|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,796.14
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$316.66 |
| Max. Negotiated Rate |
$1,616.53 |
| Rate for Payer: Aetna Commercial |
$1,526.72
|
| Rate for Payer: Aetna Medicare |
$467.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$561.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$561.29
|
| Rate for Payer: BCBS Complete |
$332.47
|
| Rate for Payer: BCBS MAPPO |
$449.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.61
|
| Rate for Payer: BCN Commercial |
$1,476.61
|
| Rate for Payer: BCN Medicare Advantage |
$449.04
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cofinity Commercial |
$1,544.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.04
|
| Rate for Payer: Healthscope Commercial |
$1,616.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,347.11
|
| Rate for Payer: Mclaren Medicaid |
$316.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.49
|
| Rate for Payer: Meridian Medicaid |
$332.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$516.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$493.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.72
|
| Rate for Payer: Nomi Health Commercial |
$1,472.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,347.11
|
| Rate for Payer: PACE Senior Care Partners |
$426.58
|
| Rate for Payer: PACE SWMI |
$449.04
|
| Rate for Payer: PHP Commercial |
$1,526.72
|
| Rate for Payer: PHP Medicare Advantage |
$449.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,562.64
|
| Rate for Payer: Priority Health Medicare |
$453.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,250.11
|
| Rate for Payer: Railroad Medicare Medicare |
$449.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,580.60
|
| Rate for Payer: UHC Core |
$1,499.78
|
| Rate for Payer: UHC Exchange |
$449.04
|
| Rate for Payer: UHC Medicaid |
$316.66
|
| Rate for Payer: UHC Medicare Advantage |
$449.04
|
| Rate for Payer: UHCCP Medicaid |
$316.66
|
| Rate for Payer: VA VA |
$449.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,347.11
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
IP
|
$1,796.14
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,250.11 |
| Max. Negotiated Rate |
$1,616.53 |
| Rate for Payer: Aetna Commercial |
$1,526.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,483.43
|
| Rate for Payer: BCN Commercial |
$1,483.43
|
| Rate for Payer: Cash Price |
$1,436.91
|
| Rate for Payer: Cofinity Commercial |
$1,544.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.91
|
| Rate for Payer: Healthscope Commercial |
$1,616.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,347.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.72
|
| Rate for Payer: Nomi Health Commercial |
$1,472.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,347.11
|
| Rate for Payer: PHP Commercial |
$1,526.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,562.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,250.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,580.60
|
| Rate for Payer: UHC Core |
$1,499.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,347.11
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,099.99
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$370.23 |
| Max. Negotiated Rate |
$1,889.99 |
| Rate for Payer: Aetna Commercial |
$1,784.99
|
| Rate for Payer: Aetna Medicare |
$546.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.25
|
| Rate for Payer: BCBS Complete |
$388.71
|
| Rate for Payer: BCBS MAPPO |
$525.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.40
|
| Rate for Payer: BCN Commercial |
$1,726.40
|
| Rate for Payer: BCN Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cofinity Commercial |
$1,805.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$525.00
|
| Rate for Payer: Healthscope Commercial |
$1,889.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,574.99
|
| Rate for Payer: Mclaren Medicaid |
$370.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.25
|
| Rate for Payer: Meridian Medicaid |
$388.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$577.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.99
|
| Rate for Payer: Nomi Health Commercial |
$1,721.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.99
|
| Rate for Payer: PACE Senior Care Partners |
$498.75
|
| Rate for Payer: PACE SWMI |
$525.00
|
| Rate for Payer: PHP Commercial |
$1,784.99
|
| Rate for Payer: PHP Medicare Advantage |
$525.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,826.99
|
| Rate for Payer: Priority Health Medicare |
$530.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,461.59
|
| Rate for Payer: Railroad Medicare Medicare |
$525.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,847.99
|
| Rate for Payer: UHC Core |
$1,753.49
|
| Rate for Payer: UHC Exchange |
$525.00
|
| Rate for Payer: UHC Medicaid |
$370.23
|
