|
HC WHOLEY EXCHANGE
|
Facility
|
IP
|
$509.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.08 |
| Max. Negotiated Rate |
$458.42 |
| Rate for Payer: Aetna Commercial |
$432.95
|
| Rate for Payer: BCBS Trust/PPO |
$415.78
|
| Rate for Payer: BCN Commercial |
$393.63
|
| Rate for Payer: Cash Price |
$407.48
|
| Rate for Payer: Cofinity Commercial |
$438.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.48
|
| Rate for Payer: Healthscope Commercial |
$458.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.95
|
| Rate for Payer: Nomi Health Commercial |
$417.67
|
| Rate for Payer: PHP Commercial |
$432.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.08
|
| Rate for Payer: Priority Health HMO/PPO |
$443.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.23
|
| Rate for Payer: UHC Core |
$425.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.01
|
|
|
HC WILLOW IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC WILLOW IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
IP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$243.63 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: BCBS Trust/PPO |
$305.97
|
| Rate for Payer: BCN Commercial |
$289.66
|
| 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: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.63
|
| Rate for Payer: Priority Health HMO/PPO |
$326.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.13
|
| 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 FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.02 |
| 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 |
$149.93
|
| Rate for Payer: BCBS MAPPO |
$93.70
|
| Rate for Payer: BCBS Trust/PPO |
$308.14
|
| Rate for Payer: BCN Commercial |
$291.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Nomi Health Commercial |
$307.35
|
| 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 Cigna Priority Health |
$243.63
|
| Rate for Payer: Priority Health HMO/PPO |
$326.09
|
| Rate for Payer: Priority Health Medicare |
$94.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.13
|
| 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 Dual Complete DSNP |
$93.70
|
| Rate for Payer: UHC Exchange |
$93.70
|
| Rate for Payer: UHC Medicare Advantage |
$93.70
|
| Rate for Payer: VA VA |
$93.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.12
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,033.24 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: Aetna Medicare |
$2,014.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,420.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,420.91
|
| Rate for Payer: BCBS Complete |
$1,084.97
|
| Rate for Payer: BCBS MAPPO |
$1,936.72
|
| Rate for Payer: BCBS Trust/PPO |
$6,368.73
|
| Rate for Payer: BCN Commercial |
$6,023.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,936.72
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,936.72
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,810.18
|
| Rate for Payer: Mclaren Medicaid |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,033.56
|
| Rate for Payer: Meridian Medicaid |
$1,084.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,227.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,584.86
|
| Rate for Payer: Nomi Health Commercial |
$6,352.46
|
| Rate for Payer: PACE Senior Care Partners |
$1,839.89
|
| Rate for Payer: PACE SWMI |
$1,936.72
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,936.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: Priority Health HMO/PPO |
$6,739.80
|
| Rate for Payer: Priority Health Medicare |
$1,956.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,190.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,936.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,817.27
|
| Rate for Payer: UHC Core |
$6,468.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,936.72
|
| Rate for Payer: UHC Exchange |
$1,936.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,936.72
|
| Rate for Payer: UHCCP Medicaid |
$1,033.24
|
| Rate for Payer: VA VA |
$1,936.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,810.18
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,035.48 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: BCBS Trust/PPO |
$6,323.79
|
| Rate for Payer: BCN Commercial |
$5,986.80
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,810.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,584.86
|
| Rate for Payer: Nomi Health Commercial |
$6,352.46
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: Priority Health HMO/PPO |
$6,739.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,190.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,817.27
|
| Rate for Payer: UHC Core |
$6,468.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,810.18
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna Commercial |
$221.41
|
| Rate for Payer: Aetna Medicare |
$67.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.40
|
