|
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
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
OP
|
$152.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna Commercial |
$129.76
|
| Rate for Payer: Aetna Medicare |
$39.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.71
|
| Rate for Payer: BCBS Complete |
$28.26
|
| Rate for Payer: BCBS MAPPO |
$38.16
|
| Rate for Payer: BCBS Trust/PPO |
$125.50
|
| Rate for Payer: BCN Commercial |
$125.50
|
| Rate for Payer: BCN Medicare Advantage |
$38.16
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cofinity Commercial |
$131.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.16
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.50
|
| Rate for Payer: Mclaren Medicaid |
$26.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.07
|
| Rate for Payer: Meridian Medicaid |
$28.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.76
|
| Rate for Payer: Nomi Health Commercial |
$125.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.50
|
| Rate for Payer: PACE Senior Care Partners |
$36.26
|
| Rate for Payer: PACE SWMI |
$38.16
|
| Rate for Payer: PHP Commercial |
$129.76
|
| Rate for Payer: PHP Medicare Advantage |
$38.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.81
|
| Rate for Payer: Priority Health Medicare |
$38.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.25
|
| Rate for Payer: Railroad Medicare Medicare |
$38.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.34
|
| Rate for Payer: UHC Core |
$127.47
|
| Rate for Payer: UHC Exchange |
$38.16
|
| Rate for Payer: UHC Medicaid |
$26.91
|
| Rate for Payer: UHC Medicare Advantage |
$38.16
|
| Rate for Payer: UHCCP Medicaid |
$26.91
|
| Rate for Payer: VA VA |
$38.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.50
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
IP
|
$152.66
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$137.39 |
| Rate for Payer: Aetna Commercial |
$129.76
|
| Rate for Payer: BCBS Trust/PPO |
$126.08
|
| Rate for Payer: BCN Commercial |
$126.08
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: Cofinity Commercial |
$131.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.13
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.76
|
| Rate for Payer: Nomi Health Commercial |
$125.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.50
|
| Rate for Payer: PHP Commercial |
$129.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.34
|
| Rate for Payer: UHC Core |
$127.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.50
|
|
|
HC AFB CULTURE
|
Facility
|
OP
|
$93.01
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$83.71 |
| Rate for Payer: Aetna Commercial |
$79.06
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.07
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: BCBS MAPPO |
$23.25
|
| Rate for Payer: BCBS Trust/PPO |
$76.46
|
| Rate for Payer: BCN Commercial |
$76.46
|
| Rate for Payer: BCN Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$74.41
|
| Rate for Payer: Cofinity Commercial |
$79.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$83.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.76
|
| Rate for Payer: Mclaren Medicaid |
$16.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.42
|
| Rate for Payer: Meridian Medicaid |
$17.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.06
|
| Rate for Payer: Nomi Health Commercial |
$76.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.76
|
| Rate for Payer: PACE Senior Care Partners |
$22.09
|
| Rate for Payer: PACE SWMI |
$23.25
|
| Rate for Payer: PHP Commercial |
$79.06
|
| Rate for Payer: PHP Medicare Advantage |
$23.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.92
|
| Rate for Payer: Priority Health Medicare |
$23.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.73
|
| Rate for Payer: Railroad Medicare Medicare |
$23.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.85
|
| Rate for Payer: UHC Core |
$77.66
|
| Rate for Payer: UHC Exchange |
$23.25
|
| Rate for Payer: UHC Medicaid |
$16.40
|
| Rate for Payer: UHC Medicare Advantage |
$23.25
|
| Rate for Payer: UHCCP Medicaid |
$16.40
|
| Rate for Payer: VA VA |
$23.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.76
|
|
|
HC AFB CULTURE
|
Facility
|
IP
|
$93.01
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.73 |
| Max. Negotiated Rate |
$83.71 |
| Rate for Payer: Aetna Commercial |
$79.06
|
| Rate for Payer: BCBS Trust/PPO |
$76.82
|
| Rate for Payer: BCN Commercial |
$76.82
|
| Rate for Payer: Cash Price |
$74.41
|
| Rate for Payer: Cofinity Commercial |
$79.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.41
|
| Rate for Payer: Healthscope Commercial |
$83.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.06
|
| Rate for Payer: Nomi Health Commercial |
$76.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.76
|
| Rate for Payer: PHP Commercial |
$79.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.85
|
| Rate for Payer: UHC Core |
