|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.67 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Aetna Commercial |
$384.20
|
| Rate for Payer: BCBS Trust/PPO |
$349.31
|
| Rate for Payer: BCN Commercial |
$349.31
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$388.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.60
|
| Rate for Payer: Healthscope Commercial |
$406.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.20
|
| Rate for Payer: PHP Commercial |
$384.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.76
|
| Rate for Payer: UHC Core |
$377.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.00
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
IP
|
$895.03
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$545.88 |
| Max. Negotiated Rate |
$805.53 |
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: BCBS Trust/PPO |
$691.68
|
| Rate for Payer: BCN Commercial |
$691.68
|
| Rate for Payer: Cash Price |
$716.02
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.02
|
| Rate for Payer: Healthscope Commercial |
$805.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$760.78
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$778.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.63
|
| Rate for Payer: UHC Core |
$747.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.27
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
OP
|
$895.03
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$212.57 |
| Max. Negotiated Rate |
$805.53 |
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna Medicare |
$232.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.70
|
| Rate for Payer: BCBS Complete |
$358.01
|
| Rate for Payer: BCBS MAPPO |
$223.76
|
| Rate for Payer: BCBS Trust/PPO |
$695.89
|
| Rate for Payer: BCN Commercial |
$695.89
|
| Rate for Payer: BCN Medicare Advantage |
$223.76
|
| Rate for Payer: Cash Price |
$716.02
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.76
|
| Rate for Payer: Healthscope Commercial |
$805.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$234.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$760.78
|
| Rate for Payer: PACE Senior Care Partners |
$212.57
|
| Rate for Payer: PACE SWMI |
$223.76
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: PHP Medicare Advantage |
$223.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$778.68
|
| Rate for Payer: Priority Health Medicare |
$223.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.88
|
| Rate for Payer: Railroad Medicare Medicare |
$223.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.63
|
| Rate for Payer: UHC Core |
$747.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.76
|
| Rate for Payer: UHC Medicare Advantage |
$230.47
|
| Rate for Payer: VA VA |
$223.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.27
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
IP
|
$257.83
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$219.16
|
| Rate for Payer: BCBS Trust/PPO |
$199.25
|
| Rate for Payer: BCN Commercial |
$199.25
|
| Rate for Payer: Cash Price |
$206.26
|
| Rate for Payer: Cofinity Commercial |
$221.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.26
|
| Rate for Payer: Healthscope Commercial |
$232.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.16
|
| Rate for Payer: PHP Commercial |
$219.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.89
|
| Rate for Payer: UHC Core |
$215.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.37
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
OP
|
$257.83
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$61.23 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$219.16
|
| Rate for Payer: Aetna Medicare |
$67.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.57
|
| Rate for Payer: BCBS Complete |
$103.13
|
| Rate for Payer: BCBS MAPPO |
$64.46
|
| Rate for Payer: BCBS Trust/PPO |
$200.46
|
| Rate for Payer: BCN Commercial |
$200.46
|
| Rate for Payer: BCN Medicare Advantage |
$64.46
|
| Rate for Payer: Cash Price |
$206.26
|
| Rate for Payer: Cofinity Commercial |
$221.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$232.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.16
|
| Rate for Payer: PACE Senior Care Partners |
$61.23
|
| Rate for Payer: PACE SWMI |
$64.46
|
| Rate for Payer: PHP Commercial |
$219.16
|
| Rate for Payer: PHP Medicare Advantage |
$64.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.31
|
| Rate for Payer: Priority Health Medicare |
$64.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.25
|
| Rate for Payer: Railroad Medicare Medicare |
$64.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.89
|
| Rate for Payer: UHC Core |
$215.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.46
|
| Rate for Payer: UHC Medicare Advantage |
$66.39
|
| Rate for Payer: VA VA |
$64.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.37
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
IP
|
$1,975.92
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,205.11 |
| Max. Negotiated Rate |
$1,778.33 |
| Rate for Payer: Aetna Commercial |
$1,679.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.99
|