| Rate for Payer: BCBS Complete |
$104.19
|
| Rate for Payer: BCBS MAPPO |
$65.12
|
| Rate for Payer: BCBS Trust/PPO |
$214.14
|
| Rate for Payer: BCN Commercial |
$202.52
|
| Rate for Payer: BCN Medicare Advantage |
$65.12
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$224.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.12
|
| Rate for Payer: Healthscope Commercial |
$234.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: Nomi Health Commercial |
$213.59
|
| Rate for Payer: PACE Senior Care Partners |
$61.86
|
| Rate for Payer: PACE SWMI |
$65.12
|
| Rate for Payer: PHP Commercial |
$221.41
|
| Rate for Payer: PHP Medicare Advantage |
$65.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: Priority Health HMO/PPO |
$226.62
|
| Rate for Payer: Priority Health Medicare |
$65.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.52
|
| Rate for Payer: Railroad Medicare Medicare |
$65.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.22
|
| Rate for Payer: UHC Core |
$217.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.12
|
| Rate for Payer: UHC Exchange |
$65.12
|
| Rate for Payer: UHC Medicare Advantage |
$65.12
|
| Rate for Payer: VA VA |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.36
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna Commercial |
$221.41
|
| Rate for Payer: BCBS Trust/PPO |
$212.63
|
| Rate for Payer: BCN Commercial |
$201.30
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$224.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Healthscope Commercial |
$234.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: Nomi Health Commercial |
$213.59
|
| Rate for Payer: PHP Commercial |
$221.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: Priority Health HMO/PPO |
$226.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.22
|
| Rate for Payer: UHC Core |
$217.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.36
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$447.78
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$291.06 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna Commercial |
$380.61
|
| Rate for Payer: BCBS Trust/PPO |
$365.52
|
| Rate for Payer: BCN Commercial |
$346.04
|
| Rate for Payer: Cash Price |
$358.22
|
| Rate for Payer: Cofinity Commercial |
$385.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.22
|
| Rate for Payer: Healthscope Commercial |
$403.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.61
|
| Rate for Payer: Nomi Health Commercial |
$367.18
|
| Rate for Payer: PHP Commercial |
$380.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.06
|
| Rate for Payer: Priority Health HMO/PPO |
$389.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.05
|
| Rate for Payer: UHC Core |
$373.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.84
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$447.78
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.35 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna Commercial |
$380.61
|
| Rate for Payer: Aetna Medicare |
$116.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.93
|
| Rate for Payer: BCBS Complete |
$179.11
|
| Rate for Payer: BCBS MAPPO |
$111.94
|
| Rate for Payer: BCBS Trust/PPO |
$368.12
|
| Rate for Payer: BCN Commercial |
$348.15
|
| Rate for Payer: BCN Medicare Advantage |
$111.94
|
| Rate for Payer: Cash Price |
$358.22
|
| Rate for Payer: Cofinity Commercial |
$385.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.94
|
| Rate for Payer: Healthscope Commercial |
$403.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.61
|
| Rate for Payer: Nomi Health Commercial |
$367.18
|
| Rate for Payer: PACE Senior Care Partners |
$106.35
|
| Rate for Payer: PACE SWMI |
$111.94
|
| Rate for Payer: PHP Commercial |
$380.61
|
| Rate for Payer: PHP Medicare Advantage |
$111.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.06
|
| Rate for Payer: Priority Health HMO/PPO |
$389.57
|
| Rate for Payer: Priority Health Medicare |
$113.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.01
|
| Rate for Payer: Railroad Medicare Medicare |
$111.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.05
|
| Rate for Payer: UHC Core |
$373.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.94
|
| Rate for Payer: UHC Exchange |
$111.94
|
| Rate for Payer: UHC Medicare Advantage |
$111.94
|
| Rate for Payer: VA VA |
$111.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.84
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$240.88
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.57 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna Commercial |
$204.75
|
| Rate for Payer: BCBS Trust/PPO |
$196.63
|
| Rate for Payer: BCN Commercial |
$186.15
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: Nomi Health Commercial |
$197.52
|
| Rate for Payer: PHP Commercial |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health HMO/PPO |
$209.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.97
