|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
OP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: Aetna Medicare |
$92.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.03
|
| Rate for Payer: BCBS Complete |
$65.77
|
| Rate for Payer: BCBS MAPPO |
$88.83
|
| Rate for Payer: BCBS Trust/PPO |
$292.10
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$292.10
|
| Rate for Payer: BCN Medicare Advantage |
$88.83
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.83
|
| Rate for Payer: Healthscope Commercial |
$319.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Mclaren Medicaid |
$62.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.27
|
| Rate for Payer: Meridian Medicaid |
$65.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.01
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.48
|
| Rate for Payer: PACE Senior Care Partners |
$84.39
|
| Rate for Payer: PACE SWMI |
$88.83
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: PHP Medicare Advantage |
$88.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$309.12
|
| Rate for Payer: Priority Health Medicare |
$89.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.30
|
| Rate for Payer: Railroad Medicare Medicare |
$88.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.67
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: UHC Exchange |
$88.83
|
| Rate for Payer: UHC Medicaid |
$62.64
|
| Rate for Payer: UHC Medicare Advantage |
$88.83
|
| Rate for Payer: UHCCP Medicaid |
$62.64
|
| Rate for Payer: VA VA |
$88.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$128.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.51
|
| Rate for Payer: BCBS Complete |
$91.52
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Mclaren Medicaid |
$87.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: Meridian Medicaid |
$91.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PACE Senior Care Partners |
$117.43
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Medicare |
$124.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.12
|
| Rate for Payer: Railroad Medicare Medicare |
$123.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: UHC Exchange |
$123.61
|
| Rate for Payer: UHC Medicaid |
$87.17
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
| Rate for Payer: UHCCP Medicaid |
$87.17
|
| Rate for Payer: VA VA |
$123.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$344.12 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: BCBS Trust/PPO |
$408.35
|
| Rate for Payer: BCN Commercial |
$408.35
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.68 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$179.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.27
|
| Rate for Payer: BCBS Complete |
$127.51
|
| Rate for Payer: BCBS MAPPO |
$172.21
|
| Rate for Payer: BCBS Trust/PPO |
$566.30
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$566.30
|
| Rate for Payer: BCN Medicare Advantage |
$172.21
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.21
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Mclaren Medicaid |
$121.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.82
|
| Rate for Payer: Meridian Medicaid |
$127.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$189.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PACE Senior Care Partners |
$163.60
|
| Rate for Payer: PACE SWMI |
$172.21
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: PHP Medicare Advantage |
$172.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$173.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.44
|
| Rate for Payer: Railroad Medicare Medicare |
$172.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: UHC Exchange |
$172.21
|
| Rate for Payer: UHC Medicaid |
$121.44
|
| Rate for Payer: UHC Medicare Advantage |
$172.21
|
| Rate for Payer: UHCCP Medicaid |
$121.44
|
| Rate for Payer: VA VA |
$172.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$479.44 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: BCBS Trust/PPO |
$568.92
|
| Rate for Payer: BCN Commercial |
$568.92
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$599.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.68 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna Medicare |
$227.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.29
|
| Rate for Payer: BCBS Complete |
$161.87
|
| Rate for Payer: BCBS MAPPO |
$218.63
|
| Rate for Payer: BCBS Trust/PPO |
$718.94
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$718.94
|
| Rate for Payer: BCN Medicare Advantage |
$218.63
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.63
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Mclaren Medicaid |
$154.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.56
|
| Rate for Payer: Meridian Medicaid |
$161.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Nomi Health Commercial |
$717.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PACE Senior Care Partners |
$207.70
|
| Rate for Payer: PACE SWMI |
$218.63