| Rate for Payer: UHC Medicare Advantage |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$370.23
|
| Rate for Payer: VA VA |
$525.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,574.99
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,099.99
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,461.59 |
| Max. Negotiated Rate |
$1,889.99 |
| Rate for Payer: Aetna Commercial |
$1,784.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,734.38
|
| Rate for Payer: BCN Commercial |
$1,734.38
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cofinity Commercial |
$1,805.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.99
|
| Rate for Payer: Healthscope Commercial |
$1,889.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,574.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.99
|
| Rate for Payer: Nomi Health Commercial |
$1,721.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.99
|
| Rate for Payer: PHP Commercial |
$1,784.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,826.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,461.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,847.99
|
| Rate for Payer: UHC Core |
$1,753.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,574.99
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,295.29
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$404.66 |
| Max. Negotiated Rate |
$2,065.76 |
| Rate for Payer: Aetna Commercial |
$1,951.00
|
| Rate for Payer: Aetna Medicare |
$596.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$717.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$717.28
|
| Rate for Payer: BCBS Complete |
$424.86
|
| Rate for Payer: BCBS MAPPO |
$573.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,886.96
|
| Rate for Payer: BCN Commercial |
$1,886.96
|
| Rate for Payer: BCN Medicare Advantage |
$573.82
|
| Rate for Payer: Cash Price |
$1,836.23
|
| Rate for Payer: Cofinity Commercial |
$1,973.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,836.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.82
|
| Rate for Payer: Healthscope Commercial |
$2,065.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,721.47
|
| Rate for Payer: Mclaren Medicaid |
$404.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$602.51
|
| Rate for Payer: Meridian Medicaid |
$424.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$659.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$631.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,951.00
|
| Rate for Payer: Nomi Health Commercial |
$1,882.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.47
|
| Rate for Payer: PACE Senior Care Partners |
$545.13
|
| Rate for Payer: PACE SWMI |
$573.82
|
| Rate for Payer: PHP Commercial |
$1,951.00
|
| Rate for Payer: PHP Medicare Advantage |
$573.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,996.90
|
| Rate for Payer: Priority Health Medicare |
$579.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,597.52
|
| Rate for Payer: Railroad Medicare Medicare |
$573.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,019.86
|
| Rate for Payer: UHC Core |
$1,916.57
|
| Rate for Payer: UHC Exchange |
$573.82
|
| Rate for Payer: UHC Medicaid |
$404.66
|
| Rate for Payer: UHC Medicare Advantage |
$573.82
|
| Rate for Payer: UHCCP Medicaid |
$404.66
|
| Rate for Payer: VA VA |
$573.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,721.47
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,295.29
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,597.52 |
| Max. Negotiated Rate |
$2,065.76 |
| Rate for Payer: Aetna Commercial |
$1,951.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.68
|
| Rate for Payer: BCN Commercial |
$1,895.68
|
| Rate for Payer: Cash Price |
$1,836.23
|
| Rate for Payer: Cofinity Commercial |
$1,973.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,836.23
|
| Rate for Payer: Healthscope Commercial |
$2,065.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,721.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,951.00
|
| Rate for Payer: Nomi Health Commercial |
$1,882.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.47
|
| Rate for Payer: PHP Commercial |
$1,951.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,996.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,597.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,019.86
|
| Rate for Payer: UHC Core |
$1,916.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,721.47
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,964.32
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,367.17 |
| Max. Negotiated Rate |
$1,767.89 |
| Rate for Payer: Aetna Commercial |
$1,669.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,622.33
|
| Rate for Payer: BCN Commercial |
$1,622.33
|
| Rate for Payer: Cash Price |
$1,571.46
|
| Rate for Payer: Cofinity Commercial |
$1,689.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.46
|