|
| Rate for Payer: UHC Core |
$201.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.66
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$240.88
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.21 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna Commercial |
$204.75
|
| Rate for Payer: Aetna Medicare |
$62.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.28
|
| Rate for Payer: BCBS Complete |
$96.35
|
| Rate for Payer: BCBS MAPPO |
$60.22
|
| Rate for Payer: BCBS Trust/PPO |
$198.03
|
| Rate for Payer: BCN Commercial |
$187.28
|
| Rate for Payer: BCN Medicare Advantage |
$60.22
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.22
|
| Rate for Payer: Healthscope Commercial |
$216.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: Nomi Health Commercial |
$197.52
|
| Rate for Payer: PACE Senior Care Partners |
$57.21
|
| Rate for Payer: PACE SWMI |
$60.22
|
| Rate for Payer: PHP Commercial |
$204.75
|
| Rate for Payer: PHP Medicare Advantage |
$60.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health HMO/PPO |
$209.57
|
| Rate for Payer: Priority Health Medicare |
$60.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.39
|
| Rate for Payer: Railroad Medicare Medicare |
$60.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.97
|
| Rate for Payer: UHC Core |
$201.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.22
|
| Rate for Payer: UHC Exchange |
$60.22
|
| Rate for Payer: UHC Medicare Advantage |
$60.22
|
| Rate for Payer: VA VA |
$60.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.66
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,168.27
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$759.38 |
| Max. Negotiated Rate |
$1,051.44 |
| Rate for Payer: Aetna Commercial |
$993.03
|
| Rate for Payer: BCBS Trust/PPO |
$953.66
|
| Rate for Payer: BCN Commercial |
$902.84
|
| Rate for Payer: Cash Price |
$934.62
|
| Rate for Payer: Cofinity Commercial |
$1,004.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.62
|
| Rate for Payer: Healthscope Commercial |
$1,051.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.03
|
| Rate for Payer: Nomi Health Commercial |
$957.98
|
| Rate for Payer: PHP Commercial |
$993.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.38
|
| Rate for Payer: Priority Health HMO/PPO |
$1,016.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$782.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,028.08
|
| Rate for Payer: UHC Core |
$975.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.20
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,168.27
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.46 |
| Max. Negotiated Rate |
$1,051.44 |
| Rate for Payer: Aetna Commercial |
$993.03
|
| Rate for Payer: Aetna Medicare |
$303.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.08
|
| Rate for Payer: BCBS Complete |
$467.31
|
| Rate for Payer: BCBS MAPPO |
$292.07
|
| Rate for Payer: BCBS Trust/PPO |
$960.43
|
| Rate for Payer: BCN Commercial |
$908.33
|
| Rate for Payer: BCN Medicare Advantage |
$292.07
|
| Rate for Payer: Cash Price |
$934.62
|
| Rate for Payer: Cofinity Commercial |
$1,004.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.07
|
| Rate for Payer: Healthscope Commercial |
$1,051.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.03
|
| Rate for Payer: Nomi Health Commercial |
$957.98
|
| Rate for Payer: PACE Senior Care Partners |
$277.46
|
| Rate for Payer: PACE SWMI |
$292.07
|
| Rate for Payer: PHP Commercial |
$993.03
|
| Rate for Payer: PHP Medicare Advantage |
$292.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.38
|
| Rate for Payer: Priority Health HMO/PPO |
$1,016.39
|
| Rate for Payer: Priority Health Medicare |
$294.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$782.74
|
| Rate for Payer: Railroad Medicare Medicare |
$292.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,028.08
|
| Rate for Payer: UHC Core |
$975.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.07
|
| Rate for Payer: UHC Exchange |
$292.07
|
| Rate for Payer: UHC Medicare Advantage |
$292.07
|
| Rate for Payer: VA VA |
$292.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.20
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$722.64
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.72 |
| Max. Negotiated Rate |
$650.38 |
| Rate for Payer: Aetna Commercial |
$614.24
|
| Rate for Payer: BCBS Trust/PPO |
$589.89
|
| Rate for Payer: BCN Commercial |
$558.46
|
| Rate for Payer: Cash Price |
$578.11
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.11
|
| Rate for Payer: Healthscope Commercial |
$650.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.24
|
| Rate for Payer: Nomi Health Commercial |
$592.56
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.72
|
| Rate for Payer: Priority Health HMO/PPO |
$628.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.92
|
| Rate for Payer: UHC Core |
