|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$4.56
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$4.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$4.35
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC SILVADENE 400 GM
|
Facility
|
IP
|
$253.52
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$164.79 |
| Max. Negotiated Rate |
$228.17 |
| Rate for Payer: Aetna Commercial |
$215.49
|
| Rate for Payer: BCBS Trust/PPO |
$206.95
|
| Rate for Payer: BCN Commercial |
$195.92
|
| Rate for Payer: Cash Price |
$202.82
|
| Rate for Payer: Cofinity Commercial |
$218.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.82
|
| Rate for Payer: Healthscope Commercial |
$228.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.49
|
| Rate for Payer: Nomi Health Commercial |
$207.89
|
| Rate for Payer: PHP Commercial |
$215.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.79
|
| Rate for Payer: Priority Health HMO/PPO |
$220.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.10
|
| Rate for Payer: UHC Core |
$211.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.14
|
|
|
HC SILVADENE 400 GM
|
Facility
|
OP
|
$253.52
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.21 |
| Max. Negotiated Rate |
$228.17 |
| Rate for Payer: Aetna Commercial |
$215.49
|
| Rate for Payer: Aetna Medicare |
$65.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.22
|
| Rate for Payer: BCBS Complete |
$101.41
|
| Rate for Payer: BCBS MAPPO |
$63.38
|
| Rate for Payer: BCBS Trust/PPO |
$208.42
|
| Rate for Payer: BCN Commercial |
$197.11
|
| Rate for Payer: BCN Medicare Advantage |
$63.38
|
| Rate for Payer: Cash Price |
$202.82
|
| Rate for Payer: Cofinity Commercial |
$218.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.38
|
| Rate for Payer: Healthscope Commercial |
$228.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.49
|
| Rate for Payer: Nomi Health Commercial |
$207.89
|
| Rate for Payer: PACE Senior Care Partners |
$60.21
|
| Rate for Payer: PACE SWMI |
$63.38
|
| Rate for Payer: PHP Commercial |
$215.49
|
| Rate for Payer: PHP Medicare Advantage |
$63.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.79
|
| Rate for Payer: Priority Health HMO/PPO |
$220.56
|
| Rate for Payer: Priority Health Medicare |
$64.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.86
|
| Rate for Payer: Railroad Medicare Medicare |
$63.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.10
|
| Rate for Payer: UHC Core |
$211.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.38
|
| Rate for Payer: UHC Exchange |
$63.38
|
| Rate for Payer: UHC Medicare Advantage |
$63.38
|
| Rate for Payer: VA VA |
$63.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.14
|
|
|
HC SILVADENE 85 GM
|
Facility
|
OP
|
$104.62
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.85 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.69
|
| Rate for Payer: BCBS Complete |
$41.85
|
| Rate for Payer: BCBS MAPPO |
$26.16
|
| Rate for Payer: BCBS Trust/PPO |
$86.01
|
| Rate for Payer: BCN Commercial |
$81.34
|
| Rate for Payer: BCN Medicare Advantage |
$26.16
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: PACE Senior Care Partners |
$24.85
|
| Rate for Payer: PACE SWMI |
$26.16
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: PHP Medicare Advantage |
$26.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.00
|
| Rate for Payer: Priority Health HMO/PPO |
$91.02
|
| Rate for Payer: Priority Health Medicare |
$26.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.10
|
| Rate for Payer: Railroad Medicare Medicare |
$26.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.07
|
| Rate for Payer: UHC Core |
$87.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.16
|
| Rate for Payer: UHC Exchange |
$26.16
|
| Rate for Payer: UHC Medicare Advantage |
$26.16
|
| Rate for Payer: VA VA |
$26.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
HC SILVADENE 85 GM
|
Facility
|
IP
|
$104.62
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: BCBS Trust/PPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$80.85
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.00
|
| Rate for Payer: Priority Health HMO/PPO |
$91.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.07
|
| Rate for Payer: UHC Core |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
HC SILVER 4X4
|
Facility
|
OP
|
$65.41
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$58.87 |
| Rate for Payer: Aetna Commercial |
$55.60
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.44
|
| Rate for Payer: BCBS Complete |
$26.16
|
| Rate for Payer: BCBS MAPPO |
$16.35
|
| Rate for Payer: BCBS Trust/PPO |
$53.77
|
| Rate for Payer: BCN Commercial |
$50.86
|
| Rate for Payer: BCN Medicare Advantage |
$16.35
|
| Rate for Payer: Cash Price |
$52.33
|
| Rate for Payer: Cofinity Commercial |
$56.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.35
|
| Rate for Payer: Healthscope Commercial |
$58.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.60
|
| Rate for Payer: Nomi Health Commercial |
$53.64
|
| Rate for Payer: PACE Senior Care Partners |
$15.53
|