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: PHP Medicare Advantage |
$218.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$760.83
|
| Rate for Payer: Priority Health Medicare |
$220.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.67
|
| Rate for Payer: Railroad Medicare Medicare |
$218.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.58
|
| Rate for Payer: UHC Core |
$730.22
|
| Rate for Payer: UHC Exchange |
$218.63
|
| Rate for Payer: UHC Medicaid |
$154.18
|
| Rate for Payer: UHC Medicare Advantage |
$218.63
|
| Rate for Payer: UHCCP Medicaid |
$154.18
|
| Rate for Payer: VA VA |
$218.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$608.67 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: BCBS Trust/PPO |
$722.27
|
| Rate for Payer: BCN Commercial |
$722.27
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Nomi Health Commercial |
$717.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$760.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.58
|
| Rate for Payer: UHC Core |
$730.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.86 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna Medicare |
$271.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.90
|
| Rate for Payer: BCBS Complete |
$193.04
|
| Rate for Payer: BCBS MAPPO |
$260.72
|
| Rate for Payer: BCBS Trust/PPO |
$857.35
|
| Rate for Payer: BCN Commercial |
$857.35
|
| Rate for Payer: BCN Medicare Advantage |
$260.72
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.72
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Mclaren Medicaid |
$183.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.76
|
| Rate for Payer: Meridian Medicaid |
$193.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Nomi Health Commercial |
$855.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PACE Senior Care Partners |
$247.68
|
| Rate for Payer: PACE SWMI |
$260.72
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: PHP Medicare Advantage |
$260.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$907.31
|
| Rate for Payer: Priority Health Medicare |
$263.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.84
|
| Rate for Payer: Railroad Medicare Medicare |
$260.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.73
|
| Rate for Payer: UHC Core |
$870.80
|
| Rate for Payer: UHC Exchange |
$260.72
|
| Rate for Payer: UHC Medicaid |
$183.86
|
| Rate for Payer: UHC Medicare Advantage |
$260.72
|
| Rate for Payer: UHCCP Medicaid |
$183.86
|
| Rate for Payer: VA VA |
$260.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$725.84 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: BCBS Trust/PPO |
$861.31
|
| Rate for Payer: BCN Commercial |
$861.31
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Nomi Health Commercial |
$855.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$907.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.73
|
| Rate for Payer: UHC Core |
$870.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
OP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: Aetna Medicare |
$96.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.48
|
| Rate for Payer: BCBS Complete |
$68.99
|
| Rate for Payer: BCBS MAPPO |
$93.19
|
| Rate for Payer: BCBS Trust/PPO |
$306.43
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$306.43
|
| Rate for Payer: BCN Medicare Advantage |
$93.19
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.19
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.56
|
| Rate for Payer: Mclaren Medicaid |
$65.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.84
|
| Rate for Payer: Meridian Medicaid |
$68.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: Nomi Health Commercial |
$305.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.56
|
| Rate for Payer: PACE Senior Care Partners |
$88.53
|
| Rate for Payer: PACE SWMI |
$93.19
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: PHP Medicare Advantage |
$93.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.28
|
| Rate for Payer: Priority Health Medicare |
$94.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.43
|
| Rate for Payer: Railroad Medicare Medicare |
$93.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.01
|
| Rate for Payer: UHC Core |
$311.24
|
| Rate for Payer: UHC Exchange |
$93.19
|
| Rate for Payer: UHC Medicaid |
$65.71
|
| Rate for Payer: UHC Medicare Advantage |
$93.19
|
| Rate for Payer: UHCCP Medicaid |
$65.71
|
| Rate for Payer: VA VA |
$93.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.56
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.43 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: BCBS Trust/PPO |
$307.85
|
| Rate for Payer: BCN Commercial |
$307.85
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$320.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: Nomi Health Commercial |
$305.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.56
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.01
|
| Rate for Payer: UHC Core |