| Rate for Payer: Healthscope Commercial |
$1,767.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.67
|
| Rate for Payer: Nomi Health Commercial |
$1,610.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.24
|
| Rate for Payer: PHP Commercial |
$1,669.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,708.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,367.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.60
|
| Rate for Payer: UHC Core |
$1,640.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.24
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,964.32
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$346.31 |
| Max. Negotiated Rate |
$1,767.89 |
| Rate for Payer: Aetna Commercial |
$1,669.67
|
| Rate for Payer: Aetna Medicare |
$510.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.85
|
| Rate for Payer: BCBS Complete |
$363.60
|
| Rate for Payer: BCBS MAPPO |
$491.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.87
|
| Rate for Payer: BCN Commercial |
$1,614.87
|
| Rate for Payer: BCN Medicare Advantage |
$491.08
|
| Rate for Payer: Cash Price |
$1,571.46
|
| Rate for Payer: Cofinity Commercial |
$1,689.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.08
|
| Rate for Payer: Healthscope Commercial |
$1,767.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.24
|
| Rate for Payer: Mclaren Medicaid |
$346.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.63
|
| Rate for Payer: Meridian Medicaid |
$363.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$540.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.67
|
| Rate for Payer: Nomi Health Commercial |
$1,610.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.24
|
| Rate for Payer: PACE Senior Care Partners |
$466.53
|
| Rate for Payer: PACE SWMI |
$491.08
|
| Rate for Payer: PHP Commercial |
$1,669.67
|
| Rate for Payer: PHP Medicare Advantage |
$491.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,708.96
|
| Rate for Payer: Priority Health Medicare |
$495.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,367.17
|
| Rate for Payer: Railroad Medicare Medicare |
$491.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.60
|
| Rate for Payer: UHC Core |
$1,640.21
|
| Rate for Payer: UHC Exchange |
$491.08
|
| Rate for Payer: UHC Medicaid |
$346.31
|
| Rate for Payer: UHC Medicare Advantage |
$491.08
|
| Rate for Payer: UHCCP Medicaid |
$346.31
|
| Rate for Payer: VA VA |
$491.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.24
|
|
|
HC EXTENDED RECOVERY PER HR
|
Facility
|
OP
|
$145.86
|
|
| Hospital Charge Code |
71000038
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$131.27 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: Aetna Medicare |
$37.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.58
|
| Rate for Payer: BCBS Complete |
$27.00
|
| Rate for Payer: BCBS MAPPO |
$36.47
|
| Rate for Payer: BCBS Trust/PPO |
$119.91
|
| Rate for Payer: BCN Commercial |
$119.91
|
| Rate for Payer: BCN Medicare Advantage |
$36.47
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.47
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.39
|
| Rate for Payer: Mclaren Medicaid |
$25.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.29
|
| Rate for Payer: Meridian Medicaid |
$27.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.98
|
| Rate for Payer: Nomi Health Commercial |
$119.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.39
|
| Rate for Payer: PACE Senior Care Partners |
$34.64
|
| Rate for Payer: PACE SWMI |
$36.47
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: PHP Medicare Advantage |
$36.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.90
|
| Rate for Payer: Priority Health Medicare |
$36.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.52
|
| Rate for Payer: Railroad Medicare Medicare |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.36
|
| Rate for Payer: UHC Core |
$121.79
|
| Rate for Payer: UHC Exchange |
$36.47
|
| Rate for Payer: UHC Medicaid |
$25.72
|
| Rate for Payer: UHC Medicare Advantage |
$36.47
|
| Rate for Payer: UHCCP Medicaid |
$25.72
|
| Rate for Payer: VA VA |
$36.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.39
|
|
|
HC EXTENDED RECOVERY PER HR
|
Facility
|
IP
|
$145.86
|
|
| Hospital Charge Code |
71000038
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$131.27 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: BCBS Trust/PPO |
$120.47
|
| Rate for Payer: BCN Commercial |
$120.47
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.98
|
| Rate for Payer: Nomi Health Commercial |
$119.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.39
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.36
|
| Rate for Payer: UHC Core |
$121.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.39
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,072.62
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.54 |
| Max. Negotiated Rate |
