|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
IP
|
$399.83
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.89 |
| Max. Negotiated Rate |
$359.85 |
| Rate for Payer: Aetna Commercial |
$339.86
|
| Rate for Payer: BCBS Trust/PPO |
$326.38
|
| Rate for Payer: BCN Commercial |
$308.99
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cofinity Commercial |
$343.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.86
|
| Rate for Payer: Healthscope Commercial |
$359.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.86
|
| Rate for Payer: Nomi Health Commercial |
$327.86
|
| Rate for Payer: PHP Commercial |
$339.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.89
|
| Rate for Payer: Priority Health HMO/PPO |
$347.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.85
|
| Rate for Payer: UHC Core |
$333.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.87
|
|
|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
OP
|
$399.83
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.96 |
| Max. Negotiated Rate |
$359.85 |
| Rate for Payer: Aetna Commercial |
$339.86
|
| Rate for Payer: Aetna Medicare |
$103.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.95
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$99.96
|
| Rate for Payer: BCBS Trust/PPO |
$328.70
|
| Rate for Payer: BCN Commercial |
$310.87
|
| Rate for Payer: BCN Medicare Advantage |
$99.96
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cofinity Commercial |
$343.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.96
|
| Rate for Payer: Healthscope Commercial |
$359.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.87
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.96
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.86
|
| Rate for Payer: Nomi Health Commercial |
$327.86
|
| Rate for Payer: PACE Senior Care Partners |
$94.96
|
| Rate for Payer: PACE SWMI |
$99.96
|
| Rate for Payer: PHP Commercial |
$339.86
|
| Rate for Payer: PHP Medicare Advantage |
$99.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.89
|
| Rate for Payer: Priority Health HMO/PPO |
$347.85
|
| Rate for Payer: Priority Health Medicare |
$100.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.89
|
| Rate for Payer: Railroad Medicare Medicare |
$99.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.85
|
| Rate for Payer: UHC Core |
$333.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.96
|
| Rate for Payer: UHC Exchange |
$99.96
|
| Rate for Payer: UHC Medicare Advantage |
$99.96
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$99.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.87
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
OP
|
$1,789.39
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$424.98 |
| Max. Negotiated Rate |
$1,610.45 |
| Rate for Payer: Aetna Commercial |
$1,520.98
|
| Rate for Payer: Aetna Medicare |
$465.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$559.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$559.18
|
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: BCBS MAPPO |
$447.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.06
|
| Rate for Payer: BCN Commercial |
$1,391.25
|
| Rate for Payer: BCN Medicare Advantage |
$447.35
|
| Rate for Payer: Cash Price |
$1,431.51
|
| Rate for Payer: Cash Price |
$1,431.51
|
| Rate for Payer: Cofinity Commercial |
$1,538.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.35
|
| Rate for Payer: Healthscope Commercial |
$1,610.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,342.04
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.71
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.98
|
| Rate for Payer: Nomi Health Commercial |
$1,467.30
|
| Rate for Payer: PACE Senior Care Partners |
$424.98
|
| Rate for Payer: PACE SWMI |
$447.35
|
| Rate for Payer: PHP Commercial |
$1,520.98
|
| Rate for Payer: PHP Medicare Advantage |
$447.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,163.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,556.77
|
| Rate for Payer: Priority Health Medicare |
$451.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,198.89
|
| Rate for Payer: Railroad Medicare Medicare |
$447.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,574.66
|
| Rate for Payer: UHC Core |
$1,494.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.35
|
| Rate for Payer: UHC Exchange |
$447.35
|
| Rate for Payer: UHC Medicare Advantage |
$447.35
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
| Rate for Payer: VA VA |
$447.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,342.04
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
IP
|
$1,789.39
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,163.10 |
| Max. Negotiated Rate |
$1,610.45 |
| Rate for Payer: Aetna Commercial |
$1,520.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,460.68
|
| Rate for Payer: BCN Commercial |
$1,382.84
|
| Rate for Payer: Cash Price |
$1,431.51
|
| Rate for Payer: Cofinity Commercial |
$1,538.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.51
|
| Rate for Payer: Healthscope Commercial |
$1,610.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,342.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.98
|
| Rate for Payer: Nomi Health Commercial |
$1,467.30
|
| Rate for Payer: PHP Commercial |
$1,520.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,163.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,556.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,198.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,574.66
|
| Rate for Payer: UHC Core |
$1,494.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,342.04
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
OP
|
$195.98
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$176.38 |
| Rate for Payer: Aetna Commercial |
$166.58
|
| Rate for Payer: Aetna Medicare |
$50.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.24
|
| Rate for Payer: BCBS Complete |
$78.39
|
| Rate for Payer: BCBS MAPPO |
$49.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.12
|
| Rate for Payer: BCN Commercial |
$152.37
|
| Rate for Payer: BCN Medicare Advantage |
$49.00
|
| Rate for Payer: Cash Price |
$156.78
|
| Rate for Payer: Cofinity Commercial |
$168.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.00
|
| Rate for Payer: Healthscope Commercial |
$176.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.58
|
| Rate for Payer: Nomi Health Commercial |
$160.70
|
| Rate for Payer: PACE Senior Care Partners |
$46.55
|
| Rate for Payer: PACE SWMI |
$49.00
|
| Rate for Payer: PHP Commercial |
$166.58
|
| Rate for Payer: PHP Medicare Advantage |
$49.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.39
|
| Rate for Payer: Priority Health HMO/PPO |
$170.50
|
| Rate for Payer: Priority Health Medicare |
$49.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.31
