|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$11.61
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$30.79
|
| Rate for Payer: BCN Commercial |
$29.12
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$11.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$11.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Senior Care Partners |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.36
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UHC Medicare Advantage |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$11.05
|
| Rate for Payer: VA VA |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$30.79
|
| Rate for Payer: BCN Commercial |
$29.12
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$9.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$9.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PACE Senior Care Partners |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.36
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UHC Medicare Advantage |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.57
|
| Rate for Payer: BCN Commercial |
$28.94
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$31.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.04
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$30.43
|
| Rate for Payer: BCBS Trust/PPO |
$100.07
|
| Rate for Payer: BCN Commercial |
$94.65
|
| Rate for Payer: BCN Medicare Advantage |
$30.43
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.43
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.30
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.95
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: PACE Senior Care Partners |
$28.91
|
| Rate for Payer: PACE SWMI |
$30.43
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: PHP Medicare Advantage |
$30.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health HMO/PPO |
$105.91
|
| Rate for Payer: Priority Health Medicare |
$30.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.56
|
| Rate for Payer: Railroad Medicare Medicare |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.12
|
| Rate for Payer: UHC Core |
$101.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.43
|
| Rate for Payer: UHC Exchange |
$30.43
|
| Rate for Payer: UHC Medicare Advantage |
$30.43
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.30
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.12 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: BCBS Trust/PPO |
$99.37
|
| Rate for Payer: BCN Commercial |
$94.07
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health HMO/PPO |
$105.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.12
|
| Rate for Payer: UHC Core |
$101.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.30
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$31.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.04
|
| Rate for Payer: BCBS Complete |
$32.52
|
| Rate for Payer: BCBS MAPPO |
$30.43
|
| Rate for Payer: BCBS Trust/PPO |
$100.07
|
| Rate for Payer: BCN Commercial |
$94.65
|
| Rate for Payer: BCN Medicare Advantage |
$30.43
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.43
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.30
|
| Rate for Payer: Mclaren Medicaid |
$30.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.95
|
| Rate for Payer: Meridian Medicaid |
$32.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: PACE Senior Care Partners |
$28.91
|
| Rate for Payer: PACE SWMI |
$30.43
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: PHP Medicare Advantage |
$30.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health HMO/PPO |
$105.91
|
| Rate for Payer: Priority Health Medicare |
$30.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.56
|
| Rate for Payer: Railroad Medicare Medicare |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.12
|
| Rate for Payer: UHC Core |
$101.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.43
|
| Rate for Payer: UHC Exchange |
$30.43
|
| Rate for Payer: UHC Medicare Advantage |
$30.43
|
| Rate for Payer: UHCCP Medicaid |
$30.97
|
| Rate for Payer: VA VA |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.30
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.12 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: BCBS Trust/PPO |
$99.37
|
| Rate for Payer: BCN Commercial |
$94.07
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health HMO/PPO |
$105.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.12
|
| Rate for Payer: UHC Core |
$101.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.30
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$728.19 |
| Max. Negotiated Rate |
$1,008.26 |
| Rate for Payer: Aetna Commercial |
$952.25
|
| Rate for Payer: BCBS Trust/PPO |
$914.49
|
| Rate for Payer: BCN Commercial |
$865.76
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$963.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Healthscope Commercial |
$1,008.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: Nomi Health Commercial |
$918.64
|
| Rate for Payer: PHP Commercial |
$952.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: Priority Health HMO/PPO |
$974.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$750.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$985.86
|
| Rate for Payer: UHC Core |
$935.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.22
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$1,008.26 |
| Rate for Payer: Aetna Commercial |
$952.25
