|
HC BURN CARE MEDIUM
|
Facility
|
IP
|
$542.58
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.64 |
| Max. Negotiated Rate |
$488.32 |
| Rate for Payer: Aetna Commercial |
$461.19
|
| Rate for Payer: BCBS Trust/PPO |
$448.12
|
| Rate for Payer: BCN Commercial |
$448.12
|
| Rate for Payer: Cash Price |
$434.06
|
| Rate for Payer: Cofinity Commercial |
$466.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.06
|
| Rate for Payer: Healthscope Commercial |
$488.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.19
|
| Rate for Payer: Nomi Health Commercial |
$444.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.94
|
| Rate for Payer: PHP Commercial |
$461.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$472.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$377.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.47
|
| Rate for Payer: UHC Core |
$453.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.94
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
OP
|
$542.58
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.66 |
| Max. Negotiated Rate |
$488.32 |
| Rate for Payer: Aetna Commercial |
$461.19
|
| Rate for Payer: Aetna Medicare |
$141.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.56
|
| Rate for Payer: BCBS Complete |
$100.43
|
| Rate for Payer: BCBS MAPPO |
$135.65
|
| Rate for Payer: BCBS Trust/PPO |
$446.06
|
| Rate for Payer: BCN Commercial |
$446.06
|
| Rate for Payer: BCN Medicare Advantage |
$135.65
|
| Rate for Payer: Cash Price |
$434.06
|
| Rate for Payer: Cofinity Commercial |
$466.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.65
|
| Rate for Payer: Healthscope Commercial |
$488.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.94
|
| Rate for Payer: Mclaren Medicaid |
$95.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.43
|
| Rate for Payer: Meridian Medicaid |
$100.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.19
|
| Rate for Payer: Nomi Health Commercial |
$444.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.94
|
| Rate for Payer: PACE Senior Care Partners |
$128.86
|
| Rate for Payer: PACE SWMI |
$135.65
|
| Rate for Payer: PHP Commercial |
$461.19
|
| Rate for Payer: PHP Medicare Advantage |
$135.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$472.04
|
| Rate for Payer: Priority Health Medicare |
$137.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$377.64
|
| Rate for Payer: Railroad Medicare Medicare |
$135.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.47
|
| Rate for Payer: UHC Core |
$453.05
|
| Rate for Payer: UHC Exchange |
$135.65
|
| Rate for Payer: UHC Medicaid |
$95.66
|
| Rate for Payer: UHC Medicare Advantage |
$135.65
|
| Rate for Payer: UHCCP Medicaid |
$95.66
|
| Rate for Payer: VA VA |
$135.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.94
|
|
|
HC BURN CARE SMALL
|
Facility
|
IP
|
$372.50
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.26 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Aetna Commercial |
$316.62
|
| Rate for Payer: BCBS Trust/PPO |
$307.65
|
| Rate for Payer: BCN Commercial |
$307.65
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cofinity Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.00
|
| Rate for Payer: Healthscope Commercial |
$335.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.62
|
| Rate for Payer: Nomi Health Commercial |
$305.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.38
|
| Rate for Payer: PHP Commercial |
$316.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.80
|
| Rate for Payer: UHC Core |
$311.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.38
|
|
|
HC BURN CARE SMALL
|
Facility
|
OP
|
$372.50
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Aetna Commercial |
$316.62
|
| Rate for Payer: Aetna Medicare |
$96.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.41
|
| Rate for Payer: BCBS Complete |
$68.95
|
| Rate for Payer: BCBS MAPPO |
$93.12
|
| Rate for Payer: BCBS Trust/PPO |
$306.23
|
| Rate for Payer: BCN Commercial |
$306.23
|
| Rate for Payer: BCN Medicare Advantage |
$93.12
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cofinity Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$335.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.38
|
| Rate for Payer: Mclaren Medicaid |
$65.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.78
|
| Rate for Payer: Meridian Medicaid |
$68.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.62
|
| Rate for Payer: Nomi Health Commercial |
$305.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.38
|
| Rate for Payer: PACE Senior Care Partners |
$88.47
|
| Rate for Payer: PACE SWMI |
$93.12
|
| Rate for Payer: PHP Commercial |
$316.62
|
| Rate for Payer: PHP Medicare Advantage |
$93.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.07
|
| Rate for Payer: Priority Health Medicare |
$94.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.26
|
| Rate for Payer: Railroad Medicare Medicare |
$93.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.80
|
| Rate for Payer: UHC Core |
$311.04
|
| Rate for Payer: UHC Exchange |
$93.12
|
| Rate for Payer: UHC Medicaid |
$65.67
|
| Rate for Payer: UHC Medicare Advantage |
$93.12
|
| Rate for Payer: UHCCP Medicaid |
$65.67
|
| Rate for Payer: VA VA |
$93.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.38
|
|
|
HC BURN R&B