$311.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.56
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
OP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Medicare |
$42.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.61
|
| Rate for Payer: BCBS Complete |
$30.57
|
| Rate for Payer: BCBS MAPPO |
$41.29
|
| Rate for Payer: BCBS Trust/PPO |
$135.78
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$135.78
|
| Rate for Payer: BCN Medicare Advantage |
$41.29
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.29
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.87
|
| Rate for Payer: Mclaren Medicaid |
$29.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.35
|
| Rate for Payer: Meridian Medicaid |
$30.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Nomi Health Commercial |
$135.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.87
|
| Rate for Payer: PACE Senior Care Partners |
$39.23
|
| Rate for Payer: PACE SWMI |
$41.29
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: PHP Medicare Advantage |
$41.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.69
|
| Rate for Payer: Priority Health Medicare |
$41.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.95
|
| Rate for Payer: Railroad Medicare Medicare |
$41.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.34
|
| Rate for Payer: UHC Core |
$137.91
|
| Rate for Payer: UHC Exchange |
$41.29
|
| Rate for Payer: UHC Medicaid |
$29.12
|
| Rate for Payer: UHC Medicare Advantage |
$41.29
|
| Rate for Payer: UHCCP Medicaid |
$29.12
|
| Rate for Payer: VA VA |
$41.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.87
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
IP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: BCBS Trust/PPO |
$136.41
|
| Rate for Payer: BCN Commercial |
$136.41
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$148.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Nomi Health Commercial |
$135.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.87
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.34
|
| Rate for Payer: UHC Core |
$137.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.87
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$344.12 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: BCBS Trust/PPO |
$408.35
|
| Rate for Payer: BCN Commercial |
$408.35
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna Medicare |
$128.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.51
|
| Rate for Payer: BCBS Complete |
$91.52
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.82
|
| Rate for Payer: Mclaren Medicaid |
$87.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: Meridian Medicaid |
$91.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: PACE Senior Care Partners |
$117.43
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Medicare |
$124.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.12
|
| Rate for Payer: Railroad Medicare Medicare |
$123.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.10
|
| Rate for Payer: UHC Core |
$412.85
|
| Rate for Payer: UHC Exchange |
$123.61
|
| Rate for Payer: UHC Medicaid |
$87.17
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
| Rate for Payer: UHCCP Medicaid |
$87.17
|
| Rate for Payer: VA VA |
$123.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.82
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$479.44 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: BCBS Trust/PPO |
$568.92
|
| Rate for Payer: BCN Commercial |
$568.92
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$599.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$619.97 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna Medicare |
$179.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.27
|
| Rate for Payer: BCBS Complete |
$127.51
|
| Rate for Payer: BCBS MAPPO |
$172.21
|
| Rate for Payer: BCBS Trust/PPO |
$566.30
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$566.30
|
| Rate for Payer: BCN Medicare Advantage |
$172.21
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.21
|
| Rate for Payer: Healthscope Commercial |
$619.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Mclaren Medicaid |
$121.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.82
|
| Rate for Payer: Meridian Medicaid |
$127.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$189.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: PACE Senior Care Partners |
$163.60
|
| Rate for Payer: PACE SWMI |
$172.21
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: PHP Medicare Advantage |
$172.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$173.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.44
|
| Rate for Payer: Railroad Medicare Medicare |
$172.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.19
|
| Rate for Payer: UHC Core |
$575.19
|
| Rate for Payer: UHC Exchange |
$172.21
|
| Rate for Payer: UHC Medicaid |
$121.44
|
| Rate for Payer: UHC Medicare Advantage |
$172.21
|
| Rate for Payer: UHCCP Medicaid |
$121.44
|
| Rate for Payer: VA VA |