$1,865.36 |
| Rate for Payer: Aetna Commercial |
$1,761.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.78
|
| Rate for Payer: BCN Commercial |
$1,711.78
|
| Rate for Payer: Cash Price |
$1,658.10
|
| Rate for Payer: Cofinity Commercial |
$1,782.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.10
|
| Rate for Payer: Healthscope Commercial |
$1,865.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,554.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.73
|
| Rate for Payer: Nomi Health Commercial |
$1,699.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,554.46
|
| Rate for Payer: PHP Commercial |
$1,761.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,803.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,442.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,823.91
|
| Rate for Payer: UHC Core |
$1,730.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,554.46
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,072.62
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$1,865.36 |
| Rate for Payer: Aetna Commercial |
$1,761.73
|
| Rate for Payer: Aetna Medicare |
$538.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$647.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$647.69
|
| Rate for Payer: BCBS Complete |
$383.64
|
| Rate for Payer: BCBS MAPPO |
$518.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.90
|
| Rate for Payer: BCN Commercial |
$1,703.90
|
| Rate for Payer: BCN Medicare Advantage |
$518.15
|
| Rate for Payer: Cash Price |
$1,658.10
|
| Rate for Payer: Cofinity Commercial |
$1,782.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.15
|
| Rate for Payer: Healthscope Commercial |
$1,865.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,554.46
|
| Rate for Payer: Mclaren Medicaid |
$365.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$544.06
|
| Rate for Payer: Meridian Medicaid |
$383.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$569.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,761.73
|
| Rate for Payer: Nomi Health Commercial |
$1,699.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,554.46
|
| Rate for Payer: PACE Senior Care Partners |
$492.25
|
| Rate for Payer: PACE SWMI |
$518.15
|
| Rate for Payer: PHP Commercial |
$1,761.73
|
| Rate for Payer: PHP Medicare Advantage |
$518.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,803.18
|
| Rate for Payer: Priority Health Medicare |
$523.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,442.54
|
| Rate for Payer: Railroad Medicare Medicare |
$518.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,823.91
|
| Rate for Payer: UHC Core |
$1,730.64
|
| Rate for Payer: UHC Exchange |
$518.15
|
| Rate for Payer: UHC Medicaid |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$518.15
|
| Rate for Payer: UHCCP Medicaid |
$365.40
|
| Rate for Payer: VA VA |
$518.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,554.46
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,418.07
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.31 |
| Max. Negotiated Rate |
$2,176.26 |
| Rate for Payer: Aetna Commercial |
$2,055.36
|
| Rate for Payer: Aetna Medicare |
$628.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$755.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$755.65
|
| Rate for Payer: BCBS Complete |
$447.58
|
| Rate for Payer: BCBS MAPPO |
$604.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,987.90
|
| Rate for Payer: BCN Commercial |
$1,987.90
|
| Rate for Payer: BCN Medicare Advantage |
$604.52
|
| Rate for Payer: Cash Price |
$1,934.46
|
| Rate for Payer: Cofinity Commercial |
$2,079.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.52
|
| Rate for Payer: Healthscope Commercial |
$2,176.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,813.55
|
| Rate for Payer: Mclaren Medicaid |
$426.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$634.74
|
| Rate for Payer: Meridian Medicaid |
$447.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$695.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$664.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.36
|
| Rate for Payer: Nomi Health Commercial |
$1,982.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,813.55
|
| Rate for Payer: PACE Senior Care Partners |
$574.29
|
| Rate for Payer: PACE SWMI |
$604.52
|
| Rate for Payer: PHP Commercial |
$2,055.36
|
| Rate for Payer: PHP Medicare Advantage |
$604.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,103.72
|
| Rate for Payer: Priority Health Medicare |
$610.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,682.98
|
| Rate for Payer: Railroad Medicare Medicare |
$604.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,127.90
|
| Rate for Payer: UHC Core |
$2,019.09
|
| Rate for Payer: UHC Exchange |
$604.52
|
| Rate for Payer: UHC Medicaid |
$426.31
|
| Rate for Payer: UHC Medicare Advantage |
$604.52
|
| Rate for Payer: UHCCP Medicaid |
$426.31