| Rate for Payer: PACE SWMI |
$16.35
|
| Rate for Payer: PHP Commercial |
$55.60
|
| Rate for Payer: PHP Medicare Advantage |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.52
|
| Rate for Payer: Priority Health HMO/PPO |
$56.91
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.82
|
| Rate for Payer: Railroad Medicare Medicare |
$16.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.56
|
| Rate for Payer: UHC Core |
$54.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.35
|
| Rate for Payer: UHC Exchange |
$16.35
|
| Rate for Payer: UHC Medicare Advantage |
$16.35
|
| Rate for Payer: VA VA |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.06
|
|
|
HC SILVER 4X4
|
Facility
|
IP
|
$65.41
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$58.87 |
| Rate for Payer: Aetna Commercial |
$55.60
|
| Rate for Payer: BCBS Trust/PPO |
$53.39
|
| Rate for Payer: BCN Commercial |
$50.55
|
| Rate for Payer: Cash Price |
$52.33
|
| Rate for Payer: Cofinity Commercial |
$56.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.33
|
| Rate for Payer: Healthscope Commercial |
$58.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.60
|
| Rate for Payer: Nomi Health Commercial |
$53.64
|
| Rate for Payer: PHP Commercial |
$55.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.52
|
| Rate for Payer: Priority Health HMO/PPO |
$56.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.56
|
| Rate for Payer: UHC Core |
$54.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.06
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,746.56
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,077.31 |
| Max. Negotiated Rate |
$7,871.90 |
| Rate for Payer: Aetna Commercial |
$7,434.58
|
| Rate for Payer: Aetna Medicare |
$2,274.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,733.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,733.30
|
| Rate for Payer: BCBS Complete |
$3,498.62
|
| Rate for Payer: BCBS MAPPO |
$2,186.64
|
| Rate for Payer: BCBS Trust/PPO |
$7,190.55
|
| Rate for Payer: BCN Commercial |
$6,800.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,186.64
|
| Rate for Payer: Cash Price |
$6,997.25
|
| Rate for Payer: Cofinity Commercial |
$7,522.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,997.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,186.64
|
| Rate for Payer: Healthscope Commercial |
$7,871.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,559.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,295.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,514.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,434.58
|
| Rate for Payer: Nomi Health Commercial |
$7,172.18
|
| Rate for Payer: PACE Senior Care Partners |
$2,077.31
|
| Rate for Payer: PACE SWMI |
$2,186.64
|
| Rate for Payer: PHP Commercial |
$7,434.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,186.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,685.26
|
| Rate for Payer: Priority Health HMO/PPO |
$7,609.51
|
| Rate for Payer: Priority Health Medicare |
$2,208.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,860.20
|
| Rate for Payer: Railroad Medicare Medicare |
$2,186.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,696.97
|
| Rate for Payer: UHC Core |
$7,303.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,186.64
|
| Rate for Payer: UHC Exchange |
$2,186.64
|
| Rate for Payer: UHC Medicare Advantage |
$2,186.64
|
| Rate for Payer: VA VA |
$2,186.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,559.92
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,746.56
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,685.26 |
| Max. Negotiated Rate |
$7,871.90 |
| Rate for Payer: Aetna Commercial |
$7,434.58
|
| Rate for Payer: BCBS Trust/PPO |
$7,139.82
|
| Rate for Payer: BCN Commercial |
$6,759.34
|
| Rate for Payer: Cash Price |
$6,997.25
|
| Rate for Payer: Cofinity Commercial |
$7,522.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,997.25
|
| Rate for Payer: Healthscope Commercial |
$7,871.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,559.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,434.58
|
| Rate for Payer: Nomi Health Commercial |
$7,172.18
|
| Rate for Payer: PHP Commercial |
$7,434.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,685.26
|
| Rate for Payer: Priority Health HMO/PPO |
$7,609.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,860.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,696.97
|
| Rate for Payer: UHC Core |
$7,303.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,559.92
|
|
|
HC SILVER ROPE
|
Facility
|
OP
|
$54.58
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: Aetna Medicare |
$14.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.06
|
| Rate for Payer: BCBS Complete |
$21.83
|
| Rate for Payer: BCBS MAPPO |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$44.87
|
| Rate for Payer: BCN Commercial |
$42.44
|
| Rate for Payer: BCN Medicare Advantage |
$13.64
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$49.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: PACE Senior Care Partners |
$12.96
|