$172.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$608.67 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: BCBS Trust/PPO |
$722.27
|
| Rate for Payer: BCN Commercial |
$722.27
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Nomi Health Commercial |
$717.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$760.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.58
|
| Rate for Payer: UHC Core |
$730.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna Medicare |
$227.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.29
|
| Rate for Payer: BCBS Complete |
$161.87
|
| Rate for Payer: BCBS MAPPO |
$218.63
|
| Rate for Payer: BCBS Trust/PPO |
$718.94
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$718.94
|
| Rate for Payer: BCN Medicare Advantage |
$218.63
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.63
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.89
|
| Rate for Payer: Mclaren Medicaid |
$154.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.56
|
| Rate for Payer: Meridian Medicaid |
$161.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Nomi Health Commercial |
$717.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: PACE Senior Care Partners |
$207.70
|
| Rate for Payer: PACE SWMI |
$218.63
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: PHP Medicare Advantage |
$218.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$760.83
|
| Rate for Payer: Priority Health Medicare |
$220.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.67
|
| Rate for Payer: Railroad Medicare Medicare |
$218.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.58
|
| Rate for Payer: UHC Core |
$730.22
|
| Rate for Payer: UHC Exchange |
$218.63
|
| Rate for Payer: UHC Medicaid |
$154.18
|
| Rate for Payer: UHC Medicare Advantage |
$218.63
|
| Rate for Payer: UHCCP Medicaid |
$154.18
|
| Rate for Payer: VA VA |
$218.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.89
|
|
|
HC ACB NEW PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$725.84 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: BCBS Trust/PPO |
$861.31
|
| Rate for Payer: BCN Commercial |
$861.31
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Nomi Health Commercial |
$855.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$907.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.73
|
| Rate for Payer: UHC Core |
$870.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACB NEW PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: Aetna Medicare |
$271.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.90
|
| Rate for Payer: BCBS Complete |
$193.04
|
| Rate for Payer: BCBS MAPPO |
$260.72
|
| Rate for Payer: BCBS Trust/PPO |
$857.35
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$857.35
|
| Rate for Payer: BCN Medicare Advantage |
$260.72
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$896.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.72
|
| Rate for Payer: Healthscope Commercial |
$938.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$782.16
|
| Rate for Payer: Mclaren Medicaid |
$183.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.76
|
| Rate for Payer: Meridian Medicaid |
$193.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Nomi Health Commercial |
$855.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: PACE Senior Care Partners |
$247.68
|
| Rate for Payer: PACE SWMI |
$260.72
|
| Rate for Payer: PHP Commercial |
$886.45
|
| Rate for Payer: PHP Medicare Advantage |
$260.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$907.31
|
| Rate for Payer: Priority Health Medicare |
$263.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.84
|
| Rate for Payer: Railroad Medicare Medicare |
$260.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.73
|
| Rate for Payer: UHC Core |
$870.80
|
| Rate for Payer: UHC Exchange |
$260.72
|
| Rate for Payer: UHC Medicaid |
$183.86
|
| Rate for Payer: UHC Medicare Advantage |
$260.72
|
| Rate for Payer: UHCCP Medicaid |
$183.86
|
| Rate for Payer: VA VA |
$260.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$782.16
|
|
|
HC ACCESS AORTA
|
Facility
|
OP
|
$3,998.72
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.97 |
| Max. Negotiated Rate |
$3,598.85 |
| Rate for Payer: Aetna Commercial |
$3,398.91
|
| Rate for Payer: Aetna Medicare |
$1,039.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,249.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,249.60
|
| Rate for Payer: BCBS Complete |
$740.16
|
| Rate for Payer: BCBS MAPPO |
$999.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,287.35
|
| Rate for Payer: BCN Commercial |
$3,287.35
|
| Rate for Payer: BCN Medicare Advantage |
$999.68
|
| Rate for Payer: Cash Price |
$3,198.98
|
| Rate for Payer: Cofinity Commercial |
$3,438.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$999.68
|
| Rate for Payer: Healthscope Commercial |
$3,598.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,999.04
|
| Rate for Payer: Mclaren Medicaid |