|
| Rate for Payer: Aetna Medicare |
$291.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.09
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$280.07
|
| Rate for Payer: BCBS Trust/PPO |
$920.99
|
| Rate for Payer: BCN Commercial |
$871.03
|
| Rate for Payer: BCN Medicare Advantage |
$280.07
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$963.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.07
|
| Rate for Payer: Healthscope Commercial |
$1,008.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.22
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.08
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: Nomi Health Commercial |
$918.64
|
| Rate for Payer: PACE Senior Care Partners |
$266.07
|
| Rate for Payer: PACE SWMI |
$280.07
|
| Rate for Payer: PHP Commercial |
$952.25
|
| Rate for Payer: PHP Medicare Advantage |
$280.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: Priority Health HMO/PPO |
$974.65
|
| Rate for Payer: Priority Health Medicare |
$282.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$750.59
|
| Rate for Payer: Railroad Medicare Medicare |
$280.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$985.86
|
| Rate for Payer: UHC Core |
$935.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.07
|
| Rate for Payer: UHC Exchange |
$280.07
|
| Rate for Payer: UHC Medicare Advantage |
$280.07
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$280.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.22
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$375.87 |
| Max. Negotiated Rate |
$2,256.23 |
| Rate for Payer: Aetna Commercial |
$2,130.88
|
| Rate for Payer: Aetna Medicare |
$651.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$783.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$783.41
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$626.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,060.94
|
| Rate for Payer: BCN Commercial |
$1,949.13
|
| Rate for Payer: BCN Medicare Advantage |
$626.73
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$2,155.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.73
|
| Rate for Payer: Healthscope Commercial |
$2,256.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.19
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.07
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$720.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: Nomi Health Commercial |
$2,055.67
|
| Rate for Payer: PACE Senior Care Partners |
$595.39
|
| Rate for Payer: PACE SWMI |
$626.73
|
| Rate for Payer: PHP Commercial |
$2,130.88
|
| Rate for Payer: PHP Medicare Advantage |
$626.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2,181.02
|
| Rate for Payer: Priority Health Medicare |
$633.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,679.64
|
| Rate for Payer: Railroad Medicare Medicare |
$626.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,206.09
|
| Rate for Payer: UHC Core |
$2,093.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.73
|
| Rate for Payer: UHC Exchange |
$626.73
|
| Rate for Payer: UHC Medicare Advantage |
$626.73
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$626.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.19
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,629.50 |
| Max. Negotiated Rate |
$2,256.23 |
| Rate for Payer: Aetna Commercial |
$2,130.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,046.40
|
| Rate for Payer: BCN Commercial |
$1,937.35
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$2,155.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Healthscope Commercial |
$2,256.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: Nomi Health Commercial |
$2,055.67
|
| Rate for Payer: PHP Commercial |
$2,130.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2,181.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,679.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,206.09
|
| Rate for Payer: UHC Core |
$2,093.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.19
|
|
|
HC EP VISUAL
|
Facility
|
OP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$186.66 |
| Max. Negotiated Rate |
$707.33 |
| Rate for Payer: Aetna Commercial |
$668.03
|
| Rate for Payer: Aetna Medicare |
$204.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.60
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$196.48
|
| Rate for Payer: BCBS Trust/PPO |
$646.10
|
| Rate for Payer: BCN Commercial |
$611.05
|
| Rate for Payer: BCN Medicare Advantage |
$196.48
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$675.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.48
|
| Rate for Payer: Healthscope Commercial |
$707.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.44
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.30
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: Nomi Health Commercial |
$644.45
|
| Rate for Payer: PACE Senior Care Partners |
$186.66
|
| Rate for Payer: PACE SWMI |
$196.48
|
| Rate for Payer: PHP Commercial |
$668.03
|
| Rate for Payer: PHP Medicare Advantage |
$196.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: Priority Health HMO/PPO |
$683.75
|
| Rate for Payer: Priority Health Medicare |
$198.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.57
|
| Rate for Payer: Railroad Medicare Medicare |
$196.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.61
|
| Rate for Payer: UHC Core |
$656.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.48
|
