|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
OP
|
$3,366.24
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.11 |
| Max. Negotiated Rate |
$3,029.62 |
| Rate for Payer: Aetna Commercial |
$2,861.30
|
| Rate for Payer: Aetna Medicare |
$875.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,051.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,051.95
|
| Rate for Payer: BCBS Complete |
$611.22
|
| Rate for Payer: BCBS MAPPO |
$841.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,617.25
|
| Rate for Payer: BCN Commercial |
$2,617.25
|
| Rate for Payer: BCN Medicare Advantage |
$841.56
|
| Rate for Payer: Cash Price |
$2,692.99
|
| Rate for Payer: Cash Price |
$2,692.99
|
| Rate for Payer: Cofinity Commercial |
$2,894.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,692.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$841.56
|
| Rate for Payer: Healthscope Commercial |
$3,029.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,524.68
|
| Rate for Payer: Mclaren Medicaid |
$582.11
|
| Rate for Payer: Meridian Medicaid |
$611.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$883.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$967.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,861.30
|
| Rate for Payer: PACE Senior Care Partners |
$799.48
|
| Rate for Payer: PACE SWMI |
$841.56
|
| Rate for Payer: PHP Commercial |
$2,861.30
|
| Rate for Payer: PHP Medicare Advantage |
$841.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,356.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,928.63
|
| Rate for Payer: Priority Health Medicare |
$841.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,053.07
|
| Rate for Payer: Railroad Medicare Medicare |
$841.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,962.29
|
| Rate for Payer: UHC Core |
$2,810.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$841.56
|
| Rate for Payer: UHC Medicare Advantage |
$866.81
|
| Rate for Payer: VA VA |
$841.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,524.68
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
IP
|
$3,366.24
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,053.07 |
| Max. Negotiated Rate |
$3,029.62 |
| Rate for Payer: Aetna Commercial |
$2,861.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.43
|
| Rate for Payer: BCN Commercial |
$2,601.43
|
| Rate for Payer: Cash Price |
$2,692.99
|
| Rate for Payer: Cofinity Commercial |
$2,894.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,692.99
|
| Rate for Payer: Healthscope Commercial |
$3,029.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,524.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,861.30
|
| Rate for Payer: PHP Commercial |
$2,861.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,356.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,928.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,053.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,962.29
|
| Rate for Payer: UHC Core |
$2,810.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,524.68
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
IP
|
$2,007.51
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.38 |
| Max. Negotiated Rate |
$1,806.76 |
| Rate for Payer: Aetna Commercial |
$1,706.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.40
|
| Rate for Payer: BCN Commercial |
$1,551.40
|
| Rate for Payer: Cash Price |
$1,606.01
|
| Rate for Payer: Cofinity Commercial |
$1,726.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.01
|
| Rate for Payer: Healthscope Commercial |
$1,806.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,505.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,706.38
|
| Rate for Payer: PHP Commercial |
$1,706.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,746.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,224.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,766.61
|
| Rate for Payer: UHC Core |
$1,676.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,505.63
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
OP
|
$2,007.51
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$1,806.76 |
| Rate for Payer: Aetna Commercial |
$1,706.38
|
| Rate for Payer: Aetna Medicare |
$521.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$627.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$627.35
|
| Rate for Payer: BCBS Complete |
$442.42
|
| Rate for Payer: BCBS MAPPO |
$501.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,560.84
|
| Rate for Payer: BCN Commercial |
$1,560.84
|
| Rate for Payer: BCN Medicare Advantage |
$501.88
|
| Rate for Payer: Cash Price |
$1,606.01
|
| Rate for Payer: Cash Price |
$1,606.01
|
| Rate for Payer: Cofinity Commercial |
$1,726.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.88
|
| Rate for Payer: Healthscope Commercial |
$1,806.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,505.63
|
| Rate for Payer: Mclaren Medicaid |
$421.35
|
| Rate for Payer: Meridian Medicaid |
$442.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$526.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,706.38
|
| Rate for Payer: PACE Senior Care Partners |
$476.78
|
| Rate for Payer: PACE SWMI |
$501.88
|
| Rate for Payer: PHP Commercial |
$1,706.38
|
| Rate for Payer: PHP Medicare Advantage |
$501.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,746.53