$704.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,049.66
|
| Rate for Payer: Meridian Medicaid |
$740.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,149.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,099.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.91
|
| Rate for Payer: Nomi Health Commercial |
$3,278.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.04
|
| Rate for Payer: PACE Senior Care Partners |
$949.70
|
| Rate for Payer: PACE SWMI |
$999.68
|
| Rate for Payer: PHP Commercial |
$3,398.91
|
| Rate for Payer: PHP Medicare Advantage |
$999.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$704.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,478.89
|
| Rate for Payer: Priority Health Medicare |
$1,009.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,783.11
|
| Rate for Payer: Railroad Medicare Medicare |
$999.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,518.87
|
| Rate for Payer: UHC Core |
$3,338.93
|
| Rate for Payer: UHC Exchange |
$999.68
|
| Rate for Payer: UHC Medicaid |
$704.97
|
| Rate for Payer: UHC Medicare Advantage |
$999.68
|
| Rate for Payer: UHCCP Medicaid |
$704.97
|
| Rate for Payer: VA VA |
$999.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,999.04
|
|
|
HC ACCESS AORTA
|
Facility
|
IP
|
$3,998.72
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,783.11 |
| Max. Negotiated Rate |
$3,598.85 |
| Rate for Payer: Aetna Commercial |
$3,398.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,302.54
|
| Rate for Payer: BCN Commercial |
$3,302.54
|
| Rate for Payer: Cash Price |
$3,198.98
|
| Rate for Payer: Cofinity Commercial |
$3,438.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.98
|
| Rate for Payer: Healthscope Commercial |
$3,598.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,999.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.91
|
| Rate for Payer: Nomi Health Commercial |
$3,278.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.04
|
| Rate for Payer: PHP Commercial |
$3,398.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,478.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,783.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,518.87
|
| Rate for Payer: UHC Core |
$3,338.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,999.04
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
OP
|
$510.94
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.08 |
| Max. Negotiated Rate |
$459.85 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Medicare |
$132.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.67
|
| Rate for Payer: BCBS Complete |
$94.57
|
| Rate for Payer: BCBS MAPPO |
$127.73
|
| Rate for Payer: BCBS Trust/PPO |
$420.04
|
| Rate for Payer: BCN Commercial |
$420.04
|
| Rate for Payer: BCN Medicare Advantage |
$127.73
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cofinity Commercial |
$439.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.73
|
| Rate for Payer: Healthscope Commercial |
$459.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.20
|
| Rate for Payer: Mclaren Medicaid |
$90.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.12
|
| Rate for Payer: Meridian Medicaid |
$94.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.30
|
| Rate for Payer: Nomi Health Commercial |
$418.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.20
|
| Rate for Payer: PACE Senior Care Partners |
$121.35
|
| Rate for Payer: PACE SWMI |
$127.73
|
| Rate for Payer: PHP Commercial |
$434.30
|
| Rate for Payer: PHP Medicare Advantage |
$127.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$444.52
|
| Rate for Payer: Priority Health Medicare |
$129.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.61
|
| Rate for Payer: Railroad Medicare Medicare |
$127.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.63
|
| Rate for Payer: UHC Core |
$426.63
|
| Rate for Payer: UHC Exchange |
$127.73
|
| Rate for Payer: UHC Medicaid |
$90.08
|
| Rate for Payer: UHC Medicare Advantage |
$127.73
|
| Rate for Payer: UHCCP Medicaid |
$90.08
|
| Rate for Payer: VA VA |
$127.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.20
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
IP
|
$510.94
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.61 |
| Max. Negotiated Rate |
$459.85 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: BCBS Trust/PPO |
$421.99
|
| Rate for Payer: BCN Commercial |
$421.99
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cofinity Commercial |
$439.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.75
|
| Rate for Payer: Healthscope Commercial |
$459.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.30
|
| Rate for Payer: Nomi Health Commercial |
$418.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.20
|
| Rate for Payer: PHP Commercial |
$434.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$444.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.63
|
| Rate for Payer: UHC Core |
$426.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.20
|
|