|
| Rate for Payer: VA VA |
$604.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,813.55
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,418.07
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,682.98 |
| Max. Negotiated Rate |
$2,176.26 |
| Rate for Payer: Aetna Commercial |
$2,055.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,997.08
|
| Rate for Payer: BCN Commercial |
$1,997.08
|
| Rate for Payer: Cash Price |
$1,934.46
|
| Rate for Payer: Cofinity Commercial |
$2,079.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.46
|
| Rate for Payer: Healthscope Commercial |
$2,176.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,813.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.36
|
| Rate for Payer: Nomi Health Commercial |
$1,982.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,813.55
|
| Rate for Payer: PHP Commercial |
$2,055.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,103.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,682.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,127.90
|
| Rate for Payer: UHC Core |
$2,019.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,813.55
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$92.95
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$64.69 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna Commercial |
$79.01
|
| Rate for Payer: BCBS Trust/PPO |
$76.77
|
| Rate for Payer: BCN Commercial |
$76.77
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cofinity Commercial |
$79.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.36
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.01
|
| Rate for Payer: Nomi Health Commercial |
$76.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.71
|
| Rate for Payer: PHP Commercial |
$79.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.80
|
| Rate for Payer: UHC Core |
$77.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.71
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$92.95
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna Commercial |
$79.01
|
| Rate for Payer: Aetna Medicare |
$24.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.05
|
| Rate for Payer: BCBS Complete |
$17.21
|
| Rate for Payer: BCBS MAPPO |
$23.24
|
| Rate for Payer: BCBS Trust/PPO |
$76.41
|
| Rate for Payer: BCN Commercial |
$76.41
|
| Rate for Payer: BCN Medicare Advantage |
$23.24
|
| Rate for Payer: Cash Price |
$74.36
|
| Rate for Payer: Cofinity Commercial |
$79.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.24
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.71
|
| Rate for Payer: Mclaren Medicaid |
$16.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.40
|
| Rate for Payer: Meridian Medicaid |
$17.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.01
|
| Rate for Payer: Nomi Health Commercial |
$76.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.71
|
| Rate for Payer: PACE Senior Care Partners |
$22.08
|
| Rate for Payer: PACE SWMI |
$23.24
|
| Rate for Payer: PHP Commercial |
$79.01
|
| Rate for Payer: PHP Medicare Advantage |
$23.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.87
|
| Rate for Payer: Priority Health Medicare |
$23.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.69
|
| Rate for Payer: Railroad Medicare Medicare |
$23.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.80
|
| Rate for Payer: UHC Core |
$77.61
|
| Rate for Payer: UHC Exchange |
$23.24
|
| Rate for Payer: UHC Medicaid |
$16.39
|
| Rate for Payer: UHC Medicare Advantage |
$23.24
|
| Rate for Payer: UHCCP Medicaid |
$16.39
|
| Rate for Payer: VA VA |
$23.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.71
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$140.14
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$126.13 |
| Rate for Payer: Aetna Commercial |
$119.12
|
| Rate for Payer: BCBS Trust/PPO |
$115.74
|
| Rate for Payer: BCN Commercial |
$115.74
|
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Cofinity Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.11
|
| Rate for Payer: Healthscope Commercial |
$126.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.12
|
| Rate for Payer: Nomi Health Commercial |
$114.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.11
|
| Rate for Payer: PHP Commercial |
$119.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.32
|
| Rate for Payer: UHC Core |
$117.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.11
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$140.14
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$126.13 |
| Rate for Payer: Aetna Commercial |
$119.12
|
| Rate for Payer: Aetna Medicare |
$36.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.79
|
| Rate for Payer: BCBS Complete |
$25.94
|
| Rate for Payer: BCBS MAPPO |
$35.03
|
| Rate for Payer: BCBS Trust/PPO |
$115.21
|
| Rate for Payer: BCN Commercial |
$115.21
|
| Rate for Payer: BCN Medicare Advantage |