|
Facility
|
IP
|
$7,587.64
|
|
| Hospital Charge Code |
20700001
|
|
Hospital Revenue Code
|
207
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$6,828.88 |
| Rate for Payer: Aetna Commercial |
$6,449.49
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,266.63
|
| Rate for Payer: BCN Commercial |
$6,266.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$6,070.11
|
| Rate for Payer: Cash Price |
$6,070.11
|
| Rate for Payer: Cofinity Commercial |
$6,525.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,070.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$6,828.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,690.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,449.49
|
| Rate for Payer: Nomi Health Commercial |
$6,221.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,690.73
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$6,449.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,601.25
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,281.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,677.12
|
| Rate for Payer: UHC Core |
$6,335.68
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,690.73
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
IP
|
$228.35
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.93 |
| Max. Negotiated Rate |
$205.51 |
| Rate for Payer: Aetna Commercial |
$194.10
|
| Rate for Payer: BCBS Trust/PPO |
$188.59
|
| Rate for Payer: BCN Commercial |
$188.59
|
| Rate for Payer: Cash Price |
$182.68
|
| Rate for Payer: Cofinity Commercial |
$196.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.68
|
| Rate for Payer: Healthscope Commercial |
$205.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.10
|
| Rate for Payer: Nomi Health Commercial |
$187.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.26
|
| Rate for Payer: PHP Commercial |
$194.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.95
|
| Rate for Payer: UHC Core |
$190.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.26
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
OP
|
$228.35
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$205.51 |
| Rate for Payer: Aetna Commercial |
$194.10
|
| Rate for Payer: Aetna Medicare |
$59.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.36
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$57.09
|
| Rate for Payer: BCBS Trust/PPO |
$187.73
|
| Rate for Payer: BCN Commercial |
$187.73
|
| Rate for Payer: BCN Medicare Advantage |
$57.09
|
| Rate for Payer: Cash Price |
$182.68
|
| Rate for Payer: Cofinity Commercial |
$196.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.09
|
| Rate for Payer: Healthscope Commercial |
$205.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.26
|
| Rate for Payer: Mclaren Medicaid |
$40.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.94
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.10
|
| Rate for Payer: Nomi Health Commercial |
$187.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.26
|
| Rate for Payer: PACE Senior Care Partners |
$54.23
|
| Rate for Payer: PACE SWMI |
$57.09
|
| Rate for Payer: PHP Commercial |
$194.10
|
| Rate for Payer: PHP Medicare Advantage |
$57.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.66
|
| Rate for Payer: Priority Health Medicare |
$57.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.95
|
| Rate for Payer: UHC Core |
$190.67
|
| Rate for Payer: UHC Exchange |
$57.09
|
| Rate for Payer: UHC Medicaid |
$40.26
|
| Rate for Payer: UHC Medicare Advantage |
$57.09
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
| Rate for Payer: VA VA |
$57.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.26
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: BCBS Trust/PPO |
$63.98
|
| Rate for Payer: BCN Commercial |
$63.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.17
|
| Rate for Payer: UHC Core |
$64.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$20.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.21
|
| Rate for Payer: BCBS Complete |
$14.34
|
| Rate for Payer: BCBS MAPPO |
$19.37
|
| Rate for Payer: BCBS Trust/PPO |
$63.69
|
| Rate for Payer: BCN Commercial |
$63.69
|
| Rate for Payer: BCN Medicare Advantage |
$19.37
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Mclaren Medicaid |
$13.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.34
|
| Rate for Payer: Meridian Medicaid |
$14.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Senior Care Partners |
$18.40
|
| Rate for Payer: PACE SWMI |
$19.37
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$19.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.40
|
| Rate for Payer: Priority Health Medicare |
$19.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.92
|
| Rate for Payer: Railroad Medicare Medicare |
$19.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.17
|
| Rate for Payer: UHC Core |
$64.69
|
| Rate for Payer: UHC Exchange |
$19.37
|
| Rate for Payer: UHC Medicaid |
$13.66
|
| Rate for Payer: UHC Medicare Advantage |
$19.37
|
| Rate for Payer: UHCCP Medicaid |
$13.66
|
| Rate for Payer: VA VA |
$19.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.77
|
| Rate for Payer: BCN Commercial |
$62.77
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$65.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$68.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.60