| Rate for Payer: UHC Exchange |
$196.48
|
| Rate for Payer: UHC Medicare Advantage |
$196.48
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$196.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.44
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$510.85 |
| Max. Negotiated Rate |
$707.33 |
| Rate for Payer: Aetna Commercial |
$668.03
|
| Rate for Payer: BCBS Trust/PPO |
$641.55
|
| Rate for Payer: BCN Commercial |
$607.36
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$675.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Healthscope Commercial |
$707.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: Nomi Health Commercial |
$644.45
|
| Rate for Payer: PHP Commercial |
$668.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: Priority Health HMO/PPO |
$683.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.61
|
| Rate for Payer: UHC Core |
$656.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.44
|
|
|
HC ERBE IRRIGATION
|
Facility
|
IP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$205.29 |
| Max. Negotiated Rate |
$284.25 |
| Rate for Payer: Aetna Commercial |
$268.46
|
| Rate for Payer: BCBS Trust/PPO |
$257.81
|
| Rate for Payer: BCN Commercial |
$244.07
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Healthscope Commercial |
$284.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: Nomi Health Commercial |
$258.98
|
| Rate for Payer: PHP Commercial |
$268.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: Priority Health HMO/PPO |
$274.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.93
|
| Rate for Payer: UHC Core |
$263.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.87
|
|
|
HC ERBE IRRIGATION
|
Facility
|
OP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$284.25 |
| Rate for Payer: Aetna Commercial |
$268.46
|
| Rate for Payer: Aetna Medicare |
$82.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.70
|
| Rate for Payer: BCBS Complete |
$126.33
|
| Rate for Payer: BCBS MAPPO |
$78.96
|
| Rate for Payer: BCBS Trust/PPO |
$259.64
|
| Rate for Payer: BCN Commercial |
$245.56
|
| Rate for Payer: BCN Medicare Advantage |
$78.96
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$284.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: Nomi Health Commercial |
$258.98
|
| Rate for Payer: PACE Senior Care Partners |
$75.01
|
| Rate for Payer: PACE SWMI |
$78.96
|
| Rate for Payer: PHP Commercial |
$268.46
|
| Rate for Payer: PHP Medicare Advantage |
$78.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: Priority Health HMO/PPO |
$274.77
|
| Rate for Payer: Priority Health Medicare |
$79.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.61
|
| Rate for Payer: Railroad Medicare Medicare |
$78.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.93
|
| Rate for Payer: UHC Core |
$263.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.96
|
| Rate for Payer: UHC Exchange |
$78.96
|
| Rate for Payer: UHC Medicare Advantage |
$78.96
|
| Rate for Payer: VA VA |
$78.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.87
|
|
|
HC ER BURN CARE
|
Facility
|
OP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.97 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| Rate for Payer: Aetna Medicare |
$105.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.27
|
| Rate for Payer: BCBS Complete |
$161.63
|
| Rate for Payer: BCBS MAPPO |
$101.02
|
| Rate for Payer: BCBS Trust/PPO |
$332.19
|
| Rate for Payer: BCN Commercial |
$314.16
|
| Rate for Payer: BCN Medicare Advantage |
$101.02
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$347.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.02
|
| Rate for Payer: Healthscope Commercial |
$363.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: Nomi Health Commercial |
$331.34
|
| Rate for Payer: PACE Senior Care Partners |
$95.97
|
| Rate for Payer: PACE SWMI |
$101.02
|
| Rate for Payer: PHP Commercial |
$343.46
|
| Rate for Payer: PHP Medicare Advantage |
$101.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: Priority Health HMO/PPO |
$351.54
|
| Rate for Payer: Priority Health Medicare |
$102.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.73
|
| Rate for Payer: Railroad Medicare Medicare |
$101.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.58
|
| Rate for Payer: UHC Core |
$337.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.02
|
| Rate for Payer: UHC Exchange |
$101.02
|
| Rate for Payer: UHC Medicare Advantage |
$101.02
|
| Rate for Payer: VA VA |
$101.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.05
|
|
|
HC ER BURN CARE
|
Facility
|
IP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.65 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| Rate for Payer: BCBS Trust/PPO |
$329.84
|
| Rate for Payer: BCN Commercial |
$312.27
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$347.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Healthscope Commercial |
$363.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: Nomi Health Commercial |
$331.34
|
| Rate for Payer: PHP Commercial |
$343.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: Priority Health HMO/PPO |
$351.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.58
|
| Rate for Payer: UHC Core |
$337.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.05
|
|
|
HC ERCP
|
Facility
|
OP
|
$3,396.96
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$806.78 |
| Max. Negotiated Rate |
$3,057.26 |
| Rate for Payer: Aetna Commercial |