$77.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.76
|
|
|
HC AFB SMEAR
|
Facility
|
OP
|
$59.82
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.69
|
| Rate for Payer: BCBS Complete |
$11.07
|
| Rate for Payer: BCBS MAPPO |
$14.96
|
| Rate for Payer: BCBS Trust/PPO |
$49.18
|
| Rate for Payer: BCN Commercial |
$49.18
|
| Rate for Payer: BCN Medicare Advantage |
$14.96
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.87
|
| Rate for Payer: Mclaren Medicaid |
$10.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.70
|
| Rate for Payer: Meridian Medicaid |
$11.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: PACE Senior Care Partners |
$14.21
|
| Rate for Payer: PACE SWMI |
$14.96
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.04
|
| Rate for Payer: Priority Health Medicare |
$15.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.63
|
| Rate for Payer: Railroad Medicare Medicare |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$49.95
|
| Rate for Payer: UHC Exchange |
$14.96
|
| Rate for Payer: UHC Medicaid |
$10.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.96
|
| Rate for Payer: UHCCP Medicaid |
$10.55
|
| Rate for Payer: VA VA |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.87
|
|
|
HC AFB SMEAR
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: BCBS Trust/PPO |
$49.41
|
| Rate for Payer: BCN Commercial |
$49.41
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.87
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$49.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.87
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
IP
|
$735.42
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$511.85 |
| Max. Negotiated Rate |
$661.88 |
| Rate for Payer: Aetna Commercial |
$625.11
|
| Rate for Payer: BCBS Trust/PPO |
$607.38
|
| Rate for Payer: BCN Commercial |
$607.38
|
| Rate for Payer: Cash Price |
$588.34
|
| Rate for Payer: Cofinity Commercial |
$632.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.34
|
| Rate for Payer: Healthscope Commercial |
$661.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.11
|
| Rate for Payer: Nomi Health Commercial |
$603.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.57
|
| Rate for Payer: PHP Commercial |
$625.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$639.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.17
|
| Rate for Payer: UHC Core |
$614.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.57
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
OP
|
$735.42
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.65 |
| Max. Negotiated Rate |
$661.88 |
| Rate for Payer: Aetna Commercial |
$625.11
|
| Rate for Payer: Aetna Medicare |
$191.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.82
|
| Rate for Payer: BCBS Complete |
$136.13
|
| Rate for Payer: BCBS MAPPO |
$183.85
|
| Rate for Payer: BCBS Trust/PPO |
$604.59
|
| Rate for Payer: BCN Commercial |
$604.59
|
| Rate for Payer: BCN Medicare Advantage |
$183.85
|
| Rate for Payer: Cash Price |
$588.34
|
| Rate for Payer: Cofinity Commercial |
$632.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.85
|
| Rate for Payer: Healthscope Commercial |
$661.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.57
|
| Rate for Payer: Mclaren Medicaid |
$129.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.05
|
| Rate for Payer: Meridian Medicaid |
$136.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.11
|
| Rate for Payer: Nomi Health Commercial |
$603.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.57
|
| Rate for Payer: PACE Senior Care Partners |
$174.66
|
| Rate for Payer: PACE SWMI |
$183.85
|
| Rate for Payer: PHP Commercial |
$625.11
|
| Rate for Payer: PHP Medicare Advantage |
$183.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$639.82
|
| Rate for Payer: Priority Health Medicare |
$185.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.85
|
| Rate for Payer: Railroad Medicare Medicare |
$183.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.17
|
| Rate for Payer: UHC Core |
$614.08
|
| Rate for Payer: UHC Exchange |
$183.85
|
| Rate for Payer: UHC Medicaid |
$129.65
|
| Rate for Payer: UHC Medicare Advantage |
$183.85
|
| Rate for Payer: UHCCP Medicaid |
$129.65
|
| Rate for Payer: VA VA |
$183.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.57
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
IP
|
$443.49
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$308.67 |
| Max. Negotiated Rate |
$399.14 |
| Rate for Payer: Aetna Commercial |
$376.97
|
| Rate for Payer: BCBS Trust/PPO |
$366.28
|
| Rate for Payer: BCN Commercial |
$366.28
|
| Rate for Payer: Cash Price |
$354.79
|
| Rate for Payer: Cofinity Commercial |
$381.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.79
|
| Rate for Payer: Healthscope Commercial |
$399.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.97
|
| Rate for Payer: Nomi Health Commercial |
$363.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.62
|
| Rate for Payer: PHP Commercial |
