|
HC WILLOW IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC WILLOW IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Medicare |
$97.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.13
|
| Rate for Payer: BCBS Complete |
$69.38
|
| Rate for Payer: BCBS MAPPO |
$93.70
|
| Rate for Payer: BCBS Trust/PPO |
$308.14
|
| Rate for Payer: BCN Commercial |
$308.14
|
| Rate for Payer: BCN Medicare Advantage |
$93.70
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.70
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.12
|
| Rate for Payer: Mclaren Medicaid |
$66.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.39
|
| Rate for Payer: Meridian Medicaid |
$69.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Nomi Health Commercial |
$307.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.12
|
| Rate for Payer: PACE Senior Care Partners |
$89.02
|
| Rate for Payer: PACE SWMI |
$93.70
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: PHP Medicare Advantage |
$93.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.09
|
| Rate for Payer: Priority Health Medicare |
$94.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.87
|
| Rate for Payer: Railroad Medicare Medicare |
$93.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.84
|
| Rate for Payer: UHC Core |
$312.97
|
| Rate for Payer: UHC Exchange |
$93.70
|
| Rate for Payer: UHC Medicaid |
$66.08
|
| Rate for Payer: UHC Medicare Advantage |
$93.70
|
| Rate for Payer: UHCCP Medicaid |
$66.08
|
| Rate for Payer: VA VA |
$93.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.12
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
IP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: BCBS Trust/PPO |
$309.56
|
| Rate for Payer: BCN Commercial |
$309.56
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Nomi Health Commercial |
$307.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.12
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$326.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.84
|
| Rate for Payer: UHC Core |
$312.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.12
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,901.84
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,499.68 |
| Max. Negotiated Rate |
$7,111.66 |
| Rate for Payer: Aetna Commercial |
$6,716.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,526.13
|
| Rate for Payer: BCN Commercial |
$6,526.13
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cofinity Commercial |
$6,795.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,321.47
|
| Rate for Payer: Healthscope Commercial |
$7,111.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,926.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,716.56
|
| Rate for Payer: Nomi Health Commercial |
$6,479.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,926.38
|
| Rate for Payer: PHP Commercial |
$6,716.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,874.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,499.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,953.62
|
| Rate for Payer: UHC Core |
$6,598.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,926.38
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,901.84
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,393.09 |
| Max. Negotiated Rate |
$7,111.66 |
| Rate for Payer: Aetna Commercial |
$6,716.56
|
| Rate for Payer: Aetna Medicare |
$2,054.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,469.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,469.32
|
| Rate for Payer: BCBS Complete |
$1,462.63
|
| Rate for Payer: BCBS MAPPO |
$1,975.46
|
| Rate for Payer: BCBS Trust/PPO |
$6,496.10
|
| Rate for Payer: BCN Commercial |
$6,496.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,975.46
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cofinity Commercial |
$6,795.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,321.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,975.46
|
| Rate for Payer: Healthscope Commercial |
$7,111.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,926.38
|
| Rate for Payer: Mclaren Medicaid |
$1,393.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,074.23
|
| Rate for Payer: Meridian Medicaid |
$1,462.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,271.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,173.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,716.56
|
| Rate for Payer: Nomi Health Commercial |
$6,479.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,926.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,876.69
|
| Rate for Payer: PACE SWMI |
$1,975.46
|
| Rate for Payer: PHP Commercial |
$6,716.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,975.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,393.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,874.60
|
| Rate for Payer: Priority Health Medicare |
$1,995.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,499.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,975.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,953.62
|
| Rate for Payer: UHC Core |
$6,598.04
|
| Rate for Payer: UHC Exchange |
$1,975.46
|
| Rate for Payer: UHC Medicaid |
$1,393.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,975.46
|
| Rate for Payer: UHCCP Medicaid |
$1,393.09
|
| Rate for Payer: VA VA |
$1,975.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,926.38
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$265.69
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$184.92 |
| Max. Negotiated Rate |
$239.12 |
| Rate for Payer: Aetna Commercial |
$225.84
|
| Rate for Payer: BCBS Trust/PPO |