| Rate for Payer: BCN Commercial |
$1,526.99
|
| Rate for Payer: Cash Price |
$1,580.74
|
| Rate for Payer: Cofinity Commercial |
$1,699.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.74
|
| Rate for Payer: Healthscope Commercial |
$1,778.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,679.53
|
| Rate for Payer: PHP Commercial |
$1,679.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,719.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,205.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.81
|
| Rate for Payer: UHC Core |
$1,649.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.94
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
OP
|
$1,975.92
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$469.28 |
| Max. Negotiated Rate |
$1,778.33 |
| Rate for Payer: Aetna Commercial |
$1,679.53
|
| Rate for Payer: Aetna Medicare |
$513.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$617.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$617.48
|
| Rate for Payer: BCBS Complete |
$790.37
|
| Rate for Payer: BCBS MAPPO |
$493.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,536.28
|
| Rate for Payer: BCN Commercial |
$1,536.28
|
| Rate for Payer: BCN Medicare Advantage |
$493.98
|
| Rate for Payer: Cash Price |
$1,580.74
|
| Rate for Payer: Cofinity Commercial |
$1,699.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.98
|
| Rate for Payer: Healthscope Commercial |
$1,778.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$518.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,679.53
|
| Rate for Payer: PACE Senior Care Partners |
$469.28
|
| Rate for Payer: PACE SWMI |
$493.98
|
| Rate for Payer: PHP Commercial |
$1,679.53
|
| Rate for Payer: PHP Medicare Advantage |
$493.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,719.05
|
| Rate for Payer: Priority Health Medicare |
$493.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,205.11
|
| Rate for Payer: Railroad Medicare Medicare |
$493.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.81
|
| Rate for Payer: UHC Core |
$1,649.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.98
|
| Rate for Payer: UHC Medicare Advantage |
$508.80
|
| Rate for Payer: VA VA |
$493.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.94
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
OP
|
$393.30
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.41 |
| Max. Negotiated Rate |
$353.97 |
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna Medicare |
$102.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.91
|
| Rate for Payer: BCBS Complete |
$157.32
|
| Rate for Payer: BCBS MAPPO |
$98.32
|
| Rate for Payer: BCBS Trust/PPO |
$305.79
|
| Rate for Payer: BCN Commercial |
$305.79
|
| Rate for Payer: BCN Medicare Advantage |
$98.32
|
| Rate for Payer: Cash Price |
$314.64
|
| Rate for Payer: Cofinity Commercial |
$338.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.32
|
| Rate for Payer: Healthscope Commercial |
$353.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$103.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.30
|
| Rate for Payer: PACE Senior Care Partners |
$93.41
|
| Rate for Payer: PACE SWMI |
$98.32
|
| Rate for Payer: PHP Commercial |
$334.30
|
| Rate for Payer: PHP Medicare Advantage |
$98.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.17
|
| Rate for Payer: Priority Health Medicare |
$98.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.87
|
| Rate for Payer: Railroad Medicare Medicare |
$98.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.10
|
| Rate for Payer: UHC Core |
$328.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.32
|
| Rate for Payer: UHC Medicare Advantage |
$101.27
|
| Rate for Payer: VA VA |
$98.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.98
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
IP
|
$393.30
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$239.87 |
| Max. Negotiated Rate |
$353.97 |
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: BCBS Trust/PPO |
$303.94
|
| Rate for Payer: BCN Commercial |
$303.94
|
| Rate for Payer: Cash Price |
$314.64
|
| Rate for Payer: Cofinity Commercial |
$338.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.64
|
| Rate for Payer: Healthscope Commercial |
$353.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.30
|
| Rate for Payer: PHP Commercial |
$334.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.10
|
| Rate for Payer: UHC Core |
$328.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.98
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
OP
|
$3,073.19
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$729.88 |
| Max. Negotiated Rate |
$2,765.87 |
| Rate for Payer: Aetna Commercial |
$2,612.21
|
| Rate for Payer: Aetna Medicare |
$799.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$960.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$960.37
|
| Rate for Payer: BCBS Complete |
$1,229.28
|
| Rate for Payer: BCBS MAPPO |
$768.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,389.41
|
| Rate for Payer: BCN Commercial |
$2,389.41
|
| Rate for Payer: BCN Medicare Advantage |
$768.30
|
| Rate for Payer: Cash Price |
$2,458.55
|