|
| Rate for Payer: Priority Health Medicare |
$501.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,224.38
|
| Rate for Payer: Railroad Medicare Medicare |
$501.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,766.61
|
| Rate for Payer: UHC Core |
$1,676.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$501.88
|
| Rate for Payer: UHC Medicare Advantage |
$516.93
|
| Rate for Payer: VA VA |
$501.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,505.63
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
IP
|
$1,391.19
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$848.49 |
| Max. Negotiated Rate |
$1,252.07 |
| Rate for Payer: Aetna Commercial |
$1,182.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.11
|
| Rate for Payer: BCN Commercial |
$1,075.11
|
| Rate for Payer: Cash Price |
$1,112.95
|
| Rate for Payer: Cofinity Commercial |
$1,196.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,112.95
|
| Rate for Payer: Healthscope Commercial |
$1,252.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,043.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,182.51
|
| Rate for Payer: PHP Commercial |
$1,182.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,210.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$848.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.25
|
| Rate for Payer: UHC Core |
$1,161.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,043.39
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
OP
|
$1,391.19
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.54 |
| Max. Negotiated Rate |
$1,252.07 |
| Rate for Payer: Aetna Commercial |
$1,182.51
|
| Rate for Payer: Aetna Medicare |
$361.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.75
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$347.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.65
|
| Rate for Payer: BCN Commercial |
$1,081.65
|
| Rate for Payer: BCN Medicare Advantage |
$347.80
|
| Rate for Payer: Cash Price |
$1,112.95
|
| Rate for Payer: Cash Price |
$1,112.95
|
| Rate for Payer: Cofinity Commercial |
$1,196.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,112.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.80
|
| Rate for Payer: Healthscope Commercial |
$1,252.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,043.39
|
| Rate for Payer: Mclaren Medicaid |
$290.54
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$365.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,182.51
|
| Rate for Payer: PACE Senior Care Partners |
$330.41
|
| Rate for Payer: PACE SWMI |
$347.80
|
| Rate for Payer: PHP Commercial |
$1,182.51
|
| Rate for Payer: PHP Medicare Advantage |
$347.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,210.34
|
| Rate for Payer: Priority Health Medicare |
$347.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$848.49
|
| Rate for Payer: Railroad Medicare Medicare |
$347.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.25
|
| Rate for Payer: UHC Core |
$1,161.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.80
|
| Rate for Payer: UHC Medicare Advantage |
$358.23
|
| Rate for Payer: VA VA |
$347.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,043.39
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$252.31
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$227.08 |
| Rate for Payer: Aetna Commercial |
$214.46
|
| Rate for Payer: Aetna Medicare |
$65.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.85
|
| Rate for Payer: BCBS Complete |
$61.16
|
| Rate for Payer: BCBS MAPPO |
$63.08
|
| Rate for Payer: BCBS Trust/PPO |
$196.17
|
| Rate for Payer: BCN Commercial |
$196.17
|
| Rate for Payer: BCN Medicare Advantage |
$63.08
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$216.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.08
|
| Rate for Payer: Healthscope Commercial |
$227.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.23
|
| Rate for Payer: Mclaren Medicaid |
$58.24
|
| Rate for Payer: Meridian Medicaid |
$61.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.46
|
| Rate for Payer: PACE Senior Care Partners |
$59.92
|
| Rate for Payer: PACE SWMI |
$63.08
|
| Rate for Payer: PHP Commercial |
$214.46
|
| Rate for Payer: PHP Medicare Advantage |
$63.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.51
|
| Rate for Payer: Priority Health Medicare |
$63.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.88
|
| Rate for Payer: Railroad Medicare Medicare |
$63.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.03
|
| Rate for Payer: UHC Core |
$210.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.08
|
| Rate for Payer: UHC Medicare Advantage |
$64.97
|
| Rate for Payer: VA VA |
$63.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.23
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
IP
|
$252.31
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.88 |
| Max. Negotiated Rate |
$227.08 |
| Rate for Payer: Aetna Commercial |
$214.46
|
| Rate for Payer: BCBS Trust/PPO |
$194.99
|
| Rate for Payer: BCN Commercial |
$194.99
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$216.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.85
|
| Rate for Payer: Healthscope Commercial |
$227.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.46
|
| Rate for Payer: PHP Commercial |