$35.03
|
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Cofinity Commercial |
$120.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.03
|
| Rate for Payer: Healthscope Commercial |
$126.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.11
|
| Rate for Payer: Mclaren Medicaid |
$24.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.79
|
| Rate for Payer: Meridian Medicaid |
$25.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.12
|
| Rate for Payer: Nomi Health Commercial |
$114.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.11
|
| Rate for Payer: PACE Senior Care Partners |
$33.28
|
| Rate for Payer: PACE SWMI |
$35.03
|
| Rate for Payer: PHP Commercial |
$119.12
|
| Rate for Payer: PHP Medicare Advantage |
$35.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.92
|
| Rate for Payer: Priority Health Medicare |
$35.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.54
|
| Rate for Payer: Railroad Medicare Medicare |
$35.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.32
|
| Rate for Payer: UHC Core |
$117.02
|
| Rate for Payer: UHC Exchange |
$35.03
|
| Rate for Payer: UHC Medicaid |
$24.71
|
| Rate for Payer: UHC Medicare Advantage |
$35.03
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: VA VA |
$35.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.11
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$587.96
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$103.66 |
| Max. Negotiated Rate |
$529.16 |
| Rate for Payer: Aetna Commercial |
$499.77
|
| Rate for Payer: Aetna Medicare |
$152.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.74
|
| Rate for Payer: BCBS Complete |
$108.83
|
| Rate for Payer: BCBS MAPPO |
$146.99
|
| Rate for Payer: BCBS Trust/PPO |
$483.36
|
| Rate for Payer: BCN Commercial |
$483.36
|
| Rate for Payer: BCN Medicare Advantage |
$146.99
|
| Rate for Payer: Cash Price |
$470.37
|
| Rate for Payer: Cofinity Commercial |
$505.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.99
|
| Rate for Payer: Healthscope Commercial |
$529.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.97
|
| Rate for Payer: Mclaren Medicaid |
$103.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.34
|
| Rate for Payer: Meridian Medicaid |
$108.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.77
|
| Rate for Payer: Nomi Health Commercial |
$482.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.97
|
| Rate for Payer: PACE Senior Care Partners |
$139.64
|
| Rate for Payer: PACE SWMI |
$146.99
|
| Rate for Payer: PHP Commercial |
$499.77
|
| Rate for Payer: PHP Medicare Advantage |
$146.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.53
|
| Rate for Payer: Priority Health Medicare |
$148.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.22
|
| Rate for Payer: Railroad Medicare Medicare |
$146.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.40
|
| Rate for Payer: UHC Core |
$490.95
|
| Rate for Payer: UHC Exchange |
$146.99
|
| Rate for Payer: UHC Medicaid |
$103.66
|
| Rate for Payer: UHC Medicare Advantage |
$146.99
|
| Rate for Payer: UHCCP Medicaid |
$103.66
|
| Rate for Payer: VA VA |
$146.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.97
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$587.96
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$409.22 |
| Max. Negotiated Rate |
$529.16 |
| Rate for Payer: Aetna Commercial |
$499.77
|
| Rate for Payer: BCBS Trust/PPO |
$485.60
|
| Rate for Payer: BCN Commercial |
$485.60
|
| Rate for Payer: Cash Price |
$470.37
|
| Rate for Payer: Cofinity Commercial |
$505.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.37
|
| Rate for Payer: Healthscope Commercial |
$529.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.77
|
| Rate for Payer: Nomi Health Commercial |
$482.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.97
|
| Rate for Payer: PHP Commercial |
$499.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.40
|
| Rate for Payer: UHC Core |
$490.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.97
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,895.09
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.40 |
| Max. Negotiated Rate |
$2,605.58 |
| Rate for Payer: Aetna Commercial |
$2,460.83
|
| Rate for Payer: Aetna Medicare |
$752.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$904.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$904.72
|
| Rate for Payer: BCBS Complete |
$535.88
|
| Rate for Payer: BCBS MAPPO |
$723.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,380.05
|
| Rate for Payer: BCN Commercial |
$2,380.05
|
| Rate for Payer: BCN Medicare Advantage |
$723.77
|
| Rate for Payer: Cash Price |
$2,316.07
|
| Rate for Payer: Cofinity Commercial |
$2,489.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,316.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$723.77
|
| Rate for Payer: Healthscope Commercial |