| Rate for Payer: Cofinity Commercial |
$2,642.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.30
|
| Rate for Payer: Healthscope Commercial |
$2,765.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,304.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$883.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.21
|
| Rate for Payer: PACE Senior Care Partners |
$729.88
|
| Rate for Payer: PACE SWMI |
$768.30
|
| Rate for Payer: PHP Commercial |
$2,612.21
|
| Rate for Payer: PHP Medicare Advantage |
$768.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,673.68
|
| Rate for Payer: Priority Health Medicare |
$768.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,874.34
|
| Rate for Payer: Railroad Medicare Medicare |
$768.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,704.41
|
| Rate for Payer: UHC Core |
$2,566.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$768.30
|
| Rate for Payer: UHC Medicare Advantage |
$791.35
|
| Rate for Payer: VA VA |
$768.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,304.89
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
IP
|
$3,073.19
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,874.34 |
| Max. Negotiated Rate |
$2,765.87 |
| Rate for Payer: Aetna Commercial |
$2,612.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,374.96
|
| Rate for Payer: BCN Commercial |
$2,374.96
|
| Rate for Payer: Cash Price |
$2,458.55
|
| Rate for Payer: Cofinity Commercial |
$2,642.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.55
|
| Rate for Payer: Healthscope Commercial |
$2,765.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,304.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.21
|
| Rate for Payer: PHP Commercial |
$2,612.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,673.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,874.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,704.41
|
| Rate for Payer: UHC Core |
$2,566.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,304.89
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,178.99
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$280.01 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,002.14
|
| Rate for Payer: Aetna Medicare |
$306.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.43
|
| Rate for Payer: BCBS Complete |
$471.60
|
| Rate for Payer: BCBS MAPPO |
$294.75
|
| Rate for Payer: BCBS Trust/PPO |
$916.66
|
| Rate for Payer: BCN Commercial |
$916.66
|
| Rate for Payer: BCN Medicare Advantage |
$294.75
|
| Rate for Payer: Cash Price |
$943.19
|
| Rate for Payer: Cofinity Commercial |
$1,013.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.75
|
| Rate for Payer: Healthscope Commercial |
$1,061.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$884.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$309.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,002.14
|
| Rate for Payer: PACE Senior Care Partners |
$280.01
|
| Rate for Payer: PACE SWMI |
$294.75
|
| Rate for Payer: PHP Commercial |
$1,002.14
|
| Rate for Payer: PHP Medicare Advantage |
$294.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,025.72
|
| Rate for Payer: Priority Health Medicare |
$294.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$719.07
|
| Rate for Payer: Railroad Medicare Medicare |
$294.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,037.51
|
| Rate for Payer: UHC Core |
$984.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.75
|
| Rate for Payer: UHC Medicare Advantage |
$303.59
|
| Rate for Payer: VA VA |
$294.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$884.24
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,178.99
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$719.07 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,002.14
|
| Rate for Payer: BCBS Trust/PPO |
$911.12
|
| Rate for Payer: BCN Commercial |
$911.12
|
| Rate for Payer: Cash Price |
$943.19
|
| Rate for Payer: Cofinity Commercial |
$1,013.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.19
|
| Rate for Payer: Healthscope Commercial |
$1,061.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$884.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,002.14
|
| Rate for Payer: PHP Commercial |
$1,002.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,025.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$719.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,037.51
|
| Rate for Payer: UHC Core |
$984.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$884.24
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
IP
|
$3,645.08
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,223.13 |
| Max. Negotiated Rate |
$3,280.57 |
| Rate for Payer: Aetna Commercial |
$3,098.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,816.92
|
| Rate for Payer: BCN Commercial |
$2,816.92
|
| Rate for Payer: Cash Price |
$2,916.06
|
| Rate for Payer: Cofinity Commercial |
$3,134.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,916.06
|
| Rate for Payer: Healthscope Commercial |
$3,280.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,733.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,098.32
|