$2,887.42
|
| Rate for Payer: Aetna Medicare |
$883.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,061.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,061.55
|
| Rate for Payer: BCBS Complete |
$1,358.78
|
| Rate for Payer: BCBS MAPPO |
$849.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,792.64
|
| Rate for Payer: BCN Commercial |
$2,641.14
|
| Rate for Payer: BCN Medicare Advantage |
$849.24
|
| Rate for Payer: Cash Price |
$2,717.57
|
| Rate for Payer: Cofinity Commercial |
$2,921.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,717.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.24
|
| Rate for Payer: Healthscope Commercial |
$3,057.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,547.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$976.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,887.42
|
| Rate for Payer: Nomi Health Commercial |
$2,785.51
|
| Rate for Payer: PACE Senior Care Partners |
$806.78
|
| Rate for Payer: PACE SWMI |
$849.24
|
| Rate for Payer: PHP Commercial |
$2,887.42
|
| Rate for Payer: PHP Medicare Advantage |
$849.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,208.02
|
| Rate for Payer: Priority Health HMO/PPO |
$2,955.36
|
| Rate for Payer: Priority Health Medicare |
$857.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,275.96
|
| Rate for Payer: Railroad Medicare Medicare |
$849.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,989.32
|
| Rate for Payer: UHC Core |
$2,836.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.24
|
| Rate for Payer: UHC Exchange |
$849.24
|
| Rate for Payer: UHC Medicare Advantage |
$849.24
|
| Rate for Payer: VA VA |
$849.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,547.72
|
|
|
HC ERCP
|
Facility
|
IP
|
$3,396.96
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,208.02 |
| Max. Negotiated Rate |
$3,057.26 |
| Rate for Payer: Aetna Commercial |
$2,887.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,772.94
|
| Rate for Payer: BCN Commercial |
$2,625.17
|
| Rate for Payer: Cash Price |
$2,717.57
|
| Rate for Payer: Cofinity Commercial |
$2,921.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,717.57
|
| Rate for Payer: Healthscope Commercial |
$3,057.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,547.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,887.42
|
| Rate for Payer: Nomi Health Commercial |
$2,785.51
|
| Rate for Payer: PHP Commercial |
$2,887.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,208.02
|
| Rate for Payer: Priority Health HMO/PPO |
$2,955.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,275.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,989.32
|
| Rate for Payer: UHC Core |
$2,836.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,547.72
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
OP
|
$4,045.90
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$960.90 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.02
|
| Rate for Payer: Aetna Medicare |
$1,051.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,264.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,264.34
|
| Rate for Payer: BCBS Complete |
$1,618.36
|
| Rate for Payer: BCBS MAPPO |
$1,011.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,326.13
|
| Rate for Payer: BCN Commercial |
$3,145.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,011.48
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,011.48
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,034.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,062.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.02
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: PACE Senior Care Partners |
$960.90
|
| Rate for Payer: PACE SWMI |
$1,011.48
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,011.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health HMO/PPO |
$3,519.93
|
| Rate for Payer: Priority Health Medicare |
$1,021.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,710.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,011.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,560.39
|
| Rate for Payer: UHC Core |
$3,378.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,011.48
|
| Rate for Payer: UHC Exchange |
$1,011.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,011.48
|
| Rate for Payer: VA VA |
$1,011.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,034.42
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
IP
|
$4,045.90
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,629.84 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,302.67
|
| Rate for Payer: BCN Commercial |
$3,126.67
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,034.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.02
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health HMO/PPO |
$3,519.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,710.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,560.39
|
| Rate for Payer: UHC Core |
$3,378.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,034.42
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
IP
|
$895.36
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$581.98 |
| Max. Negotiated Rate |
$805.82 |
| Rate for Payer: Aetna Commercial |
$761.06
|
| Rate for Payer: BCBS Trust/PPO |
$730.88
|
| Rate for Payer: BCN Commercial |
$691.93
|
| Rate for Payer: Cash Price |
$716.29
|
| Rate for Payer: Cofinity Commercial |