$2,605.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,171.32
|
| Rate for Payer: Mclaren Medicaid |
$510.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.96
|
| Rate for Payer: Meridian Medicaid |
$535.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$832.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$796.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,460.83
|
| Rate for Payer: Nomi Health Commercial |
$2,373.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,171.32
|
| Rate for Payer: PACE Senior Care Partners |
$687.58
|
| Rate for Payer: PACE SWMI |
$723.77
|
| Rate for Payer: PHP Commercial |
$2,460.83
|
| Rate for Payer: PHP Medicare Advantage |
$723.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,518.73
|
| Rate for Payer: Priority Health Medicare |
$731.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,014.98
|
| Rate for Payer: Railroad Medicare Medicare |
$723.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,547.68
|
| Rate for Payer: UHC Core |
$2,417.40
|
| Rate for Payer: UHC Exchange |
$723.77
|
| Rate for Payer: UHC Medicaid |
$510.40
|
| Rate for Payer: UHC Medicare Advantage |
$723.77
|
| Rate for Payer: UHCCP Medicaid |
$510.40
|
| Rate for Payer: VA VA |
$723.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,171.32
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$2,895.09
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,014.98 |
| Max. Negotiated Rate |
$2,605.58 |
| Rate for Payer: Aetna Commercial |
$2,460.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,391.05
|
| Rate for Payer: BCN Commercial |
$2,391.05
|
| Rate for Payer: Cash Price |
$2,316.07
|
| Rate for Payer: Cofinity Commercial |
$2,489.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,316.07
|
| Rate for Payer: Healthscope Commercial |
$2,605.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,171.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,460.83
|
| Rate for Payer: Nomi Health Commercial |
$2,373.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,171.32
|
| Rate for Payer: PHP Commercial |
$2,460.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,518.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,014.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,547.68
|
| Rate for Payer: UHC Core |
$2,417.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,171.32
|
|
|
HC EXTRACTION
|
Facility
|
OP
|
$278.14
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna Medicare |
$72.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.92
|
| Rate for Payer: BCBS Complete |
$51.48
|
| Rate for Payer: BCBS MAPPO |
$69.53
|
| Rate for Payer: BCBS Trust/PPO |
$228.66
|
| Rate for Payer: BCN Commercial |
$228.66
|
| Rate for Payer: BCN Medicare Advantage |
$69.53
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Mclaren Medicaid |
$49.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.01
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PACE Senior Care Partners |
$66.06
|
| Rate for Payer: PACE SWMI |
$69.53
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: PHP Medicare Advantage |
$69.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.98
|
| Rate for Payer: Priority Health Medicare |
$70.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: Railroad Medicare Medicare |
$69.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.76
|
| Rate for Payer: UHC Core |
$232.25
|
| Rate for Payer: UHC Exchange |
$69.53
|
| Rate for Payer: UHC Medicaid |
$49.04
|
| Rate for Payer: UHC Medicare Advantage |
$69.53
|
| Rate for Payer: UHCCP Medicaid |
$49.04
|
| Rate for Payer: VA VA |
$69.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC EXTRACTION
|
Facility
|
IP
|
$278.14
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
76100282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.59 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: BCBS Trust/PPO |
$229.72
|
| Rate for Payer: BCN Commercial |
$229.72
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.76
|
| Rate for Payer: UHC Core |
$232.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.60
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$398.50
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.36 |
| Max. Negotiated Rate |
$358.65 |
| Rate for Payer: Aetna Commercial |
$338.73
|
| Rate for Payer: BCBS Trust/PPO |
$329.12
|
| Rate for Payer: BCN Commercial |
$329.12
|
| Rate for Payer: Cash Price |
$318.80
|
| Rate for Payer: Cofinity Commercial |
$342.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.80
|
| Rate for Payer: Healthscope Commercial |
$358.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.73
|
| Rate for Payer: Nomi Health Commercial |
$326.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.88
|
| Rate for Payer: PHP Commercial |
$338.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.68
|
| Rate for Payer: UHC Core |
$332.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.88
|
|