| Rate for Payer: PACE SWMI |
$13.64
|
| Rate for Payer: PHP Commercial |
$46.39
|
| Rate for Payer: PHP Medicare Advantage |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health HMO/PPO |
$47.48
|
| Rate for Payer: Priority Health Medicare |
$13.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.57
|
| Rate for Payer: Railroad Medicare Medicare |
$13.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.03
|
| Rate for Payer: UHC Core |
$45.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.64
|
| Rate for Payer: UHC Exchange |
$13.64
|
| Rate for Payer: UHC Medicare Advantage |
$13.64
|
| Rate for Payer: VA VA |
$13.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.94
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$54.58
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: BCBS Trust/PPO |
$44.55
|
| Rate for Payer: BCN Commercial |
$42.18
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$49.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: PHP Commercial |
$46.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health HMO/PPO |
$47.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.03
|
| Rate for Payer: UHC Core |
$45.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.94
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$91.09
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.21 |
| Max. Negotiated Rate |
$81.98 |
| Rate for Payer: Aetna Commercial |
$77.43
|
| Rate for Payer: BCBS Trust/PPO |
$74.36
|
| Rate for Payer: BCN Commercial |
$70.39
|
| Rate for Payer: Cash Price |
$72.87
|
| Rate for Payer: Cofinity Commercial |
$78.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.87
|
| Rate for Payer: Healthscope Commercial |
$81.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.43
|
| Rate for Payer: Nomi Health Commercial |
$74.69
|
| Rate for Payer: PHP Commercial |
$77.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.21
|
| Rate for Payer: Priority Health HMO/PPO |
$79.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.16
|
| Rate for Payer: UHC Core |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.32
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$91.09
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$81.98 |
| Rate for Payer: Aetna Commercial |
$77.43
|
| Rate for Payer: Aetna Medicare |
$23.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.47
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS MAPPO |
$22.77
|
| Rate for Payer: BCBS Trust/PPO |
$74.89
|
| Rate for Payer: BCN Commercial |
$70.82
|
| Rate for Payer: BCN Medicare Advantage |
$22.77
|
| Rate for Payer: Cash Price |
$72.87
|
| Rate for Payer: Cash Price |
$72.87
|
| Rate for Payer: Cofinity Commercial |
$78.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.77
|
| Rate for Payer: Healthscope Commercial |
$81.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.32
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.91
|
| Rate for Payer: Meridian Medicaid |
$9.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.43
|
| Rate for Payer: Nomi Health Commercial |
$74.69
|
| Rate for Payer: PACE Senior Care Partners |
$21.63
|
| Rate for Payer: PACE SWMI |
$22.77
|
| Rate for Payer: PHP Commercial |
$77.43
|
| Rate for Payer: PHP Medicare Advantage |
$22.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.21
|
| Rate for Payer: Priority Health HMO/PPO |
$79.25
|
| Rate for Payer: Priority Health Medicare |
$23.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.03
|
| Rate for Payer: Railroad Medicare Medicare |
$22.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.16
|
| Rate for Payer: UHC Core |
$76.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.77
|
| Rate for Payer: UHC Exchange |
$22.77
|
| Rate for Payer: UHC Medicare Advantage |
$22.77
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$22.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.32
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$361.15
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.77 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna Medicare |
$93.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.86
|
| Rate for Payer: BCBS Complete |
$184.65
|
| Rate for Payer: BCBS MAPPO |
$90.29
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$280.79
|
| Rate for Payer: BCN Medicare Advantage |
$90.29
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.29
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.86
|
| Rate for Payer: Mclaren Medicaid |
$175.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.80
|
| Rate for Payer: Meridian Medicaid |
$184.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: PACE Senior Care Partners |
$85.77
|
| Rate for Payer: PACE SWMI |
$90.29
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: PHP Medicare Advantage |
$90.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO |
$314.20
|
| Rate for Payer: Priority Health Medicare |
$91.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.97
|
| Rate for Payer: Railroad Medicare Medicare |
$90.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.81
|
| Rate for Payer: UHC Core |