$376.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.27
|
| Rate for Payer: UHC Core |
$370.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.62
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
OP
|
$443.49
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$399.14 |
| Rate for Payer: Aetna Commercial |
$376.97
|
| Rate for Payer: Aetna Medicare |
$115.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.59
|
| Rate for Payer: BCBS Complete |
$82.09
|
| Rate for Payer: BCBS MAPPO |
$110.87
|
| Rate for Payer: BCBS Trust/PPO |
$364.59
|
| Rate for Payer: BCN Commercial |
$364.59
|
| Rate for Payer: BCN Medicare Advantage |
$110.87
|
| Rate for Payer: Cash Price |
$354.79
|
| Rate for Payer: Cofinity Commercial |
$381.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.87
|
| Rate for Payer: Healthscope Commercial |
$399.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.62
|
| Rate for Payer: Mclaren Medicaid |
$78.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.42
|
| Rate for Payer: Meridian Medicaid |
$82.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.97
|
| Rate for Payer: Nomi Health Commercial |
$363.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.62
|
| Rate for Payer: PACE Senior Care Partners |
$105.33
|
| Rate for Payer: PACE SWMI |
$110.87
|
| Rate for Payer: PHP Commercial |
$376.97
|
| Rate for Payer: PHP Medicare Advantage |
$110.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.84
|
| Rate for Payer: Priority Health Medicare |
$111.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.67
|
| Rate for Payer: Railroad Medicare Medicare |
$110.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.27
|
| Rate for Payer: UHC Core |
$370.31
|
| Rate for Payer: UHC Exchange |
$110.87
|
| Rate for Payer: UHC Medicaid |
$78.19
|
| Rate for Payer: UHC Medicare Advantage |
$110.87
|
| Rate for Payer: UHCCP Medicaid |
$78.19
|
| Rate for Payer: VA VA |
$110.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.62
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.20
|
| Rate for Payer: BCN Commercial |
$41.20
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$40.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.89
|
| Rate for Payer: UHC Core |
$41.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.41
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
OP
|
$49.88
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.59
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$12.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.01
|
| Rate for Payer: BCN Commercial |
$41.01
|
| Rate for Payer: BCN Medicare Advantage |
$12.47
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.47
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.41
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.09
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$40.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PACE Senior Care Partners |
$11.85
|
| Rate for Payer: PACE SWMI |
$12.47
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: PHP Medicare Advantage |
$12.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.40
|
| Rate for Payer: Priority Health Medicare |
$12.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.72
|
| Rate for Payer: Railroad Medicare Medicare |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.89
|
| Rate for Payer: UHC Core |
$41.65
|
| Rate for Payer: UHC Exchange |
$12.47
|
| Rate for Payer: UHC Medicaid |
$8.79
|
| Rate for Payer: UHC Medicare Advantage |
$12.47
|
| Rate for Payer: UHCCP Medicaid |
$8.79
|
| Rate for Payer: VA VA |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.41
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.19
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.48
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$17.11
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC ALBUMIN SERUM
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$32.57
|
| Rate for Payer: BCN Commercial |
$32.57
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.70
|
| Rate for Payer: UHC Core |
$32.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.57
|
|
|
HC ALBUMIN SERUM
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$10.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.32
|
| Rate for Payer: BCBS Complete |
$7.30
|
| Rate for Payer: BCBS MAPPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$32.42
|
| Rate for Payer: BCN Medicare Advantage |
$9.86
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.86
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.57
|
| Rate for Payer: Mclaren Medicaid |
$6.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.35
|
| Rate for Payer: Meridian Medicaid |
$7.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$32.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Senior Care Partners |
$9.36
|
| Rate for Payer: PACE SWMI |
$9.86
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$9.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.30