|
| Rate for Payer: Nomi Health Commercial |
$62.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PHP Commercial |
$64.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.88
|
| Rate for Payer: UHC Core |
$63.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.00
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.75
|
| Rate for Payer: BCBS Complete |
$14.07
|
| Rate for Payer: BCBS MAPPO |
$19.00
|
| Rate for Payer: BCBS Trust/PPO |
$62.48
|
| Rate for Payer: BCN Commercial |
$62.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.00
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$65.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.00
|
| Rate for Payer: Healthscope Commercial |
$68.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.00
|
| Rate for Payer: Mclaren Medicaid |
$13.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.95
|
| Rate for Payer: Meridian Medicaid |
$14.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.60
|
| Rate for Payer: Nomi Health Commercial |
$62.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PACE Senior Care Partners |
$18.05
|
| Rate for Payer: PACE SWMI |
$19.00
|
| Rate for Payer: PHP Commercial |
$64.60
|
| Rate for Payer: PHP Medicare Advantage |
$19.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.12
|
| Rate for Payer: Priority Health Medicare |
$19.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.90
|
| Rate for Payer: Railroad Medicare Medicare |
$19.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.88
|
| Rate for Payer: UHC Core |
$63.46
|
| Rate for Payer: UHC Exchange |
$19.00
|
| Rate for Payer: UHC Medicaid |
$13.40
|
| Rate for Payer: UHC Medicare Advantage |
$19.00
|
| Rate for Payer: UHCCP Medicaid |
$13.40
|
| Rate for Payer: VA VA |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.00
|
|
|
HC C1Q BINDING
|
Facility
|
OP
|
$115.48
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$98.16
|
| Rate for Payer: Aetna Medicare |
$30.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.09
|
| Rate for Payer: BCBS Complete |
$21.38
|
| Rate for Payer: BCBS MAPPO |
$28.87
|
| Rate for Payer: BCBS Trust/PPO |
$94.94
|
| Rate for Payer: BCN Commercial |
$94.94
|
| Rate for Payer: BCN Medicare Advantage |
$28.87
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.87
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.61
|
| Rate for Payer: Mclaren Medicaid |
$20.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.31
|
| Rate for Payer: Meridian Medicaid |
$21.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Nomi Health Commercial |
$94.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: PACE Senior Care Partners |
$27.43
|
| Rate for Payer: PACE SWMI |
$28.87
|
| Rate for Payer: PHP Commercial |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$28.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.47
|
| Rate for Payer: Priority Health Medicare |
$29.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.37
|
| Rate for Payer: Railroad Medicare Medicare |
$28.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.62
|
| Rate for Payer: UHC Core |
$96.43
|
| Rate for Payer: UHC Exchange |
$28.87
|
| Rate for Payer: UHC Medicaid |
$20.36
|
| Rate for Payer: UHC Medicare Advantage |
$28.87
|
| Rate for Payer: UHCCP Medicaid |
$20.36
|
| Rate for Payer: VA VA |
$28.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.61
|
|
|
HC C1Q BINDING
|
Facility
|
IP
|
$115.48
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$98.16
|
| Rate for Payer: BCBS Trust/PPO |
$95.37
|
| Rate for Payer: BCN Commercial |
$95.37
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Nomi Health Commercial |
$94.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: PHP Commercial |
$98.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.62
|
| Rate for Payer: UHC Core |
$96.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.61
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna Medicare |
$18.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.89
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: BCBS MAPPO |
$17.51
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCN Commercial |
$57.58
|
| Rate for Payer: BCN Medicare Advantage |
$17.51
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.51
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.53
|
| Rate for Payer: Mclaren Medicaid |
$12.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.39
|
| Rate for Payer: Meridian Medicaid |
$12.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Senior Care Partners |
$16.63
|
| Rate for Payer: PACE SWMI |
$17.51
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: PHP Medicare Advantage |
$17.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.93
|
| Rate for Payer: Priority Health Medicare |
$17.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.75
|
| Rate for Payer: Railroad Medicare Medicare |
$17.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.64
|
| Rate for Payer: UHC Core |
$58.48
|
| Rate for Payer: UHC Exchange |
$17.51
|
| Rate for Payer: UHC Medicaid |
$12.35
|
| Rate for Payer: UHC Medicare Advantage |
$17.51
|
| Rate for Payer: UHCCP Medicaid |
$12.35
|
| Rate for Payer: VA VA |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.53
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: BCBS Trust/PPO |
