|
HC ADMIN SARSCOV2 VACC EACH ADDL COMPONENT
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90481
|
| Hospital Charge Code |
77100067
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.52
|
| Rate for Payer: BCBS Complete |
$6.23
|
| Rate for Payer: BCBS MAPPO |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.67
|
| Rate for Payer: BCN Commercial |
$27.67
|
| Rate for Payer: BCN Medicare Advantage |
$8.41
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.25
|
| Rate for Payer: Mclaren Medicaid |
$5.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.84
|
| Rate for Payer: Meridian Medicaid |
$6.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PACE Senior Care Partners |
$7.99
|
| Rate for Payer: PACE SWMI |
$8.41
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Medicare |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.43
|
| Rate for Payer: Railroad Medicare Medicare |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Medicaid |
$5.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.41
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: VA VA |
$8.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
|
|
HC ADMIN SARSCOV2 VACC EACH ADDL COMPONENT
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90481
|
| Hospital Charge Code |
77100067
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: BCBS Trust/PPO |
$27.80
|
| Rate for Payer: BCN Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: BCBS Trust/PPO |
$450.50
|
| Rate for Payer: BCN Commercial |
$450.50
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 1ST DOSE
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
77100044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.17 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.46
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Mclaren Medicaid |
$96.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$100.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Senior Care Partners |
$129.55
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicaid |
$96.17
|
| Rate for Payer: UHC Medicare Advantage |
$136.37
|
| Rate for Payer: UHCCP Medicaid |
$96.17
|
| Rate for Payer: VA VA |
$136.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.17 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.46
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Mclaren Medicaid |
$96.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$100.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Senior Care Partners |
$129.55
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicaid |
$96.17
|
| Rate for Payer: UHC Medicare Advantage |
$136.37
|
| Rate for Payer: UHCCP Medicaid |
$96.17
|
| Rate for Payer: VA VA |
$136.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: BCBS Trust/PPO |
$450.50
|
| Rate for Payer: BCN Commercial |
$450.50
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC ADMN SARSCOV2 VACC FIRST OR ONLY COMPONENT
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.76
|
| Rate for Payer: BCBS Complete |
$18.81
|
| Rate for Payer: BCBS MAPPO |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$83.56
|
| Rate for Payer: BCN Commercial |
$83.56
|
| Rate for Payer: BCN Medicare Advantage |
$25.41
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.41
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.23
|
| Rate for Payer: Mclaren Medicaid |
$17.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.68
|
| Rate for Payer: Meridian Medicaid |
$18.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.41
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: PHP Medicare Advantage |
$25.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.43
|
| Rate for Payer: Priority Health Medicare |
$25.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.74
|
| Rate for Payer: Railroad Medicare Medicare |
$25.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.44
|
| Rate for Payer: UHC Core |
$84.87
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicaid |
$17.92
|
| Rate for Payer: UHC Medicare Advantage |
$25.41
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: VA VA |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.23
|
|
|
HC ADMN SARSCOV2 VACC FIRST OR ONLY COMPONENT
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: BCBS Trust/PPO |
$83.94
|
| Rate for Payer: BCN Commercial |
$83.94
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.44
|
| Rate for Payer: UHC Core |
$84.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.23
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.54
|
| Rate for Payer: BCN Commercial |
$131.54
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
OP
|
$69.15
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.61
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$56.85
|
| Rate for Payer: BCN Commercial |
$56.85
|
| Rate for Payer: BCN Medicare Advantage |
$17.29
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.86
|
| Rate for Payer: Mclaren Medicaid |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.15
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PACE Senior Care Partners |
$16.42
|
| Rate for Payer: PACE SWMI |
$17.29
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$17.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.16
|
| Rate for Payer: Priority Health Medicare |
$17.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.13
|
| Rate for Payer: Railroad Medicare Medicare |
$17.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.85
|
| Rate for Payer: UHC Core |
$57.74
|
| Rate for Payer: UHC Exchange |
$17.29
|
| Rate for Payer: UHC Medicaid |
$12.19
|
| Rate for Payer: UHC Medicare Advantage |
$17.29
|
| Rate for Payer: UHCCP Medicaid |
$12.19
|
| Rate for Payer: VA VA |