$301.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.29
|
| Rate for Payer: UHC Exchange |
$90.29
|
| Rate for Payer: UHC Medicare Advantage |
$90.29
|
| Rate for Payer: UHCCP Medicaid |
$175.84
|
| Rate for Payer: VA VA |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.86
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$361.15
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.75 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: BCBS Trust/PPO |
$294.81
|
| Rate for Payer: BCN Commercial |
$279.10
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO |
$314.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.81
|
| Rate for Payer: UHC Core |
$301.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.86
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$505.80 |
| Rate for Payer: Aetna Commercial |
$477.70
|
| Rate for Payer: Aetna Medicare |
$146.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.62
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$140.50
|
| Rate for Payer: BCBS Trust/PPO |
$462.02
|
| Rate for Payer: BCN Commercial |
$436.95
|
| Rate for Payer: BCN Medicare Advantage |
$140.50
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$483.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.50
|
| Rate for Payer: Healthscope Commercial |
$505.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.50
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.53
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.70
|
| Rate for Payer: Nomi Health Commercial |
$460.84
|
| Rate for Payer: PACE Senior Care Partners |
$133.47
|
| Rate for Payer: PACE SWMI |
$140.50
|
| Rate for Payer: PHP Commercial |
$477.70
|
| Rate for Payer: PHP Medicare Advantage |
$140.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.30
|
| Rate for Payer: Priority Health HMO/PPO |
$488.94
|
| Rate for Payer: Priority Health Medicare |
$141.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.54
|
| Rate for Payer: Railroad Medicare Medicare |
$140.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.56
|
| Rate for Payer: UHC Core |
$469.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.50
|
| Rate for Payer: UHC Exchange |
$140.50
|
| Rate for Payer: UHC Medicare Advantage |
$140.50
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$140.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.50
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$505.80 |
| Rate for Payer: Aetna Commercial |
$477.70
|
| Rate for Payer: BCBS Trust/PPO |
$458.76
|
| Rate for Payer: BCN Commercial |
$434.31
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$483.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.60
|
| Rate for Payer: Healthscope Commercial |
$505.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.70
|
| Rate for Payer: Nomi Health Commercial |
$460.84
|
| Rate for Payer: PHP Commercial |
$477.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.30
|
| Rate for Payer: Priority Health HMO/PPO |
$488.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.56
|
| Rate for Payer: UHC Core |
$469.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.50
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.66 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Aetna Commercial |
$542.30
|
| Rate for Payer: Aetna Medicare |
$165.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$199.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$199.38
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$159.50
|
| Rate for Payer: BCBS Trust/PPO |
$524.50
|
| Rate for Payer: BCN Commercial |
$496.05
|
| Rate for Payer: BCN Medicare Advantage |
$159.50
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$548.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.50
|
| Rate for Payer: Healthscope Commercial |
$574.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.50
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.47
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.30
|
| Rate for Payer: Nomi Health Commercial |
$523.16
|
| Rate for Payer: PACE Senior Care Partners |
$151.53
|
| Rate for Payer: PACE SWMI |
$159.50
|
| Rate for Payer: PHP Commercial |
$542.30
|
| Rate for Payer: PHP Medicare Advantage |
$159.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health HMO/PPO |
$555.06
|
| Rate for Payer: Priority Health Medicare |
$161.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.46
|
| Rate for Payer: Railroad Medicare Medicare |
$159.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.44
|
| Rate for Payer: UHC Core |
$532.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.50
|
| Rate for Payer: UHC Exchange |
$159.50
|
| Rate for Payer: UHC Medicare Advantage |
$159.50
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$159.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.50
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.70 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Aetna Commercial |
$542.30
|
| Rate for Payer: BCBS Trust/PPO |
$520.80
|
| Rate for Payer: BCN Commercial |
$493.05
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$548.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.40