$603.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.98
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$722.64
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.63 |
| Max. Negotiated Rate |
$650.38 |
| Rate for Payer: Aetna Commercial |
$614.24
|
| Rate for Payer: Aetna Medicare |
$187.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.82
|
| Rate for Payer: BCBS Complete |
$289.06
|
| Rate for Payer: BCBS MAPPO |
$180.66
|
| Rate for Payer: BCBS Trust/PPO |
$594.08
|
| Rate for Payer: BCN Commercial |
$561.85
|
| Rate for Payer: BCN Medicare Advantage |
$180.66
|
| Rate for Payer: Cash Price |
$578.11
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$650.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.24
|
| Rate for Payer: Nomi Health Commercial |
$592.56
|
| Rate for Payer: PACE Senior Care Partners |
$171.63
|
| Rate for Payer: PACE SWMI |
$180.66
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: PHP Medicare Advantage |
$180.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.72
|
| Rate for Payer: Priority Health HMO/PPO |
$628.70
|
| Rate for Payer: Priority Health Medicare |
$182.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.17
|
| Rate for Payer: Railroad Medicare Medicare |
$180.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.92
|
| Rate for Payer: UHC Core |
$603.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.66
|
| Rate for Payer: UHC Exchange |
$180.66
|
| Rate for Payer: UHC Medicare Advantage |
$180.66
|
| Rate for Payer: VA VA |
$180.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.98
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$535.95
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.37 |
| Max. Negotiated Rate |
$482.36 |
| Rate for Payer: Aetna Commercial |
$455.56
|
| Rate for Payer: BCBS Trust/PPO |
$437.50
|
| Rate for Payer: BCN Commercial |
$414.18
|
| Rate for Payer: Cash Price |
$428.76
|
| Rate for Payer: Cofinity Commercial |
$460.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.76
|
| Rate for Payer: Healthscope Commercial |
$482.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.56
|
| Rate for Payer: Nomi Health Commercial |
$439.48
|
| Rate for Payer: PHP Commercial |
$455.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.37
|
| Rate for Payer: Priority Health HMO/PPO |
$466.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.64
|
| Rate for Payer: UHC Core |
$447.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.96
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$535.95
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.29 |
| Max. Negotiated Rate |
$482.36 |
| Rate for Payer: Aetna Commercial |
$455.56
|
| Rate for Payer: Aetna Medicare |
$139.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.48
|
| Rate for Payer: BCBS Complete |
$214.38
|
| Rate for Payer: BCBS MAPPO |
$133.99
|
| Rate for Payer: BCBS Trust/PPO |
$440.60
|
| Rate for Payer: BCN Commercial |
$416.70
|
| Rate for Payer: BCN Medicare Advantage |
$133.99
|
| Rate for Payer: Cash Price |
$428.76
|
| Rate for Payer: Cofinity Commercial |
$460.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.99
|
| Rate for Payer: Healthscope Commercial |
$482.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.56
|
| Rate for Payer: Nomi Health Commercial |
$439.48
|
| Rate for Payer: PACE Senior Care Partners |
$127.29
|
| Rate for Payer: PACE SWMI |
$133.99
|
| Rate for Payer: PHP Commercial |
$455.56
|
| Rate for Payer: PHP Medicare Advantage |
$133.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.37
|
| Rate for Payer: Priority Health HMO/PPO |
$466.28
|
| Rate for Payer: Priority Health Medicare |
$135.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$359.09
|
| Rate for Payer: Railroad Medicare Medicare |
$133.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.64
|
| Rate for Payer: UHC Core |
$447.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.99
|
| Rate for Payer: UHC Exchange |
$133.99
|
| Rate for Payer: UHC Medicare Advantage |
$133.99
|
| Rate for Payer: VA VA |
$133.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.96
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$421.54
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna Medicare |
$109.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.73
|
| Rate for Payer: BCBS Complete |
$168.62
|
| Rate for Payer: BCBS MAPPO |
$105.38
|
| Rate for Payer: BCBS Trust/PPO |
$346.55
|
| Rate for Payer: BCN Commercial |
$327.75
|
| Rate for Payer: BCN Medicare Advantage |
$105.38
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.38
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: PACE Senior Care Partners |
$100.12
|
| Rate for Payer: PACE SWMI |
$105.38
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: PHP Medicare Advantage |
$105.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health HMO/PPO |
$366.74
|
| Rate for Payer: Priority Health Medicare |