| Rate for Payer: PHP Commercial |
$3,098.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,551.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,171.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,223.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,207.67
|
| Rate for Payer: UHC Core |
$3,043.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,733.81
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
OP
|
$3,645.08
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$865.71 |
| Max. Negotiated Rate |
$3,280.57 |
| Rate for Payer: Aetna Commercial |
$3,098.32
|
| Rate for Payer: Aetna Medicare |
$947.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,139.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,139.09
|
| Rate for Payer: BCBS Complete |
$1,458.03
|
| Rate for Payer: BCBS MAPPO |
$911.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,834.05
|
| Rate for Payer: BCN Commercial |
$2,834.05
|
| Rate for Payer: BCN Medicare Advantage |
$911.27
|
| Rate for Payer: Cash Price |
$2,916.06
|
| Rate for Payer: Cofinity Commercial |
$3,134.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$911.27
|
| Rate for Payer: Healthscope Commercial |
$3,280.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,733.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$956.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,047.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,098.32
|
| Rate for Payer: PACE Senior Care Partners |
$865.71
|
| Rate for Payer: PACE SWMI |
$911.27
|
| Rate for Payer: PHP Commercial |
$3,098.32
|
| Rate for Payer: PHP Medicare Advantage |
$911.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,551.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,171.22
|
| Rate for Payer: Priority Health Medicare |
$911.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,223.13
|
| Rate for Payer: Railroad Medicare Medicare |
$911.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,207.67
|
| Rate for Payer: UHC Core |
$3,043.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$911.27
|
| Rate for Payer: UHC Medicare Advantage |
$938.61
|
| Rate for Payer: VA VA |
$911.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,733.81
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,417.04
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.25 |
| Max. Negotiated Rate |
$1,275.34 |
| Rate for Payer: Aetna Commercial |
$1,204.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,095.09
|
| Rate for Payer: BCN Commercial |
$1,095.09
|
| Rate for Payer: Cash Price |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,218.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.63
|
| Rate for Payer: Healthscope Commercial |
$1,275.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,062.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.48
|
| Rate for Payer: PHP Commercial |
$1,204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$864.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,247.00
|
| Rate for Payer: UHC Core |
$1,183.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,062.78
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,417.04
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.55 |
| Max. Negotiated Rate |
$1,275.34 |
| Rate for Payer: Aetna Commercial |
$1,204.48
|
| Rate for Payer: Aetna Medicare |
$368.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.82
|
| Rate for Payer: BCBS Complete |
$566.82
|
| Rate for Payer: BCBS MAPPO |
$354.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.75
|
| Rate for Payer: BCN Commercial |
$1,101.75
|
| Rate for Payer: BCN Medicare Advantage |
$354.26
|
| Rate for Payer: Cash Price |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,218.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.26
|
| Rate for Payer: Healthscope Commercial |
$1,275.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,062.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.48
|
| Rate for Payer: PACE Senior Care Partners |
$336.55
|
| Rate for Payer: PACE SWMI |
$354.26
|
| Rate for Payer: PHP Commercial |
$1,204.48
|
| Rate for Payer: PHP Medicare Advantage |
$354.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.82
|
| Rate for Payer: Priority Health Medicare |
$354.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$864.25
|
| Rate for Payer: Railroad Medicare Medicare |
$354.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,247.00
|
| Rate for Payer: UHC Core |
$1,183.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.26
|
| Rate for Payer: UHC Medicare Advantage |
$364.89
|
| Rate for Payer: VA VA |
$354.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,062.78
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
IP
|
$4,339.52
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,646.67 |
| Max. Negotiated Rate |
$3,905.57 |
| Rate for Payer: Aetna Commercial |
$3,688.59
|
| Rate for Payer: BCBS Trust/PPO |
$3,353.58
|
| Rate for Payer: BCN Commercial |
$3,353.58
|
| Rate for Payer: Cash Price |
$3,471.62
|
| Rate for Payer: Cofinity Commercial |
$3,731.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.62
|
| Rate for Payer: Healthscope Commercial |