$214.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.03
|
| Rate for Payer: UHC Core |
$210.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.23
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
IP
|
$885.90
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$540.31 |
| Max. Negotiated Rate |
$797.31 |
| Rate for Payer: Aetna Commercial |
$753.02
|
| Rate for Payer: BCBS Trust/PPO |
$684.62
|
| Rate for Payer: BCN Commercial |
$684.62
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Commercial |
$761.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Healthscope Commercial |
$797.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$753.02
|
| Rate for Payer: PHP Commercial |
$753.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$540.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.59
|
| Rate for Payer: UHC Core |
$739.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.42
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
OP
|
$885.90
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.16 |
| Max. Negotiated Rate |
$797.31 |
| Rate for Payer: Aetna Commercial |
$753.02
|
| Rate for Payer: Aetna Medicare |
$230.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.84
|
| Rate for Payer: BCBS Complete |
$196.52
|
| Rate for Payer: BCBS MAPPO |
$221.48
|
| Rate for Payer: BCBS Trust/PPO |
$688.79
|
| Rate for Payer: BCN Commercial |
$688.79
|
| Rate for Payer: BCN Medicare Advantage |
$221.48
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Commercial |
$761.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.48
|
| Rate for Payer: Healthscope Commercial |
$797.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.42
|
| Rate for Payer: Mclaren Medicaid |
$187.16
|
| Rate for Payer: Meridian Medicaid |
$196.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$753.02
|
| Rate for Payer: PACE Senior Care Partners |
$210.40
|
| Rate for Payer: PACE SWMI |
$221.48
|
| Rate for Payer: PHP Commercial |
$753.02
|
| Rate for Payer: PHP Medicare Advantage |
$221.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.73
|
| Rate for Payer: Priority Health Medicare |
$221.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$540.31
|
| Rate for Payer: Railroad Medicare Medicare |
$221.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.59
|
| Rate for Payer: UHC Core |
$739.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.48
|
| Rate for Payer: UHC Medicare Advantage |
$228.12
|
| Rate for Payer: VA VA |
$221.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.42
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$502.02
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$451.82 |
| Rate for Payer: Aetna Commercial |
$426.72
|
| Rate for Payer: Aetna Medicare |
$130.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.88
|
| Rate for Payer: BCBS Complete |
$112.65
|
| Rate for Payer: BCBS MAPPO |
$125.50
|
| Rate for Payer: BCBS Trust/PPO |
$390.32
|
| Rate for Payer: BCN Commercial |
$390.32
|
| Rate for Payer: BCN Medicare Advantage |
$125.50
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$431.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.50
|
| Rate for Payer: Healthscope Commercial |
$451.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.52
|
| Rate for Payer: Mclaren Medicaid |
$107.29
|
| Rate for Payer: Meridian Medicaid |
$112.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.72
|
| Rate for Payer: PACE Senior Care Partners |
$119.23
|
| Rate for Payer: PACE SWMI |
$125.50
|
| Rate for Payer: PHP Commercial |
$426.72
|
| Rate for Payer: PHP Medicare Advantage |
$125.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.76
|
| Rate for Payer: Priority Health Medicare |
$125.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.18
|
| Rate for Payer: Railroad Medicare Medicare |
$125.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.78
|
| Rate for Payer: UHC Core |
$419.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.50
|
| Rate for Payer: UHC Medicare Advantage |
$129.27
|
| Rate for Payer: VA VA |
$125.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.52
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
IP
|
$502.02
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.18 |
| Max. Negotiated Rate |
$451.82 |
| Rate for Payer: Aetna Commercial |
$426.72
|
| Rate for Payer: BCBS Trust/PPO |
$387.96
|
| Rate for Payer: BCN Commercial |
$387.96
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$431.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$451.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.72
|
| Rate for Payer: PHP Commercial |
$426.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.78
|
| Rate for Payer: UHC Core |
$419.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.52
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,291.02
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$2,797.37
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,543.30
|
| Rate for Payer: BCN Commercial |
$2,543.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cofinity Commercial |
$2,830.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,632.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$2,961.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,468.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,797.37