$219.43
|
| Rate for Payer: BCN Commercial |
$219.43
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cofinity Commercial |
$228.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.55
|
| Rate for Payer: Healthscope Commercial |
$239.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.84
|
| Rate for Payer: Nomi Health Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.27
|
| Rate for Payer: PHP Commercial |
$225.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.81
|
| Rate for Payer: UHC Core |
$221.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.27
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$265.69
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$239.12 |
| Rate for Payer: Aetna Commercial |
$225.84
|
| Rate for Payer: Aetna Medicare |
$69.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.03
|
| Rate for Payer: BCBS Complete |
$49.18
|
| Rate for Payer: BCBS MAPPO |
$66.42
|
| Rate for Payer: BCBS Trust/PPO |
$218.42
|
| Rate for Payer: BCN Commercial |
$218.42
|
| Rate for Payer: BCN Medicare Advantage |
$66.42
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cofinity Commercial |
$228.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.42
|
| Rate for Payer: Healthscope Commercial |
$239.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.27
|
| Rate for Payer: Mclaren Medicaid |
$46.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.74
|
| Rate for Payer: Meridian Medicaid |
$49.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.84
|
| Rate for Payer: Nomi Health Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.27
|
| Rate for Payer: PACE Senior Care Partners |
$63.10
|
| Rate for Payer: PACE SWMI |
$66.42
|
| Rate for Payer: PHP Commercial |
$225.84
|
| Rate for Payer: PHP Medicare Advantage |
$66.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.15
|
| Rate for Payer: Priority Health Medicare |
$67.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: Railroad Medicare Medicare |
$66.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.81
|
| Rate for Payer: UHC Core |
$221.85
|
| Rate for Payer: UHC Exchange |
$66.42
|
| Rate for Payer: UHC Medicaid |
$46.84
|
| Rate for Payer: UHC Medicare Advantage |
$66.42
|
| Rate for Payer: UHCCP Medicaid |
$46.84
|
| Rate for Payer: VA VA |
$66.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.27
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$456.74
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$317.89 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: Aetna Commercial |
$388.23
|
| Rate for Payer: BCBS Trust/PPO |
$377.22
|
| Rate for Payer: BCN Commercial |
$377.22
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cofinity Commercial |
$392.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.39
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.23
|
| Rate for Payer: Nomi Health Commercial |
$374.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: PHP Commercial |
$388.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$397.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.93
|
| Rate for Payer: UHC Core |
$381.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$456.74
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: Aetna Commercial |
$388.23
|
| Rate for Payer: Aetna Medicare |
$118.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.73
|
| Rate for Payer: BCBS Complete |
$84.54
|
| Rate for Payer: BCBS MAPPO |
$114.19
|
| Rate for Payer: BCBS Trust/PPO |
$375.49
|
| Rate for Payer: BCN Commercial |
$375.49
|
| Rate for Payer: BCN Medicare Advantage |
$114.19
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cofinity Commercial |
$392.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.19
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.56
|
| Rate for Payer: Mclaren Medicaid |
$80.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.89
|
| Rate for Payer: Meridian Medicaid |
$84.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$125.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.23
|
| Rate for Payer: Nomi Health Commercial |
$374.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: PACE Senior Care Partners |
$108.48
|
| Rate for Payer: PACE SWMI |
$114.19
|
| Rate for Payer: PHP Commercial |
$388.23
|
| Rate for Payer: PHP Medicare Advantage |
$114.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$397.36
|
| Rate for Payer: Priority Health Medicare |
$115.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.89
|
| Rate for Payer: Railroad Medicare Medicare |
$114.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.93
|
| Rate for Payer: UHC Core |
$381.38
|
| Rate for Payer: UHC Exchange |
$114.19
|
| Rate for Payer: UHC Medicaid |
$80.52
|
| Rate for Payer: UHC Medicare Advantage |
$114.19
|
| Rate for Payer: UHCCP Medicaid |
$80.52
|
| Rate for Payer: VA VA |
$114.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.56
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$245.70
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: Aetna Medicare |
$63.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.78
|
| Rate for Payer: BCBS Complete |
$45.48
|
| Rate for Payer: BCBS MAPPO |
$61.42
|
| Rate for Payer: BCBS Trust/PPO |
$201.99
|
| Rate for Payer: BCN Commercial |
$201.99
|
| Rate for Payer: BCN Medicare Advantage |
$61.42
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.42
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.28
|
| Rate for Payer: Mclaren Medicaid |
$43.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.50
|
| Rate for Payer: Meridian Medicaid |
$45.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Nomi Health Commercial |