|
| Rate for Payer: Railroad Medicare Medicare |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.46
|
| Rate for Payer: UHC Core |
$163.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.00
|
| Rate for Payer: UHC Exchange |
$49.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.00
|
| Rate for Payer: VA VA |
$49.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.98
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
IP
|
$195.98
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$127.39 |
| Max. Negotiated Rate |
$176.38 |
| Rate for Payer: Aetna Commercial |
$166.58
|
| Rate for Payer: BCBS Trust/PPO |
$159.98
|
| Rate for Payer: BCN Commercial |
$151.45
|
| Rate for Payer: Cash Price |
$156.78
|
| Rate for Payer: Cofinity Commercial |
$168.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.78
|
| Rate for Payer: Healthscope Commercial |
$176.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.58
|
| Rate for Payer: Nomi Health Commercial |
$160.70
|
| Rate for Payer: PHP Commercial |
$166.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.39
|
| Rate for Payer: Priority Health HMO/PPO |
$170.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.46
|
| Rate for Payer: UHC Core |
$163.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.98
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
OP
|
$94.29
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$84.86 |
| Rate for Payer: Aetna Commercial |
$80.15
|
| Rate for Payer: Aetna Medicare |
$24.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.47
|
| Rate for Payer: BCBS Complete |
$37.72
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$77.52
|
| Rate for Payer: BCN Commercial |
$73.31
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$81.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$84.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.15
|
| Rate for Payer: Nomi Health Commercial |
$77.32
|
| Rate for Payer: PACE Senior Care Partners |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$80.15
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.29
|
| Rate for Payer: Priority Health HMO/PPO |
$82.03
|
| Rate for Payer: Priority Health Medicare |
$23.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.17
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.98
|
| Rate for Payer: UHC Core |
$78.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: VA VA |
$23.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.72
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
IP
|
$94.29
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.29 |
| Max. Negotiated Rate |
$84.86 |
| Rate for Payer: Aetna Commercial |
$80.15
|
| Rate for Payer: BCBS Trust/PPO |
$76.97
|
| Rate for Payer: BCN Commercial |
$72.87
|
| Rate for Payer: Cash Price |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$81.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.43
|
| Rate for Payer: Healthscope Commercial |
$84.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.15
|
| Rate for Payer: Nomi Health Commercial |
$77.32
|
| Rate for Payer: PHP Commercial |
$80.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.29
|
| Rate for Payer: Priority Health HMO/PPO |
$82.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.98
|
| Rate for Payer: UHC Core |
$78.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.72
|
|
|
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 |
$142.12
|
| 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 |
$276.25
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.01
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| 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 Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health HMO/PPO |
$309.12
|
| Rate for Payer: Priority Health Medicare |
$89.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.06
|
| 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 Dual Complete DSNP |
$88.83
|
| Rate for Payer: UHC Exchange |
$88.83
|
| Rate for Payer: UHC Medicare Advantage |
$88.83
|
| Rate for Payer: VA VA |
$88.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
IP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$230.95 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: BCBS Trust/PPO |
$290.04
|
| Rate for Payer: BCN Commercial |
$274.58
|
| 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: Healthscope Commercial |
$319.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.01
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health HMO/PPO |
$309.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.67
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
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 |
$321.38 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: BCBS Trust/PPO |
$403.60
|
| Rate for Payer: BCN Commercial |
$382.10
|
| 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: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.27
|
| 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 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 |
$197.77
|
| 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 |
$384.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| 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 Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Medicare |
$124.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.27
|
| 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 Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Exchange |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
| Rate for Payer: VA VA |
$123.61
|
| 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 |
$619.96 |
| 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 |
$275.54
|
| 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 |
$535.58
|
| 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 |
$619.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| 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 Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health HMO/PPO |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$173.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.53
|
| 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 Dual Complete DSNP |
$172.21
|
| Rate for Payer: UHC Exchange |
$172.21
|
| Rate for Payer: UHC Medicare Advantage |
$172.21
|
| 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 |
$447.75 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: BCBS Trust/PPO |
$562.31
|
| Rate for Payer: BCN Commercial |
$532.34
|
| 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 |
$619.96
|
| 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: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health HMO/PPO |
$599.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.53
|
| 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 |
$349.81
|