|
| Rate for Payer: Healthscope Commercial |
$574.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.30
|
| Rate for Payer: Nomi Health Commercial |
$523.16
|
| Rate for Payer: PHP Commercial |
$542.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health HMO/PPO |
$555.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.44
|
| Rate for Payer: UHC Core |
$532.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.50
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.76 |
| Max. Negotiated Rate |
$245.42 |
| Rate for Payer: Aetna Commercial |
$231.79
|
| Rate for Payer: Aetna Medicare |
$70.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.22
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$68.17
|
| Rate for Payer: BCBS Trust/PPO |
$224.18
|
| Rate for Payer: BCN Commercial |
$212.02
|
| Rate for Payer: BCN Medicare Advantage |
$68.17
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$234.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.17
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.52
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.58
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PACE Senior Care Partners |
$64.76
|
| Rate for Payer: PACE SWMI |
$68.17
|
| Rate for Payer: PHP Commercial |
$231.79
|
| Rate for Payer: PHP Medicare Advantage |
$68.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO |
$237.24
|
| Rate for Payer: Priority Health Medicare |
$68.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.70
|
| Rate for Payer: Railroad Medicare Medicare |
$68.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.97
|
| Rate for Payer: UHC Core |
$227.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.17
|
| Rate for Payer: UHC Exchange |
$68.17
|
| Rate for Payer: UHC Medicare Advantage |
$68.17
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$68.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.52
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.25 |
| Max. Negotiated Rate |
$245.42 |
| Rate for Payer: Aetna Commercial |
$231.79
|
| Rate for Payer: BCBS Trust/PPO |
$222.60
|
| Rate for Payer: BCN Commercial |
$210.73
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$234.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Healthscope Commercial |
$245.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PHP Commercial |
$231.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO |
$237.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.97
|
| Rate for Payer: UHC Core |
$227.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.52
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: BCBS Trust/PPO |
$120.09
|
| Rate for Payer: BCN Commercial |
$113.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$150.85 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.97
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$36.78
|
| Rate for Payer: BCBS Trust/PPO |
$120.94
|
| Rate for Payer: BCN Commercial |
$114.38
|
| Rate for Payer: BCN Medicare Advantage |
$36.78
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.78
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Senior Care Partners |
$34.94
|
| Rate for Payer: PACE SWMI |
$36.78
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$36.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Medicare |
$37.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: Railroad Medicare Medicare |
$36.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.78
|
| Rate for Payer: UHC Exchange |
$36.78
|
| Rate for Payer: UHC Medicare Advantage |
$36.78
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$36.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$556.48
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna Commercial |
$473.01
|
| Rate for Payer: Aetna Medicare |
$144.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.90
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$139.12
|
| Rate for Payer: BCBS Trust/PPO |
$457.48
|
| Rate for Payer: BCN Commercial |
$432.66
|
| Rate for Payer: BCN Medicare Advantage |
$139.12
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cofinity Commercial |
$478.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$500.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$417.36
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.08
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: Nomi Health Commercial |
$456.31
|
| Rate for Payer: PACE Senior Care Partners |
$132.16
|
| Rate for Payer: PACE SWMI |
$139.12
|
| Rate for Payer: PHP Commercial |
$473.01
|
| Rate for Payer: PHP Medicare Advantage |
$139.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: Priority Health HMO/PPO |
$484.14
|
| Rate for Payer: Priority Health Medicare |
$140.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.84
|
| Rate for Payer: Railroad Medicare Medicare |
$139.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.70
|
| Rate for Payer: UHC Core |
$464.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.12
|
| Rate for Payer: UHC Exchange |
$139.12
|
| Rate for Payer: UHC Medicare Advantage |
$139.12
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$417.36
|
|