$3,905.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,688.59
|
| Rate for Payer: PHP Commercial |
$3,688.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,037.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,775.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,646.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,818.78
|
| Rate for Payer: UHC Core |
$3,623.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.64
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
OP
|
$4,339.52
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,030.64 |
| Max. Negotiated Rate |
$3,905.57 |
| Rate for Payer: Aetna Commercial |
$3,688.59
|
| Rate for Payer: Aetna Medicare |
$1,128.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,356.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,356.10
|
| Rate for Payer: BCBS Complete |
$1,735.81
|
| Rate for Payer: BCBS MAPPO |
$1,084.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,373.98
|
| Rate for Payer: BCN Commercial |
$3,373.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,084.88
|
| Rate for Payer: Cash Price |
$3,471.62
|
| Rate for Payer: Cofinity Commercial |
$3,731.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,084.88
|
| Rate for Payer: Healthscope Commercial |
$3,905.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,139.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,688.59
|
| Rate for Payer: PACE Senior Care Partners |
$1,030.64
|
| Rate for Payer: PACE SWMI |
$1,084.88
|
| Rate for Payer: PHP Commercial |
$3,688.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,084.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,037.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,775.38
|
| Rate for Payer: Priority Health Medicare |
$1,084.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,646.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,084.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,818.78
|
| Rate for Payer: UHC Core |
$3,623.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,084.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,117.43
|
| Rate for Payer: VA VA |
$1,084.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.64
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,579.11
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.04 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna Commercial |
$1,342.24
|
| Rate for Payer: Aetna Medicare |
$410.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$493.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$493.47
|
| Rate for Payer: BCBS Complete |
$631.64
|
| Rate for Payer: BCBS MAPPO |
$394.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.76
|
| Rate for Payer: BCN Commercial |
$1,227.76
|
| Rate for Payer: BCN Medicare Advantage |
$394.78
|
| Rate for Payer: Cash Price |
$1,263.29
|
| Rate for Payer: Cofinity Commercial |
$1,358.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.78
|
| Rate for Payer: Healthscope Commercial |
$1,421.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$414.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.24
|
| Rate for Payer: PACE Senior Care Partners |
$375.04
|
| Rate for Payer: PACE SWMI |
$394.78
|
| Rate for Payer: PHP Commercial |
$1,342.24
|
| Rate for Payer: PHP Medicare Advantage |
$394.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,373.83
|
| Rate for Payer: Priority Health Medicare |
$394.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$963.10
|
| Rate for Payer: Railroad Medicare Medicare |
$394.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,389.62
|
| Rate for Payer: UHC Core |
$1,318.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.78
|
| Rate for Payer: UHC Medicare Advantage |
$406.62
|
| Rate for Payer: VA VA |
$394.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.33
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,579.11
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.10 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna Commercial |
$1,342.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.34
|
| Rate for Payer: BCN Commercial |
$1,220.34
|
| Rate for Payer: Cash Price |
$1,263.29
|
| Rate for Payer: Cofinity Commercial |
$1,358.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.29
|
| Rate for Payer: Healthscope Commercial |
$1,421.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,184.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.24
|
| Rate for Payer: PHP Commercial |
$1,342.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,373.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$963.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,389.62
|
| Rate for Payer: UHC Core |
$1,318.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,184.33
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
IP
|
$4,842.31
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,953.32 |
| Max. Negotiated Rate |
$4,358.08 |
| Rate for Payer: Aetna Commercial |
$4,115.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,742.14
|
| Rate for Payer: BCN Commercial |
$3,742.14
|
| Rate for Payer: Cash Price |
$3,873.85
|
| Rate for Payer: Cofinity Commercial |
$4,164.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,873.85
