|
HC APHERESIS
|
Facility
|
IP
|
$2,505.38
|
|
| Hospital Charge Code |
36000006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,528.03 |
| Max. Negotiated Rate |
$2,254.84 |
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,936.16
|
| Rate for Payer: BCN Commercial |
$1,936.16
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.30
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,879.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,179.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,528.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,204.73
|
| Rate for Payer: UHC Core |
$2,091.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,879.04
|
|
|
HC APHERESIS
|
Facility
|
OP
|
$2,505.38
|
|
| Hospital Charge Code |
36000006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.03 |
| Max. Negotiated Rate |
$2,254.84 |
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: Aetna Medicare |
$651.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.93
|
| Rate for Payer: BCBS Complete |
$1,002.15
|
| Rate for Payer: BCBS MAPPO |
$626.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,947.93
|
| Rate for Payer: BCN Commercial |
$1,947.93
|
| Rate for Payer: BCN Medicare Advantage |
$626.34
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.34
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,879.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$720.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PACE Senior Care Partners |
$595.03
|
| Rate for Payer: PACE SWMI |
$626.34
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: PHP Medicare Advantage |
$626.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,179.68
|
| Rate for Payer: Priority Health Medicare |
$626.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,528.03
|
| Rate for Payer: Railroad Medicare Medicare |
$626.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,204.73
|
| Rate for Payer: UHC Core |
$2,091.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.34
|
| Rate for Payer: UHC Medicare Advantage |
$645.14
|
| Rate for Payer: VA VA |
$626.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,879.04
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
OP
|
$129.14
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: Aetna Medicare |
$33.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.36
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCBS MAPPO |
$32.28
|
| Rate for Payer: BCBS Trust/PPO |
$100.41
|
| Rate for Payer: BCN Commercial |
$100.41
|
| Rate for Payer: BCN Medicare Advantage |
$32.28
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.28
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.77
|
| Rate for Payer: PACE Senior Care Partners |
$30.67
|
| Rate for Payer: PACE SWMI |
$32.28
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: PHP Medicare Advantage |
$32.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.35
|
| Rate for Payer: Priority Health Medicare |
$32.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.76
|
| Rate for Payer: Railroad Medicare Medicare |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.64
|
| Rate for Payer: UHC Core |
$107.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.28
|
| Rate for Payer: UHC Medicare Advantage |
$33.25
|
| Rate for Payer: VA VA |
$32.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.86
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
IP
|
$129.14
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: BCBS Trust/PPO |
$99.80
|
| Rate for Payer: BCN Commercial |
$99.80
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.31
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.77
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.64
|
| Rate for Payer: UHC Core |
$107.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.86
|
|
|
HC APNEALINK PLUS
|
Facility
|
IP
|
$733.10
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$447.12 |
| Max. Negotiated Rate |
$659.79 |
| Rate for Payer: Aetna Commercial |
$623.14
|
| Rate for Payer: BCBS Trust/PPO |
$566.54
|
| Rate for Payer: BCN Commercial |
$566.54
|
| Rate for Payer: Cash Price |
$586.48
|
| Rate for Payer: Cofinity Commercial |
$630.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.48
|
| Rate for Payer: Healthscope Commercial |
$659.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.14
|
| Rate for Payer: PHP Commercial |
$623.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.13
|
| Rate for Payer: UHC Core |
$612.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.82
|
|
|
HC APNEALINK PLUS
|
Facility
|
OP
|
$733.10
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$659.79 |
| Rate for Payer: Aetna Commercial |
$623.14
|
| Rate for Payer: Aetna Medicare |
$190.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.09
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$183.28
|
| Rate for Payer: BCBS Trust/PPO |
$569.99
|
| Rate for Payer: BCN Commercial |
$569.99
|
| Rate for Payer: BCN Medicare Advantage |
$183.28
|
| Rate for Payer: Cash Price |
$586.48
|
| Rate for Payer: Cash Price |
$586.48
|
| Rate for Payer: Cofinity Commercial |
$630.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.28
|
| Rate for Payer: Healthscope Commercial |
$659.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.82
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$192.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.14
|
| Rate for Payer: PACE Senior Care Partners |
$174.11
|
| Rate for Payer: PACE SWMI |
$183.28
|
| Rate for Payer: PHP Commercial |
$623.14
|
| Rate for Payer: PHP Medicare Advantage |
$183.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.80
|
| Rate for Payer: Priority Health Medicare |
$183.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.12
|
| Rate for Payer: Railroad Medicare Medicare |
$183.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.13
|
| Rate for Payer: UHC Core |
$612.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.28
|
| Rate for Payer: UHC Medicare Advantage |
$188.77
|
| Rate for Payer: VA VA |
$183.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.82
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna Medicare |
$17.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: BCBS Complete |
$16.34
|
| Rate for Payer: BCBS MAPPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.65
|
| Rate for Payer: BCN Commercial |
$53.65
|
| Rate for Payer: BCN Medicare Advantage |
$17.25
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Mclaren Medicaid |