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$2,797.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,863.19
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,007.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,896.10
|
| Rate for Payer: UHC Core |
$2,748.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,468.26
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.20 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: BCBS Trust/PPO |
$533.70
|
| Rate for Payer: BCN Commercial |
$533.70
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.02 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$179.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.82
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS MAPPO |
$172.65
|
| Rate for Payer: BCBS Trust/PPO |
$536.95
|
| Rate for Payer: BCN Commercial |
$536.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.65
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.65
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PACE Senior Care Partners |
$164.02
|
| Rate for Payer: PACE SWMI |
$172.65
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: PHP Medicare Advantage |
$172.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.83
|
| Rate for Payer: Priority Health Medicare |
$172.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.20
|
| Rate for Payer: Railroad Medicare Medicare |
$172.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.83
|
| Rate for Payer: VA VA |
$172.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.02 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$179.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.82
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS MAPPO |
$172.65
|
| Rate for Payer: BCBS Trust/PPO |
$536.95
|
| Rate for Payer: BCN Commercial |
$536.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.65
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.65
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PACE Senior Care Partners |
$164.02
|
| Rate for Payer: PACE SWMI |
$172.65
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: PHP Medicare Advantage |
$172.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.83
|
| Rate for Payer: Priority Health Medicare |
$172.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.20
|
| Rate for Payer: Railroad Medicare Medicare |
$172.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.83
|
| Rate for Payer: VA VA |
$172.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.20 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: BCBS Trust/PPO |
$533.70
|
| Rate for Payer: BCN Commercial |
$533.70
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$13.87
|
| Rate for Payer: Meridian Medicaid |
$14.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.51
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC ESOPHAGEAL IMPEDENCE MONITORIN
|
Facility
|
IP
|
$1,422.96
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$867.86 |
| Max. Negotiated Rate |
$1,280.66 |
| Rate for Payer: Aetna Commercial |
$1,209.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.66
|
| Rate for Payer: BCN Commercial |
$1,099.66
|
| Rate for Payer: Cash Price |
$1,138.37
|
| Rate for Payer: Cofinity Commercial |
$1,223.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.37
|
| Rate for Payer: Healthscope Commercial |
$1,280.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,209.52
|
| Rate for Payer: PHP Commercial |
$1,209.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$867.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.20
|
| Rate for Payer: UHC Core |
$1,188.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.22
|
|
|
HC ESOPHAGEAL IMPEDENCE MONITORIN
|
Facility
|
OP
|
$1,422.96
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$337.95 |
| Max. Negotiated Rate |
$1,280.66 |
| Rate for Payer: Aetna Commercial |
$1,209.52
|
| Rate for Payer: Aetna Medicare |
$369.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$444.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$444.68
|
| Rate for Payer: BCBS Complete |
$569.18
|
| Rate for Payer: BCBS MAPPO |
$355.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,106.35
|
| Rate for Payer: BCN Commercial |
$1,106.35
|
| Rate for Payer: BCN Medicare Advantage |
$355.74
|
| Rate for Payer: Cash Price |
$1,138.37
|
| Rate for Payer: Cofinity Commercial |
$1,223.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.74
|
| Rate for Payer: Healthscope Commercial |
$1,280.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$373.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$409.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,209.52
|
| Rate for Payer: PACE Senior Care Partners |
$337.95
|
| Rate for Payer: PACE SWMI |
$355.74
|
| Rate for Payer: PHP Commercial |
$1,209.52
|
| Rate for Payer: PHP Medicare Advantage |
$355.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.98
|
| Rate for Payer: Priority Health Medicare |
$355.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$867.86
|
| Rate for Payer: Railroad Medicare Medicare |
$355.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.20
|
| Rate for Payer: UHC Core |
$1,188.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.74
|
| Rate for Payer: UHC Medicare Advantage |
$366.41
|
| Rate for Payer: VA VA |
$355.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.22
|
|