$201.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: PACE Senior Care Partners |
$58.35
|
| Rate for Payer: PACE SWMI |
$61.42
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: PHP Medicare Advantage |
$61.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.76
|
| Rate for Payer: Priority Health Medicare |
$62.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.01
|
| Rate for Payer: Railroad Medicare Medicare |
$61.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.22
|
| Rate for Payer: UHC Core |
$205.16
|
| Rate for Payer: UHC Exchange |
$61.42
|
| Rate for Payer: UHC Medicaid |
$43.32
|
| Rate for Payer: UHC Medicare Advantage |
$61.42
|
| Rate for Payer: UHCCP Medicaid |
$43.32
|
| Rate for Payer: VA VA |
$61.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.28
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$245.70
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: BCBS Trust/PPO |
$202.92
|
| Rate for Payer: BCN Commercial |
$202.92
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Nomi Health Commercial |
$201.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.22
|
| Rate for Payer: UHC Core |
$205.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.28
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,191.64
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$829.38 |
| Max. Negotiated Rate |
$1,072.48 |
| Rate for Payer: Aetna Commercial |
$1,012.89
|
| Rate for Payer: BCBS Trust/PPO |
$984.18
|
| Rate for Payer: BCN Commercial |
$984.18
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cofinity Commercial |
$1,024.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$953.31
|
| Rate for Payer: Healthscope Commercial |
$1,072.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$893.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.89
|
| Rate for Payer: Nomi Health Commercial |
$977.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.73
|
| Rate for Payer: PHP Commercial |
$1,012.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,036.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$829.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.64
|
| Rate for Payer: UHC Core |
$995.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.73
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,191.64
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$1,072.48 |
| Rate for Payer: Aetna Commercial |
$1,012.89
|
| Rate for Payer: Aetna Medicare |
$309.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.39
|
| Rate for Payer: BCBS Complete |
$220.57
|
| Rate for Payer: BCBS MAPPO |
$297.91
|
| Rate for Payer: BCBS Trust/PPO |
$979.65
|
| Rate for Payer: BCN Commercial |
$979.65
|
| Rate for Payer: BCN Medicare Advantage |
$297.91
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cofinity Commercial |
$1,024.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$953.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.91
|
| Rate for Payer: Healthscope Commercial |
$1,072.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$893.73
|
| Rate for Payer: Mclaren Medicaid |
$210.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.81
|
| Rate for Payer: Meridian Medicaid |
$220.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$327.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.89
|
| Rate for Payer: Nomi Health Commercial |
$977.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.73
|
| Rate for Payer: PACE Senior Care Partners |
$283.01
|
| Rate for Payer: PACE SWMI |
$297.91
|
| Rate for Payer: PHP Commercial |
$1,012.89
|
| Rate for Payer: PHP Medicare Advantage |
$297.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,036.73
|
| Rate for Payer: Priority Health Medicare |
$300.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$829.38
|
| Rate for Payer: Railroad Medicare Medicare |
$297.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.64
|
| Rate for Payer: UHC Core |
$995.02
|
| Rate for Payer: UHC Exchange |
$297.91
|
| Rate for Payer: UHC Medicaid |
$210.09
|
| Rate for Payer: UHC Medicare Advantage |
$297.91
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$297.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.73
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$737.09
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$663.38 |
| Rate for Payer: Aetna Commercial |
$626.53
|
| Rate for Payer: Aetna Medicare |
$191.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.34
|
| Rate for Payer: BCBS Complete |
$136.44
|
| Rate for Payer: BCBS MAPPO |
$184.27
|
| Rate for Payer: BCBS Trust/PPO |
$605.96
|
| Rate for Payer: BCN Commercial |
$605.96
|
| Rate for Payer: BCN Medicare Advantage |
$184.27
|
| Rate for Payer: Cash Price |
$589.67
|
| Rate for Payer: Cash Price |
$589.67
|
| Rate for Payer: Cofinity Commercial |
$633.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.27
|
| Rate for Payer: Healthscope Commercial |
$663.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.82
|
| Rate for Payer: Mclaren Medicaid |
$129.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.49
|
| Rate for Payer: Meridian Medicaid |
$136.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.53
|
| Rate for Payer: Nomi Health Commercial |
$604.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.82
|
| Rate for Payer: PACE Senior Care Partners |
$175.06
|
| Rate for Payer: PACE SWMI |
$184.27
|
| Rate for Payer: PHP Commercial |
$626.53
|
| Rate for Payer: PHP Medicare Advantage |
$184.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$641.27
|
| Rate for Payer: Priority Health Medicare |
$186.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.01