$57.85
|
| Rate for Payer: BCN Commercial |
$57.85
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.64
|
| Rate for Payer: UHC Core |
$58.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.53
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
IP
|
$77.65
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.04 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: BCBS Trust/PPO |
$64.13
|
| Rate for Payer: BCN Commercial |
$64.13
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.12
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.00
|
| Rate for Payer: Nomi Health Commercial |
$63.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.24
|
| Rate for Payer: PHP Commercial |
$66.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Core |
$64.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.24
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
OP
|
$77.65
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Aetna Medicare |
$20.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.27
|
| Rate for Payer: BCBS Complete |
$14.37
|
| Rate for Payer: BCBS MAPPO |
$19.41
|
| Rate for Payer: BCBS Trust/PPO |
$63.84
|
| Rate for Payer: BCN Commercial |
$63.84
|
| Rate for Payer: BCN Medicare Advantage |
$19.41
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.41
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.24
|
| Rate for Payer: Mclaren Medicaid |
$13.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.38
|
| Rate for Payer: Meridian Medicaid |
$14.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.00
|
| Rate for Payer: Nomi Health Commercial |
$63.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.24
|
| Rate for Payer: PACE Senior Care Partners |
$18.44
|
| Rate for Payer: PACE SWMI |
$19.41
|
| Rate for Payer: PHP Commercial |
$66.00
|
| Rate for Payer: PHP Medicare Advantage |
$19.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.56
|
| Rate for Payer: Priority Health Medicare |
$19.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.04
|
| Rate for Payer: Railroad Medicare Medicare |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.33
|
| Rate for Payer: UHC Core |
$64.84
|
| Rate for Payer: UHC Exchange |
$19.41
|
| Rate for Payer: UHC Medicaid |
$13.69
|
| Rate for Payer: UHC Medicare Advantage |
$19.41
|
| Rate for Payer: UHCCP Medicaid |
$13.69
|
| Rate for Payer: VA VA |
$19.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.24
|
|
|
HC CA 125
|
Facility
|
OP
|
$148.88
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$133.99 |
| Rate for Payer: Aetna Commercial |
$126.55
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$27.56
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$122.39
|
| Rate for Payer: BCN Commercial |
$122.39
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Commercial |
$128.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$133.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.66
|
| Rate for Payer: Mclaren Medicaid |
$26.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: PACE Senior Care Partners |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$126.55
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.53
|
| Rate for Payer: Priority Health Medicare |
$37.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.62
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.01
|
| Rate for Payer: UHC Core |
$124.31
|
| Rate for Payer: UHC Exchange |
$37.22
|
| Rate for Payer: UHC Medicaid |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: VA VA |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.66
|
|
|
HC CA 125
|
Facility
|
IP
|
$148.88
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.62 |
| Max. Negotiated Rate |
$133.99 |
| Rate for Payer: Aetna Commercial |
$126.55
|
| Rate for Payer: BCBS Trust/PPO |
$122.96
|
| Rate for Payer: BCN Commercial |
$122.96
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Commercial |
$128.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Healthscope Commercial |
$133.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: PHP Commercial |
$126.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.01
|
| Rate for Payer: UHC Core |
$124.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.66
|
|
|
HC CADMIUM LEVEL
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.50
|
| Rate for Payer: BCBS Complete |
$9.18
|
| Rate for Payer: BCBS MAPPO |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$40.78
|
| Rate for Payer: BCN Commercial |
$40.78
|
| Rate for Payer: BCN Medicare Advantage |
$12.40
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$42.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.40
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.21
|
| Rate for Payer: Mclaren Medicaid |
$8.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.02
|
| Rate for Payer: Meridian Medicaid |
$9.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.17
|
| Rate for Payer: Nomi Health Commercial |
$40.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.21
|
| Rate for Payer: PACE Senior Care Partners |
$11.78
|
| Rate for Payer: PACE SWMI |
$12.40
|
| Rate for Payer: PHP Commercial |
$42.17
|
| Rate for Payer: PHP Medicare Advantage |
$12.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.16
|
| Rate for Payer: Priority Health Medicare |
$12.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.53