$17.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.86
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
IP
|
$69.15
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$57.11
|
| Rate for Payer: BCN Commercial |
$57.11
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.85
|
| Rate for Payer: UHC Core |
$57.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.86
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$2.89
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.83
|
| Rate for Payer: BCN Commercial |
$12.83
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Mclaren Medicaid |
$2.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$2.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: PACE Senior Care Partners |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: UHC Exchange |
$3.90
|
| Rate for Payer: UHC Medicaid |
$2.75
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$2.75
|
| Rate for Payer: VA VA |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$12.89
|
| Rate for Payer: BCN Commercial |
$12.89
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.71
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$8.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS MAPPO |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$27.92
|
| Rate for Payer: BCN Commercial |
$27.92
|
| Rate for Payer: BCN Medicare Advantage |
$8.49
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Mclaren Medicaid |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.91
|
| Rate for Payer: Meridian Medicaid |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PACE Senior Care Partners |
$8.07
|
| Rate for Payer: PACE SWMI |
$8.49
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: PHP Medicare Advantage |
$8.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Medicare |
$8.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: UHC Exchange |
$8.49
|
| Rate for Payer: UHC Medicaid |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$8.49
|
| Rate for Payer: UHCCP Medicaid |
$5.99
|
| Rate for Payer: VA VA |
$8.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: BCBS Trust/PPO |
$28.05
|
| Rate for Payer: BCN Commercial |
$28.05
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: BCBS Trust/PPO |
$28.05
|
| Rate for Payer: BCN Commercial |
$28.05
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$8.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS MAPPO |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$27.92
|
| Rate for Payer: BCN Commercial |
$27.92
|
| Rate for Payer: BCN Medicare Advantage |
$8.49
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Mclaren Medicaid |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.91
|
| Rate for Payer: Meridian Medicaid |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PACE Senior Care Partners |
$8.07
|
| Rate for Payer: PACE SWMI |
$8.49
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: PHP Medicare Advantage |
$8.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Medicare |
$8.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: UHC Exchange |
$8.49
|
| Rate for Payer: UHC Medicaid |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$8.49
|
| Rate for Payer: UHCCP Medicaid |
$5.99
|
| Rate for Payer: VA VA |
$8.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
OP
|
$164.38
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna Medicare |
$42.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.37
|
| Rate for Payer: BCBS Complete |
$30.43
|
| Rate for Payer: BCBS MAPPO |
$41.09
|
| Rate for Payer: BCBS Trust/PPO |
$135.14
|
| Rate for Payer: BCN Commercial |
$135.14
|
| Rate for Payer: BCN Medicare Advantage |
$41.09
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.09
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.28
|
| Rate for Payer: Mclaren Medicaid |
$28.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.15
|
| Rate for Payer: Meridian Medicaid |
$30.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$134.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.28
|
| Rate for Payer: PACE Senior Care Partners |
$39.04
|
| Rate for Payer: PACE SWMI |
$41.09
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: PHP Medicare Advantage |
$41.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.01
|
| Rate for Payer: Priority Health Medicare |
$41.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.41
|
| Rate for Payer: Railroad Medicare Medicare |
$41.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.65
|
| Rate for Payer: UHC Core |
$137.26
|
| Rate for Payer: UHC Exchange |
$41.09
|
| Rate for Payer: UHC Medicaid |
$28.98
|
| Rate for Payer: UHC Medicare Advantage |
$41.09
|
| Rate for Payer: UHCCP Medicaid |
$28.98
|
| Rate for Payer: VA VA |
$41.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.28
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
IP
|
$164.38
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$114.41 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: BCBS Trust/PPO |
$135.76
|
| Rate for Payer: BCN Commercial |
$135.76
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$134.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.28
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.65
|
| Rate for Payer: UHC Core |
$137.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.28
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
OP
|
$292.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$248.50
|
| Rate for Payer: Aetna Medicare |
$76.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.36
|
| Rate for Payer: BCBS Complete |
$54.11
|
| Rate for Payer: BCBS MAPPO |
$73.09
|
| Rate for Payer: BCBS Trust/PPO |
$240.34
|
| Rate for Payer: BCN Commercial |
$240.34
|
| Rate for Payer: BCN Medicare Advantage |