|
| Rate for Payer: Railroad Medicare Medicare |
$184.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.64
|
| Rate for Payer: UHC Core |
$615.47
|
| Rate for Payer: UHC Exchange |
$184.27
|
| Rate for Payer: UHC Medicaid |
$129.95
|
| Rate for Payer: UHC Medicare Advantage |
$184.27
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$184.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.82
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$737.09
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$513.01 |
| Max. Negotiated Rate |
$663.38 |
| Rate for Payer: Aetna Commercial |
$626.53
|
| Rate for Payer: BCBS Trust/PPO |
$608.76
|
| Rate for Payer: BCN Commercial |
$608.76
|
| Rate for Payer: Cash Price |
$589.67
|
| Rate for Payer: Cofinity Commercial |
$633.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.67
|
| Rate for Payer: Healthscope Commercial |
$663.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.53
|
| Rate for Payer: Nomi Health Commercial |
$604.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.82
|
| Rate for Payer: PHP Commercial |
$626.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$641.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.64
|
| Rate for Payer: UHC Core |
$615.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.82
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$546.67
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.48 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$464.67
|
| Rate for Payer: BCBS Trust/PPO |
$451.49
|
| Rate for Payer: BCN Commercial |
$451.49
|
| Rate for Payer: Cash Price |
$437.34
|
| Rate for Payer: Cofinity Commercial |
$470.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.34
|
| Rate for Payer: Healthscope Commercial |
$492.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$410.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.67
|
| Rate for Payer: Nomi Health Commercial |
$448.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.00
|
| Rate for Payer: PHP Commercial |
$464.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$475.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$380.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.07
|
| Rate for Payer: UHC Core |
$456.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$410.00
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$546.67
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.38 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$464.67
|
| Rate for Payer: Aetna Medicare |
$142.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.83
|
| Rate for Payer: BCBS Complete |
$101.19
|
| Rate for Payer: BCBS MAPPO |
$136.67
|
| Rate for Payer: BCBS Trust/PPO |
$449.42
|
| Rate for Payer: BCN Commercial |
$449.42
|
| Rate for Payer: BCN Medicare Advantage |
$136.67
|
| Rate for Payer: Cash Price |
$437.34
|
| Rate for Payer: Cash Price |
$437.34
|
| Rate for Payer: Cofinity Commercial |
$470.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.67
|
| Rate for Payer: Healthscope Commercial |
$492.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$410.00
|
| Rate for Payer: Mclaren Medicaid |
$96.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.50
|
| Rate for Payer: Meridian Medicaid |
$101.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.67
|
| Rate for Payer: Nomi Health Commercial |
$448.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.00
|
| Rate for Payer: PACE Senior Care Partners |
$129.83
|
| Rate for Payer: PACE SWMI |
$136.67
|
| Rate for Payer: PHP Commercial |
$464.67
|
| Rate for Payer: PHP Medicare Advantage |
$136.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$475.60
|
| Rate for Payer: Priority Health Medicare |
$138.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$380.48
|
| Rate for Payer: Railroad Medicare Medicare |
$136.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.07
|
| Rate for Payer: UHC Core |
$456.47
|
| Rate for Payer: UHC Exchange |
$136.67
|
| Rate for Payer: UHC Medicaid |
$96.38
|
| Rate for Payer: UHC Medicare Advantage |
$136.67
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$136.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$410.00
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$429.97
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna Medicare |
$111.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.37
|
| Rate for Payer: BCBS Complete |
$79.59
|
| Rate for Payer: BCBS MAPPO |
$107.49
|
| Rate for Payer: BCBS Trust/PPO |
$353.48
|
| Rate for Payer: BCN Commercial |
$353.48
|
| Rate for Payer: BCN Medicare Advantage |
$107.49
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.49
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$75.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.87
|
| Rate for Payer: Meridian Medicaid |
$79.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PACE Senior Care Partners |
$102.12
|
| Rate for Payer: PACE SWMI |
$107.49
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: PHP Medicare Advantage |
$107.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.07
|
| Rate for Payer: Priority Health Medicare |
$108.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.26
|
| Rate for Payer: Railroad Medicare Medicare |
$107.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.37
|
| Rate for Payer: UHC Core |
$359.02
|
| Rate for Payer: UHC Exchange |
$107.49
|
| Rate for Payer: UHC Medicaid |
$75.80
|
| Rate for Payer: UHC Medicare Advantage |
$107.49
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$107.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$429.97