$770.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.29
|
| Rate for Payer: Healthscope Commercial |
$805.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.06
|
| Rate for Payer: Nomi Health Commercial |
$734.20
|
| Rate for Payer: PHP Commercial |
$761.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.98
|
| Rate for Payer: Priority Health HMO/PPO |
$778.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$599.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.92
|
| Rate for Payer: UHC Core |
$747.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.52
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
OP
|
$895.36
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.65 |
| Max. Negotiated Rate |
$805.82 |
| Rate for Payer: Aetna Commercial |
$761.06
|
| Rate for Payer: Aetna Medicare |
$232.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.80
|
| Rate for Payer: BCBS Complete |
$358.14
|
| Rate for Payer: BCBS MAPPO |
$223.84
|
| Rate for Payer: BCBS Trust/PPO |
$736.08
|
| Rate for Payer: BCN Commercial |
$696.14
|
| Rate for Payer: BCN Medicare Advantage |
$223.84
|
| Rate for Payer: Cash Price |
$716.29
|
| Rate for Payer: Cofinity Commercial |
$770.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.84
|
| Rate for Payer: Healthscope Commercial |
$805.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.06
|
| Rate for Payer: Nomi Health Commercial |
$734.20
|
| Rate for Payer: PACE Senior Care Partners |
$212.65
|
| Rate for Payer: PACE SWMI |
$223.84
|
| Rate for Payer: PHP Commercial |
$761.06
|
| Rate for Payer: PHP Medicare Advantage |
$223.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.98
|
| Rate for Payer: Priority Health HMO/PPO |
$778.96
|
| Rate for Payer: Priority Health Medicare |
$226.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$599.89
|
| Rate for Payer: Railroad Medicare Medicare |
$223.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.92
|
| Rate for Payer: UHC Core |
$747.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.84
|
| Rate for Payer: UHC Exchange |
$223.84
|
| Rate for Payer: UHC Medicare Advantage |
$223.84
|
| Rate for Payer: VA VA |
$223.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.52
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
IP
|
$3,433.56
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,231.81 |
| Max. Negotiated Rate |
$3,090.20 |
| Rate for Payer: Aetna Commercial |
$2,918.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,802.82
|
| Rate for Payer: BCN Commercial |
$2,653.46
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cofinity Commercial |
$2,952.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,746.85
|
| Rate for Payer: Healthscope Commercial |
$3,090.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,575.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,918.53
|
| Rate for Payer: Nomi Health Commercial |
$2,815.52
|
| Rate for Payer: PHP Commercial |
$2,918.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.81
|
| Rate for Payer: Priority Health HMO/PPO |
$2,987.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,300.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,021.53
|
| Rate for Payer: UHC Core |
$2,867.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,575.17
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
OP
|
$3,433.56
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$596.89 |
| Max. Negotiated Rate |
$3,090.20 |
| Rate for Payer: Aetna Commercial |
$2,918.53
|
| Rate for Payer: Aetna Medicare |
$892.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,072.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,072.99
|
| Rate for Payer: BCBS Complete |
$626.77
|
| Rate for Payer: BCBS MAPPO |
$858.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,822.73
|
| Rate for Payer: BCN Commercial |
$2,669.59
|
| Rate for Payer: BCN Medicare Advantage |
$858.39
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cash Price |
$2,746.85
|
| Rate for Payer: Cofinity Commercial |
$2,952.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,746.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.39
|
| Rate for Payer: Healthscope Commercial |
$3,090.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,575.17
|
| Rate for Payer: Mclaren Medicaid |
$596.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.31
|
| Rate for Payer: Meridian Medicaid |
$626.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$987.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,918.53
|
| Rate for Payer: Nomi Health Commercial |
$2,815.52
|
| Rate for Payer: PACE Senior Care Partners |
$815.47
|
| Rate for Payer: PACE SWMI |
$858.39
|
| Rate for Payer: PHP Commercial |
$2,918.53
|
| Rate for Payer: PHP Medicare Advantage |
$858.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$596.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,231.81
|
| Rate for Payer: Priority Health HMO/PPO |
$2,987.20
|
| Rate for Payer: Priority Health Medicare |
$866.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,300.49
|
| Rate for Payer: Railroad Medicare Medicare |
$858.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,021.53
|
| Rate for Payer: UHC Core |
$2,867.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.39
|
| Rate for Payer: UHC Exchange |
$858.39
|
| Rate for Payer: UHC Medicare Advantage |
$858.39
|
| Rate for Payer: UHCCP Medicaid |
$596.89
|
| Rate for Payer: VA VA |
$858.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,575.17
|
|