|
| Rate for Payer: Healthscope Commercial |
$4,358.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,631.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,115.96
|
| Rate for Payer: PHP Commercial |
$4,115.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,212.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,953.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,261.23
|
| Rate for Payer: UHC Core |
$4,043.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,631.73
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
OP
|
$4,842.31
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,150.05 |
| Max. Negotiated Rate |
$4,358.08 |
| Rate for Payer: Aetna Commercial |
$4,115.96
|
| Rate for Payer: Aetna Medicare |
$1,259.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,513.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,513.22
|
| Rate for Payer: BCBS Complete |
$1,936.92
|
| Rate for Payer: BCBS MAPPO |
$1,210.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,764.90
|
| Rate for Payer: BCN Commercial |
$3,764.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,210.58
|
| Rate for Payer: Cash Price |
$3,873.85
|
| Rate for Payer: Cofinity Commercial |
$4,164.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,873.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,210.58
|
| Rate for Payer: Healthscope Commercial |
$4,358.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,631.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,271.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,392.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,115.96
|
| Rate for Payer: PACE Senior Care Partners |
$1,150.05
|
| Rate for Payer: PACE SWMI |
$1,210.58
|
| Rate for Payer: PHP Commercial |
$4,115.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,210.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,212.81
|
| Rate for Payer: Priority Health Medicare |
$1,210.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,953.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1,210.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,261.23
|
| Rate for Payer: UHC Core |
$4,043.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,210.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,246.89
|
| Rate for Payer: VA VA |
$1,210.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,631.73
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,979.54
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$470.14 |
| Max. Negotiated Rate |
$1,781.59 |
| Rate for Payer: Aetna Commercial |
$1,682.61
|
| Rate for Payer: Aetna Medicare |
$514.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$618.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$618.61
|
| Rate for Payer: BCBS Complete |
$791.82
|
| Rate for Payer: BCBS MAPPO |
$494.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,539.09
|
| Rate for Payer: BCN Commercial |
$1,539.09
|
| Rate for Payer: BCN Medicare Advantage |
$494.88
|
| Rate for Payer: Cash Price |
$1,583.63
|
| Rate for Payer: Cofinity Commercial |
$1,702.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,583.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$494.88
|
| Rate for Payer: Healthscope Commercial |
$1,781.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,484.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$519.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$569.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,682.61
|
| Rate for Payer: PACE Senior Care Partners |
$470.14
|
| Rate for Payer: PACE SWMI |
$494.88
|
| Rate for Payer: PHP Commercial |
$1,682.61
|
| Rate for Payer: PHP Medicare Advantage |
$494.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,722.20
|
| Rate for Payer: Priority Health Medicare |
$494.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,207.32
|
| Rate for Payer: Railroad Medicare Medicare |
$494.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,742.00
|
| Rate for Payer: UHC Core |
$1,652.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$494.88
|
| Rate for Payer: UHC Medicare Advantage |
$509.73
|
| Rate for Payer: VA VA |
$494.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,484.66
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,979.54
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,207.32 |
| Max. Negotiated Rate |
$1,781.59 |
| Rate for Payer: Aetna Commercial |
$1,682.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,529.79
|
| Rate for Payer: BCN Commercial |
$1,529.79
|
| Rate for Payer: Cash Price |
$1,583.63
|
| Rate for Payer: Cofinity Commercial |
$1,702.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,583.63
|
| Rate for Payer: Healthscope Commercial |
$1,781.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,484.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,682.61
|
| Rate for Payer: PHP Commercial |
$1,682.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,722.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,207.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,742.00
|
| Rate for Payer: UHC Core |
$1,652.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,484.66
|
|
