: Railroad Medicare Medicare |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: UHC Exchange |
$19.90
|
| Rate for Payer: UHC Medicaid |
$14.03
|
| Rate for Payer: UHC Medicare Advantage |
$19.90
|
| Rate for Payer: UHCCP Medicaid |
$14.03
|
| Rate for Payer: VA VA |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.87
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS MAPPO |
$19.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.43
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.90
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.90
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Mclaren Medicaid |
$14.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.89
|
| Rate for Payer: Meridian Medicaid |
$14.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.90
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$19.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Medicare |
$20.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: Railroad Medicare Medicare |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: UHC Exchange |
$19.90
|
| Rate for Payer: UHC Medicaid |
$14.03
|
| Rate for Payer: UHC Medicare Advantage |
$19.90
|
| Rate for Payer: UHCCP Medicaid |
$14.03
|
| Rate for Payer: VA VA |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.73
|
| Rate for Payer: BCN Commercial |
$65.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.73
|
| Rate for Payer: BCN Commercial |
$65.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.87
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS MAPPO |
$19.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.43
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.90
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.90
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Mclaren Medicaid |
$14.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.89
|
| Rate for Payer: Meridian Medicaid |
$14.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.90
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$19.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Medicare |
$20.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: Railroad Medicare Medicare |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: UHC Exchange |
$19.90
|
| Rate for Payer: UHC Medicaid |
$14.03
|
| Rate for Payer: UHC Medicare Advantage |
$19.90
|
| Rate for Payer: UHCCP Medicaid |
$14.03
|
| Rate for Payer: VA VA |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
IP
|
$301.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$271.55 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: BCBS Trust/PPO |
$249.19
|
| Rate for Payer: BCN Commercial |
$249.19
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cofinity Commercial |
$259.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.38
|
| Rate for Payer: Healthscope Commercial |
$271.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.46
|
| Rate for Payer: Nomi Health Commercial |
$247.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.29
|
| Rate for Payer: PHP Commercial |
$256.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.51
|
| Rate for Payer: UHC Core |
$251.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.29
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$301.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.19 |
| Max. Negotiated Rate |
$271.55 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Medicare |
$78.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.29
|
| Rate for Payer: BCBS Complete |
$55.85
|
| Rate for Payer: BCBS MAPPO |
$75.43
|
| Rate for Payer: BCBS Trust/PPO |
$248.04
|
| Rate for Payer: BCN Commercial |
$248.04
|
| Rate for Payer: BCN Medicare Advantage |
$75.43
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cofinity Commercial |
$259.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.43
|
| Rate for Payer: Healthscope Commercial |
$271.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.29
|
| Rate for Payer: Mclaren Medicaid |
$53.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.20
|
| Rate for Payer: Meridian Medicaid |
$55.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.46
|
| Rate for Payer: Nomi Health Commercial |
$247.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.29
|
| Rate for Payer: PACE Senior Care Partners |
$71.66
|
| Rate for Payer: PACE SWMI |
$75.43
|
| Rate for Payer: PHP Commercial |
$256.46
|
| Rate for Payer: PHP Medicare Advantage |
$75.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$262.50
|
| Rate for Payer: Priority Health Medicare |
$76.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.00
|
| Rate for Payer: Railroad Medicare Medicare |
$75.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.51
|
| Rate for Payer: UHC Core |
$251.94
|
| Rate for Payer: UHC Exchange |
$75.43
|
| Rate for Payer: UHC Medicaid |
$53.19
|
| Rate for Payer: UHC Medicare Advantage |
$75.43
|
| Rate for Payer: UHCCP Medicaid |
$53.19
|
| Rate for Payer: VA VA |
$75.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.29
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$337.09
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.43 |
| Max. Negotiated Rate |
$303.38 |
| Rate for Payer: Aetna Commercial |
$286.53
|
| Rate for Payer: Aetna Medicare |
$87.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.34
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$84.27
|
| Rate for Payer: BCBS Trust/PPO |
$277.12
|
| Rate for Payer: BCN Commercial |
$277.12
|
| Rate for Payer: BCN Medicare Advantage |
$84.27
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cofinity Commercial |
$289.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.27
|
| Rate for Payer: Healthscope Commercial |
$303.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.82
|
| Rate for Payer: Mclaren Medicaid |
$59.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.49
|
| Rate for Payer: Meridian Medicaid |
$62.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.53
|
| Rate for Payer: Nomi Health Commercial |
$276.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.82
|
| Rate for Payer: PACE Senior Care Partners |
$80.06
|
| Rate for Payer: PACE SWMI |
$84.27
|
| Rate for Payer: PHP Commercial |
$286.53
|
| Rate for Payer: PHP Medicare Advantage |
$84.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$293.27
|
| Rate for Payer: Priority Health Medicare |
$85.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.61
|
| Rate for Payer: Railroad Medicare Medicare |
$84.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.64
|
| Rate for Payer: UHC Core |
$281.47
|
| Rate for Payer: UHC Exchange |
$84.27
|
| Rate for Payer: UHC Medicaid |
$59.43
|
| Rate for Payer: UHC Medicare Advantage |
$84.27
|
| Rate for Payer: UHCCP Medicaid |
$59.43
|
| Rate for Payer: VA VA |
$84.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.82
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$337.09
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$234.61 |
| Max. Negotiated Rate |
$303.38 |
| Rate for Payer: Aetna Commercial |
$286.53
|
| Rate for Payer: BCBS Trust/PPO |
$278.40
|
| Rate for Payer: BCN Commercial |
$278.40
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cofinity Commercial |
$289.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.67
|
| Rate for Payer: Healthscope Commercial |
$303.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.53
|
| Rate for Payer: Nomi Health Commercial |
$276.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.82
|
| Rate for Payer: PHP Commercial |
$286.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$293.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.64
|
| Rate for Payer: UHC Core |
$281.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.82
|
|