$106.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.43
|
| Rate for Payer: Railroad Medicare Medicare |
$105.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.96
|
| Rate for Payer: UHC Core |
$351.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.38
|
| Rate for Payer: UHC Exchange |
$105.38
|
| Rate for Payer: UHC Medicare Advantage |
$105.38
|
| Rate for Payer: VA VA |
$105.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.16
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$421.54
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: BCBS Trust/PPO |
$344.10
|
| Rate for Payer: BCN Commercial |
$325.77
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health HMO/PPO |
$366.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.96
|
| Rate for Payer: UHC Core |
$351.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.16
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$122.06
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.34 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Commercial |
$103.75
|
| Rate for Payer: BCBS Trust/PPO |
$99.64
|
| Rate for Payer: BCN Commercial |
$94.33
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$104.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.65
|
| Rate for Payer: Healthscope Commercial |
$109.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.75
|
| Rate for Payer: Nomi Health Commercial |
$100.09
|
| Rate for Payer: PHP Commercial |
$103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.34
|
| Rate for Payer: Priority Health HMO/PPO |
$106.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.41
|
| Rate for Payer: UHC Core |
$101.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.54
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$122.06
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Commercial |
$103.75
|
| Rate for Payer: Aetna Medicare |
$31.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.14
|
| Rate for Payer: BCBS Complete |
$48.82
|
| Rate for Payer: BCBS MAPPO |
$30.52
|
| Rate for Payer: BCBS Trust/PPO |
$100.35
|
| Rate for Payer: BCN Commercial |
$94.90
|
| Rate for Payer: BCN Medicare Advantage |
$30.52
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$104.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.52
|
| Rate for Payer: Healthscope Commercial |
$109.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.75
|
| Rate for Payer: Nomi Health Commercial |
$100.09
|
| Rate for Payer: PACE Senior Care Partners |
$28.99
|
| Rate for Payer: PACE SWMI |
$30.52
|
| Rate for Payer: PHP Commercial |
$103.75
|
| Rate for Payer: PHP Medicare Advantage |
$30.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.34
|
| Rate for Payer: Priority Health HMO/PPO |
$106.19
|
| Rate for Payer: Priority Health Medicare |
$30.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.78
|
| Rate for Payer: Railroad Medicare Medicare |
$30.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.41
|
| Rate for Payer: UHC Core |
$101.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.52
|
| Rate for Payer: UHC Exchange |
$30.52
|
| Rate for Payer: UHC Medicare Advantage |
$30.52
|
| Rate for Payer: VA VA |
$30.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.54
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$250.29
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$162.69 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: BCBS Trust/PPO |
$204.31
|
| Rate for Payer: BCN Commercial |
$193.42
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health HMO/PPO |
$217.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.26
|
| Rate for Payer: UHC Core |
$208.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.72
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$250.29
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: Aetna Medicare |
$65.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.22
|
| Rate for Payer: BCBS Complete |
$100.12
|
| Rate for Payer: BCBS MAPPO |
$62.57
|
| Rate for Payer: BCBS Trust/PPO |
$205.76
|
| Rate for Payer: BCN Commercial |
$194.60
|
| Rate for Payer: BCN Medicare Advantage |
$62.57
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.57
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: PACE Senior Care Partners |
$59.44
|
| Rate for Payer: PACE SWMI |
$62.57
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: PHP Medicare Advantage |
$62.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health HMO/PPO |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$63.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.69
|
| Rate for Payer: Railroad Medicare Medicare |
$62.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.26
|
| Rate for Payer: UHC Core |
$208.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.57
|
| Rate for Payer: UHC Exchange |
$62.57
|
| Rate for Payer: UHC Medicare Advantage |
$62.57
|
| Rate for Payer: VA VA |
$62.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.72
|
|