$15.56
|
| Rate for Payer: Meridian Medicaid |
$16.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PACE Senior Care Partners |
$16.39
|
| Rate for Payer: PACE SWMI |
$17.25
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Medicare Advantage |
$17.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.03
|
| Rate for Payer: Priority Health Medicare |
$17.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.25
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: VA VA |
$17.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$53.32
|
| Rate for Payer: BCN Commercial |
$53.32
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$12.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$16.34
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.86
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Mclaren Medicaid |
$15.56
|
| Rate for Payer: Meridian Medicaid |
$16.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PACE Senior Care Partners |
$11.87
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.48
|
| Rate for Payer: Priority Health Medicare |
$12.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.48
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$29.95
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.11
|
| Rate for Payer: BCBS Complete |
$16.34
|
| Rate for Payer: BCBS MAPPO |
$9.69
|
| Rate for Payer: BCBS Trust/PPO |
$30.14
|
| Rate for Payer: BCN Commercial |
$30.14
|
| Rate for Payer: BCN Medicare Advantage |
$9.69
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Mclaren Medicaid |
$15.56
|
| Rate for Payer: Meridian Medicaid |
$16.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Senior Care Partners |
$9.21
|
| Rate for Payer: PACE SWMI |
$9.69
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$9.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.69
|
| Rate for Payer: UHC Medicare Advantage |
$9.98
|
| Rate for Payer: VA VA |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$24.42
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.63
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.99
|
| Rate for Payer: BCN Commercial |
$18.99
|
| Rate for Payer: BCN Medicare Advantage |
$6.10
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.10
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.76
|
| Rate for Payer: PACE Senior Care Partners |
$5.80
|
| Rate for Payer: PACE SWMI |
$6.10
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Medicare Advantage |
$6.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.25
|
| Rate for Payer: Priority Health Medicare |
$6.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.89
|
| Rate for Payer: Railroad Medicare Medicare |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.49
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.10
|
| Rate for Payer: UHC Medicare Advantage |
$6.29
|
| Rate for Payer: VA VA |
$6.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.32
|
|
|
HC APPLIANCE BELT
|
Facility
|
IP
|
$24.42
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: BCBS Trust/PPO |
$18.87
|
| Rate for Payer: BCN Commercial |
$18.87
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.76
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.49
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.32
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$34.80
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna Commercial |
$29.58
|
| Rate for Payer: Aetna Medicare |
$9.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.88
|
| Rate for Payer: BCBS Complete |
$13.92
|
| Rate for Payer: BCBS MAPPO |
$8.70
|
| Rate for Payer: BCBS Trust/PPO |
$27.06
|
| Rate for Payer: BCN Commercial |
$27.06
|
| Rate for Payer: BCN Medicare Advantage |
$8.70
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.70
|
| Rate for Payer: Healthscope Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.58
|
| Rate for Payer: PACE Senior Care Partners |
$8.26
|
| Rate for Payer: PACE SWMI |
$8.70
|
| Rate for Payer: PHP Commercial |
$29.58
|
| Rate for Payer: PHP Medicare Advantage |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.28
|
| Rate for Payer: Priority Health Medicare |
$8.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.62
|
| Rate for Payer: UHC Core |
$29.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.70
|
| Rate for Payer: UHC Medicare Advantage |
$8.96
|
| Rate for Payer: VA VA |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.10
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$34.80
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna Commercial |
$29.58
|
| Rate for Payer: BCBS Trust/PPO |
$26.89
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.84
|
| Rate for Payer: Healthscope Commercial |
$31.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.58
|
| Rate for Payer: PHP Commercial |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.62
|
| Rate for Payer: UHC Core |
$29.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.10
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$146.85
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$132.16 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: BCBS Trust/PPO |
$113.49
|
| Rate for Payer: BCN Commercial |
$113.49
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.48
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.23
|
| Rate for Payer: UHC Core |
$122.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.14
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$146.85
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$132.16 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Aetna Medicare |
$38.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.89
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$36.71
|
| Rate for Payer: BCBS Trust/PPO |
$114.18
|
| Rate for Payer: BCN Commercial |
$114.18
|
| Rate for Payer: BCN Medicare Advantage |
$36.71
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.71
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.14
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PACE Senior Care Partners |
$34.88
|
| Rate for Payer: PACE SWMI |
$36.71
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: PHP Medicare Advantage |
$36.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.76
|
| Rate for Payer: Priority Health Medicare |
$36.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.56
|
| Rate for Payer: Railroad Medicare Medicare |
$36.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.23