|
| Rate for Payer: Priority Health Medicare |
$9.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.70
|
| Rate for Payer: UHC Core |
$32.92
|
| Rate for Payer: UHC Exchange |
$9.86
|
| Rate for Payer: UHC Medicaid |
$6.95
|
| Rate for Payer: UHC Medicare Advantage |
$9.86
|
| Rate for Payer: UHCCP Medicaid |
$6.95
|
| Rate for Payer: VA VA |
$9.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.57
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
IP
|
$42.13
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$37.92 |
| Rate for Payer: Aetna Commercial |
$35.81
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Healthscope Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.81
|
| Rate for Payer: Nomi Health Commercial |
$34.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.60
|
| Rate for Payer: PHP Commercial |
$35.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.07
|
| Rate for Payer: UHC Core |
$35.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.60
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
OP
|
$42.13
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$37.92 |
| Rate for Payer: Aetna Commercial |
$35.81
|
| Rate for Payer: Aetna Medicare |
$10.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.17
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: BCBS MAPPO |
$10.53
|
| Rate for Payer: BCBS Trust/PPO |
$34.64
|
| Rate for Payer: BCN Commercial |
$34.64
|
| Rate for Payer: BCN Medicare Advantage |
$10.53
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cofinity Commercial |
$36.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.60
|
| Rate for Payer: Mclaren Medicaid |
$7.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.06
|
| Rate for Payer: Meridian Medicaid |
$7.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.81
|
| Rate for Payer: Nomi Health Commercial |
$34.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.60
|
| Rate for Payer: PACE Senior Care Partners |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.53
|
| Rate for Payer: PHP Commercial |
$35.81
|
| Rate for Payer: PHP Medicare Advantage |
$10.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.65
|
| Rate for Payer: Priority Health Medicare |
$10.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.32
|
| Rate for Payer: Railroad Medicare Medicare |
$10.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.07
|
| Rate for Payer: UHC Core |
$35.18
|
| Rate for Payer: UHC Exchange |
$10.53
|
| Rate for Payer: UHC Medicaid |
$7.43
|
| Rate for Payer: UHC Medicare Advantage |
$10.53
|
| Rate for Payer: UHCCP Medicaid |
$7.43
|
| Rate for Payer: VA VA |
$10.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.60
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$5.23
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Mclaren Medicaid |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PACE Senior Care Partners |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicaid |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: Meridian Medicaid |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
HC ALCOHOL ETHANOL LVL.
|
Facility
|
OP
|
$128.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100651
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Medicare |
$33.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.12
|
| Rate for Payer: BCBS Complete |
$23.77
|
| Rate for Payer: BCBS MAPPO |
$32.10
|
| Rate for Payer: BCBS Trust/PPO |
$105.56
|
| Rate for Payer: BCN Commercial |
$105.56
|
| Rate for Payer: BCN Medicare Advantage |
$32.10
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.10
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Mclaren Medicaid |
$22.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.70
|
| Rate for Payer: Meridian Medicaid |
$23.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: PACE Senior Care Partners |
$30.50
|
| Rate for Payer: PACE SWMI |
$32.10
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Medicare Advantage |
$32.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.71
|
| Rate for Payer: Priority Health Medicare |
$32.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.37
|
| Rate for Payer: Railroad Medicare Medicare |
$32.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.99
|
| Rate for Payer: UHC Core |
$107.21
|
| Rate for Payer: UHC Exchange |
$32.10
|
| Rate for Payer: UHC Medicaid |
$22.64
|
| Rate for Payer: UHC Medicare Advantage |
$32.10
|
| Rate for Payer: UHCCP Medicaid |
$22.64
|
| Rate for Payer: VA VA |
$32.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
|
|
HC ALCOHOL ETHANOL LVL.
|
Facility
|
IP
|
$128.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100651
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.37 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: BCBS Trust/PPO |
$106.05
|
| Rate for Payer: BCN Commercial |
$106.05
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.99
|
| Rate for Payer: UHC Core |
$107.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
|