| 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 |
$679.94
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Nomi Health Commercial |
$717.11
|
| 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 Cigna Priority Health |
$568.44
|
| Rate for Payer: Priority Health HMO/PPO |
$760.83
|
| Rate for Payer: Priority Health Medicare |
$220.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$585.93
|
| 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 Dual Complete DSNP |
$218.63
|
| Rate for Payer: UHC Exchange |
$218.63
|
| Rate for Payer: UHC Medicare Advantage |
$218.63
|
| 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 |
$568.44 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: BCBS Trust/PPO |
$713.87
|
| Rate for Payer: BCN Commercial |
$675.83
|
| 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: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.44
|
| Rate for Payer: Priority Health HMO/PPO |
$760.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$585.93
|
| 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 |
$247.68 |
| 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 |
$417.15
|
| Rate for Payer: BCBS MAPPO |
$260.72
|
| Rate for Payer: BCBS Trust/PPO |
$857.35
|
| Rate for Payer: BCN Commercial |
$810.84
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Nomi Health Commercial |
$855.16
|
| 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 Cigna Priority Health |
$677.87
|
| Rate for Payer: Priority Health HMO/PPO |
$907.31
|
| Rate for Payer: Priority Health Medicare |
$263.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$698.73
|
| 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 Dual Complete DSNP |
$260.72
|
| Rate for Payer: UHC Exchange |
$260.72
|
| Rate for Payer: UHC Medicare Advantage |
$260.72
|
| 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 |
$677.87 |
| Max. Negotiated Rate |
$938.59 |
| Rate for Payer: Aetna Commercial |
$886.45
|
| Rate for Payer: BCBS Trust/PPO |
$851.30
|
| Rate for Payer: BCN Commercial |
$805.94
|
| 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: PHP Commercial |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.87
|
| Rate for Payer: Priority Health HMO/PPO |
$907.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$698.73
|
| 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 |
$149.10
|
| Rate for Payer: BCBS MAPPO |
$93.18
|
| Rate for Payer: BCBS Trust/PPO |
$306.43
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$289.81
|
| Rate for Payer: BCN Medicare Advantage |
$93.18
|
| 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 |
$93.18
|
| Rate for Payer: Healthscope Commercial |
$335.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: Nomi Health Commercial |
$305.65
|
| Rate for Payer: PACE Senior Care Partners |
$88.53
|
| Rate for Payer: PACE SWMI |
$93.18
|
| Rate for Payer: PHP Commercial |
$316.83
|
| Rate for Payer: PHP Medicare Advantage |
$93.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.28
|
| Rate for Payer: Priority Health HMO/PPO |
$324.28
|
| Rate for Payer: Priority Health Medicare |
$94.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.74
|
| Rate for Payer: Railroad Medicare Medicare |
$93.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.01
|
| Rate for Payer: UHC Core |
$311.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.18
|
| Rate for Payer: UHC Exchange |
$93.18
|
| Rate for Payer: UHC Medicare Advantage |
$93.18
|
| Rate for Payer: VA VA |
$93.18
|
| 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 |
$242.28 |
| Max. Negotiated Rate |
$335.47 |
| Rate for Payer: Aetna Commercial |
$316.83
|
| Rate for Payer: BCBS Trust/PPO |
$304.27
|
| Rate for Payer: BCN Commercial |
$288.05
|
| 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: PHP Commercial |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.28
|
| Rate for Payer: Priority Health HMO/PPO |
$324.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.74
|
| 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 |
$66.06
|
| 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 |
$128.41
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Nomi Health Commercial |
$135.43
|
| 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 Cigna Priority Health |
$107.35
|
| Rate for Payer: Priority Health HMO/PPO |
$143.69
|
| Rate for Payer: Priority Health Medicare |
$41.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.66
|
| 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 Dual Complete DSNP |
$41.29
|
| Rate for Payer: UHC Exchange |
$41.29
|
| Rate for Payer: UHC Medicare Advantage |
$41.29
|
| 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 |
$107.35 |
| Max. Negotiated Rate |
$148.64 |
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: BCBS Trust/PPO |
$134.82
|
| Rate for Payer: BCN Commercial |
$127.64
|
| 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: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.35
|
| Rate for Payer: Priority Health HMO/PPO |
$143.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.66
|
| 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 |
$321.38 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: BCBS Trust/PPO |
$403.60
|
| Rate for Payer: BCN Commercial |
$382.10
|
| 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: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.27
|
| 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 |
$197.77
|
| 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 |
$384.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| 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 Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health HMO/PPO |
$430.15
|
| Rate for Payer: Priority Health Medicare |
$124.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.27
|
| 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 Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Exchange |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
| 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
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$619.96 |
| 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 |
$275.54
|
| 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 |
$535.58
|
| 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 |
$619.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| 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 Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health HMO/PPO |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$173.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.53
|
| 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 Dual Complete DSNP |
$172.21
|
| Rate for Payer: UHC Exchange |
$172.21
|
| Rate for Payer: UHC Medicare Advantage |
$172.21
|
| Rate for Payer: VA VA |
$172.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.64
|
|