|
| Rate for Payer: Railroad Medicare Medicare |
$12.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.66
|
| Rate for Payer: UHC Core |
$41.42
|
| Rate for Payer: UHC Exchange |
$12.40
|
| Rate for Payer: UHC Medicaid |
$8.75
|
| Rate for Payer: UHC Medicare Advantage |
$12.40
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
| Rate for Payer: VA VA |
$12.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.21
|
|
|
HC CADMIUM LEVEL
|
Facility
|
IP
|
$49.61
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.97
|
| Rate for Payer: BCN Commercial |
$40.97
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$42.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.69
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.17
|
| Rate for Payer: Nomi Health Commercial |
$40.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.21
|
| Rate for Payer: PHP Commercial |
$42.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.66
|
| Rate for Payer: UHC Core |
$41.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.21
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
IP
|
$119.92
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.46 |
| Max. Negotiated Rate |
$107.93 |
| Rate for Payer: Aetna Commercial |
$101.93
|
| Rate for Payer: BCBS Trust/PPO |
$99.04
|
| Rate for Payer: BCN Commercial |
$99.04
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cofinity Commercial |
$103.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.94
|
| Rate for Payer: Healthscope Commercial |
$107.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.93
|
| Rate for Payer: Nomi Health Commercial |
$98.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.94
|
| Rate for Payer: PHP Commercial |
$101.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.53
|
| Rate for Payer: UHC Core |
$100.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.94
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
OP
|
$119.92
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$107.93 |
| Rate for Payer: Aetna Commercial |
$101.93
|
| Rate for Payer: Aetna Medicare |
$31.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.48
|
| Rate for Payer: BCBS Complete |
$22.20
|
| Rate for Payer: BCBS MAPPO |
$29.98
|
| Rate for Payer: BCBS Trust/PPO |
$98.59
|
| Rate for Payer: BCN Commercial |
$98.59
|
| Rate for Payer: BCN Medicare Advantage |
$29.98
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cofinity Commercial |
$103.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.98
|
| Rate for Payer: Healthscope Commercial |
$107.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.94
|
| Rate for Payer: Mclaren Medicaid |
$21.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.48
|
| Rate for Payer: Meridian Medicaid |
$22.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.93
|
| Rate for Payer: Nomi Health Commercial |
$98.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.94
|
| Rate for Payer: PACE Senior Care Partners |
$28.48
|
| Rate for Payer: PACE SWMI |
$29.98
|
| Rate for Payer: PHP Commercial |
$101.93
|
| Rate for Payer: PHP Medicare Advantage |
$29.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.33
|
| Rate for Payer: Priority Health Medicare |
$30.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.46
|
| Rate for Payer: Railroad Medicare Medicare |
$29.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.53
|
| Rate for Payer: UHC Core |
$100.13
|
| Rate for Payer: UHC Exchange |
$29.98
|
| Rate for Payer: UHC Medicaid |
$21.14
|
| Rate for Payer: UHC Medicare Advantage |
$29.98
|
| Rate for Payer: UHCCP Medicaid |
$21.14
|
| Rate for Payer: VA VA |
$29.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.94
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna Medicare |
$18.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.89
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: BCBS MAPPO |
$17.51
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCN Commercial |
$57.58
|
| Rate for Payer: BCN Medicare Advantage |
$17.51
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.51
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.53
|
| Rate for Payer: Mclaren Medicaid |
$12.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.39
|
| Rate for Payer: Meridian Medicaid |
$12.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Senior Care Partners |
$16.63
|
| Rate for Payer: PACE SWMI |
$17.51
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: PHP Medicare Advantage |
$17.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.93
|
| Rate for Payer: Priority Health Medicare |
$17.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.75
|
| Rate for Payer: Railroad Medicare Medicare |
$17.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.64
|
| Rate for Payer: UHC Core |
$58.48
|
| Rate for Payer: UHC Exchange |
$17.51
|
| Rate for Payer: UHC Medicaid |
$12.35
|
| Rate for Payer: UHC Medicare Advantage |
$17.51
|
| Rate for Payer: UHCCP Medicaid |
$12.35
|
| Rate for Payer: VA VA |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.53
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: BCBS Trust/PPO |
$57.85
|
| Rate for Payer: BCN Commercial |
$57.85
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.64
|
| Rate for Payer: UHC Core |
$58.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.53
|
|