|
| Rate for Payer: UHC Core |
$122.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.71
|
| Rate for Payer: UHC Medicare Advantage |
$37.81
|
| Rate for Payer: VA VA |
$36.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.14
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,909.32
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,164.49 |
| Max. Negotiated Rate |
$1,718.39 |
| Rate for Payer: Aetna Commercial |
$1,622.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,475.52
|
| Rate for Payer: BCN Commercial |
$1,475.52
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,642.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.46
|
| Rate for Payer: Healthscope Commercial |
$1,718.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,431.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: PHP Commercial |
$1,622.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,661.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,164.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.20
|
| Rate for Payer: UHC Core |
$1,594.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,431.99
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,909.32
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.46 |
| Max. Negotiated Rate |
$1,718.39 |
| Rate for Payer: Aetna Commercial |
$1,622.92
|
| Rate for Payer: Aetna Medicare |
$496.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.66
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$477.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,484.50
|
| Rate for Payer: BCN Commercial |
$1,484.50
|
| Rate for Payer: BCN Medicare Advantage |
$477.33
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,642.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.33
|
| Rate for Payer: Healthscope Commercial |
$1,718.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,431.99
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$501.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: PACE Senior Care Partners |
$453.46
|
| Rate for Payer: PACE SWMI |
$477.33
|
| Rate for Payer: PHP Commercial |
$1,622.92
|
| Rate for Payer: PHP Medicare Advantage |
$477.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,661.11
|
| Rate for Payer: Priority Health Medicare |
$477.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,164.49
|
| Rate for Payer: Railroad Medicare Medicare |
$477.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.20
|
| Rate for Payer: UHC Core |
$1,594.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.33
|
| Rate for Payer: UHC Medicare Advantage |
$491.65
|
| Rate for Payer: VA VA |
$477.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,431.99
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,520.30
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.57 |
| Max. Negotiated Rate |
$2,471.13 |
| Rate for Payer: Aetna Commercial |
$2,142.26
|
| Rate for Payer: Aetna Medicare |
$655.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$787.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$787.59
|
| Rate for Payer: BCBS Complete |
$2,471.13
|
| Rate for Payer: BCBS MAPPO |
$630.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.53
|
| Rate for Payer: BCN Commercial |
$1,959.53
|
| Rate for Payer: BCN Medicare Advantage |
$630.08
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$2,167.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,016.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.08
|
| Rate for Payer: Healthscope Commercial |
$2,268.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,890.22
|
| Rate for Payer: Mclaren Medicaid |
$2,353.45
|
| Rate for Payer: Meridian Medicaid |
$2,471.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$661.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$724.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: PACE Senior Care Partners |
$598.57
|
| Rate for Payer: PACE SWMI |
$630.08
|
| Rate for Payer: PHP Commercial |
$2,142.26
|
| Rate for Payer: PHP Medicare Advantage |
$630.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,353.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,192.66
|
| Rate for Payer: Priority Health Medicare |
$630.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,537.13
|
| Rate for Payer: Railroad Medicare Medicare |
$630.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,217.86
|
| Rate for Payer: UHC Core |
$2,104.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$630.08
|
| Rate for Payer: UHC Medicare Advantage |
$648.98
|
| Rate for Payer: VA VA |
$630.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,890.22
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,520.30
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,537.13 |
| Max. Negotiated Rate |
$2,268.27 |
| Rate for Payer: Aetna Commercial |
$2,142.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,947.69
|
| Rate for Payer: BCN Commercial |
$1,947.69
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$2,167.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,016.24
|
| Rate for Payer: Healthscope Commercial |
$2,268.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,890.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: PHP Commercial |
$2,142.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,192.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,537.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,217.86
|
| Rate for Payer: UHC Core |
$2,104.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,890.22
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,553.43
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,557.34 |
| Max. Negotiated Rate |
$2,298.09 |
| Rate for Payer: Aetna Commercial |
$2,170.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.29
|
| Rate for Payer: BCN Commercial |
$1,973.29
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cofinity Commercial |
$2,195.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,042.74
|
| Rate for Payer: Healthscope Commercial |
$2,298.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,915.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,170.42
|
| Rate for Payer: PHP Commercial |
$2,170.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,221.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,557.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,247.02
|
| Rate for Payer: UHC Core |
$2,132.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,915.07
|
|