$73.09
|
| Rate for Payer: Cash Price |
$233.88
|
| Rate for Payer: Cofinity Commercial |
$251.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.09
|
| Rate for Payer: Healthscope Commercial |
$263.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.26
|
| Rate for Payer: Mclaren Medicaid |
$51.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.74
|
| Rate for Payer: Meridian Medicaid |
$54.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.50
|
| Rate for Payer: Nomi Health Commercial |
$239.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.26
|
| Rate for Payer: PACE Senior Care Partners |
$69.43
|
| Rate for Payer: PACE SWMI |
$73.09
|
| Rate for Payer: PHP Commercial |
$248.50
|
| Rate for Payer: PHP Medicare Advantage |
$73.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$254.34
|
| Rate for Payer: Priority Health Medicare |
$73.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.48
|
| Rate for Payer: Railroad Medicare Medicare |
$73.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.27
|
| Rate for Payer: UHC Core |
$244.11
|
| Rate for Payer: UHC Exchange |
$73.09
|
| Rate for Payer: UHC Medicaid |
$51.54
|
| Rate for Payer: UHC Medicare Advantage |
$73.09
|
| Rate for Payer: UHCCP Medicaid |
$51.54
|
| Rate for Payer: VA VA |
$73.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.26
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
IP
|
$292.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$203.48 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$248.50
|
| Rate for Payer: BCBS Trust/PPO |
$241.45
|
| Rate for Payer: BCN Commercial |
$241.45
|
| Rate for Payer: Cash Price |
$233.88
|
| Rate for Payer: Cofinity Commercial |
$251.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.88
|
| Rate for Payer: Healthscope Commercial |
$263.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.50
|
| Rate for Payer: Nomi Health Commercial |
$239.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.26
|
| Rate for Payer: PHP Commercial |
$248.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$254.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.27
|
| Rate for Payer: UHC Core |
$244.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.26
|
|
|
HC AEROBIKA
|
Facility
|
IP
|
$153.28
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.68 |
| Max. Negotiated Rate |
$137.95 |
| Rate for Payer: Aetna Commercial |
$130.29
|
| Rate for Payer: BCBS Trust/PPO |
$126.59
|
| Rate for Payer: BCN Commercial |
$126.59
|
| Rate for Payer: Cash Price |
$122.62
|
| Rate for Payer: Cofinity Commercial |
$131.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.62
|
| Rate for Payer: Healthscope Commercial |
$137.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.29
|
| Rate for Payer: Nomi Health Commercial |
$125.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.96
|
| Rate for Payer: PHP Commercial |
$130.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.89
|
| Rate for Payer: UHC Core |
$127.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.96
|
|
|
HC AEROBIKA
|
Facility
|
OP
|
$153.28
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$137.95 |
| Rate for Payer: Aetna Commercial |
$130.29
|
| Rate for Payer: Aetna Medicare |
$39.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.90
|
| Rate for Payer: BCBS Complete |
$28.37
|
| Rate for Payer: BCBS MAPPO |
$38.32
|
| Rate for Payer: BCBS Trust/PPO |
$126.01
|
| Rate for Payer: BCN Commercial |
$126.01
|
| Rate for Payer: BCN Medicare Advantage |
$38.32
|
| Rate for Payer: Cash Price |
$122.62
|
| Rate for Payer: Cofinity Commercial |
$131.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.32
|
| Rate for Payer: Healthscope Commercial |
$137.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.96
|
| Rate for Payer: Mclaren Medicaid |
$27.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.24
|
| Rate for Payer: Meridian Medicaid |
$28.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.29
|
| Rate for Payer: Nomi Health Commercial |
$125.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.96
|
| Rate for Payer: PACE Senior Care Partners |
$36.40
|
| Rate for Payer: PACE SWMI |
$38.32
|
| Rate for Payer: PHP Commercial |
$130.29
|
| Rate for Payer: PHP Medicare Advantage |
$38.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.35
|
| Rate for Payer: Priority Health Medicare |
$38.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.68
|
| Rate for Payer: Railroad Medicare Medicare |
$38.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.89
|
| Rate for Payer: UHC Core |
$127.99
|
| Rate for Payer: UHC Exchange |
$38.32
|
| Rate for Payer: UHC Medicaid |
$27.02
|
| Rate for Payer: UHC Medicare Advantage |
$38.32
|
| Rate for Payer: UHCCP Medicaid |
$27.02
|
| Rate for Payer: VA VA |
$38.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.96
|
|
|
HC AERONEB SUPPLY
|
Facility
|
IP
|
$170.55
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$118.70 |
| Max. Negotiated Rate |
$153.50 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: BCBS Trust/PPO |
$140.86
|
| Rate for Payer: BCN Commercial |
$140.86
|
| Rate for Payer: Cash Price |
$136.44
|
| Rate for Payer: Cofinity Commercial |
$146.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.44
|
| Rate for Payer: Healthscope Commercial |
$153.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.97
|
| Rate for Payer: Nomi Health Commercial |
$139.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.91
|
| Rate for Payer: PHP Commercial |
$144.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$148.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.08
|
| Rate for Payer: UHC Core |
$142.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.91
|
|