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.26 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: BCBS Trust/PPO |
$355.11
|
| Rate for Payer: BCN Commercial |
$355.11
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.37
|
| Rate for Payer: UHC Core |
$359.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$124.50
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$112.05 |
| Rate for Payer: Aetna Commercial |
$105.83
|
| Rate for Payer: Aetna Medicare |
$32.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.91
|
| Rate for Payer: BCBS Complete |
$23.04
|
| Rate for Payer: BCBS MAPPO |
$31.12
|
| Rate for Payer: BCBS Trust/PPO |
$102.35
|
| Rate for Payer: BCN Commercial |
$102.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.12
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.38
|
| Rate for Payer: Mclaren Medicaid |
$21.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.68
|
| Rate for Payer: Meridian Medicaid |
$23.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Nomi Health Commercial |
$102.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.38
|
| Rate for Payer: PACE Senior Care Partners |
$29.57
|
| Rate for Payer: PACE SWMI |
$31.12
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: PHP Medicare Advantage |
$31.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.31
|
| Rate for Payer: Priority Health Medicare |
$31.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.65
|
| Rate for Payer: Railroad Medicare Medicare |
$31.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.56
|
| Rate for Payer: UHC Core |
$103.96
|
| Rate for Payer: UHC Exchange |
$31.12
|
| Rate for Payer: UHC Medicaid |
$21.95
|
| Rate for Payer: UHC Medicare Advantage |
$31.12
|
| Rate for Payer: UHCCP Medicaid |
$21.95
|
| Rate for Payer: VA VA |
$31.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.38
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$124.50
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.65 |
| Max. Negotiated Rate |
$112.05 |
| Rate for Payer: Aetna Commercial |
$105.83
|
| Rate for Payer: BCBS Trust/PPO |
$102.82
|
| Rate for Payer: BCN Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Nomi Health Commercial |
$102.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.38
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.56
|
| Rate for Payer: UHC Core |
$103.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.38
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$255.30
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$229.77 |
| Rate for Payer: Aetna Commercial |
$217.00
|
| Rate for Payer: Aetna Medicare |
$66.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.78
|
| Rate for Payer: BCBS Complete |
$47.26
|
| Rate for Payer: BCBS MAPPO |
$63.83
|
| Rate for Payer: BCBS Trust/PPO |
$209.88
|
| Rate for Payer: BCN Commercial |
$209.88
|
| Rate for Payer: BCN Medicare Advantage |
$63.83
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cofinity Commercial |
$219.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.83
|
| Rate for Payer: Healthscope Commercial |
$229.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.47
|
| Rate for Payer: Mclaren Medicaid |
$45.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.02
|
| Rate for Payer: Meridian Medicaid |
$47.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.00
|
| Rate for Payer: Nomi Health Commercial |
$209.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.47
|
| Rate for Payer: PACE Senior Care Partners |
$60.63
|
| Rate for Payer: PACE SWMI |
$63.83
|
| Rate for Payer: PHP Commercial |
$217.00
|
| Rate for Payer: PHP Medicare Advantage |
$63.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.11
|
| Rate for Payer: Priority Health Medicare |
$64.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.69
|
| Rate for Payer: Railroad Medicare Medicare |
$63.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.66
|
| Rate for Payer: UHC Core |
$213.18
|
| Rate for Payer: UHC Exchange |
$63.83
|
| Rate for Payer: UHC Medicaid |
$45.01
|
| Rate for Payer: UHC Medicare Advantage |
$63.83
|
| Rate for Payer: UHCCP Medicaid |
$45.01
|
| Rate for Payer: VA VA |
$63.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.47
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$255.30
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$177.69 |
| Max. Negotiated Rate |
$229.77 |
| Rate for Payer: Aetna Commercial |
$217.00
|
| Rate for Payer: BCBS Trust/PPO |
$210.85
|
| Rate for Payer: BCN Commercial |
$210.85
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cofinity Commercial |
$219.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.24
|
| Rate for Payer: Healthscope Commercial |
$229.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.00
|
| Rate for Payer: Nomi Health Commercial |
$209.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.47
|
| Rate for Payer: PHP Commercial |
$217.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.66
|
| Rate for Payer: UHC Core |
$213.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.47
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
IP
|
$7.08
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$5.85
|
| Rate for Payer: BCN Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.66
|
| Rate for Payer: Healthscope Commercial |
$6.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.02
|
| Rate for Payer: Nomi Health Commercial |
$5.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.31
|
| Rate for Payer: PHP Commercial |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.23
|
| Rate for Payer: UHC Core |
$5.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.31
|
|
