|
HC ER LEVEL FIVE 99285
|
Facility
|
OP
|
$2,047.66
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$434.31 |
| Max. Negotiated Rate |
$1,842.89 |
| Rate for Payer: Aetna Commercial |
$1,740.51
|
| Rate for Payer: Aetna Medicare |
$532.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$639.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$639.89
|
| Rate for Payer: BCBS Complete |
$456.05
|
| Rate for Payer: BCBS MAPPO |
$511.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,683.38
|
| Rate for Payer: BCN Commercial |
$1,592.06
|
| Rate for Payer: BCN Medicare Advantage |
$511.92
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cofinity Commercial |
$1,760.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$511.92
|
| Rate for Payer: Healthscope Commercial |
$1,842.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,535.74
|
| Rate for Payer: Mclaren Medicaid |
$434.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.51
|
| Rate for Payer: Meridian Medicaid |
$456.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.51
|
| Rate for Payer: Nomi Health Commercial |
$1,679.08
|
| Rate for Payer: PACE Senior Care Partners |
$486.32
|
| Rate for Payer: PACE SWMI |
$511.92
|
| Rate for Payer: PHP Commercial |
$1,740.51
|
| Rate for Payer: PHP Medicare Advantage |
$511.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1,781.46
|
| Rate for Payer: Priority Health Medicare |
$517.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,371.93
|
| Rate for Payer: Railroad Medicare Medicare |
$511.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,801.94
|
| Rate for Payer: UHC Core |
$1,709.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$511.92
|
| Rate for Payer: UHC Exchange |
$511.92
|
| Rate for Payer: UHC Medicare Advantage |
$511.92
|
| Rate for Payer: UHCCP Medicaid |
$434.31
|
| Rate for Payer: VA VA |
$511.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,535.74
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
IP
|
$2,047.66
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,330.98 |
| Max. Negotiated Rate |
$1,842.89 |
| Rate for Payer: Aetna Commercial |
$1,740.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.50
|
| Rate for Payer: BCN Commercial |
$1,582.43
|
| Rate for Payer: Cash Price |
$1,638.13
|
| Rate for Payer: Cofinity Commercial |
$1,760.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.13
|
| Rate for Payer: Healthscope Commercial |
$1,842.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,535.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.51
|
| Rate for Payer: Nomi Health Commercial |
$1,679.08
|
| Rate for Payer: PHP Commercial |
$1,740.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1,781.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,371.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,801.94
|
| Rate for Payer: UHC Core |
$1,709.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,535.74
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
IP
|
$1,419.01
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$922.36 |
| Max. Negotiated Rate |
$1,277.11 |
| Rate for Payer: Aetna Commercial |
$1,206.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.34
|
| Rate for Payer: BCN Commercial |
$1,096.61
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cofinity Commercial |
$1,220.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,135.21
|
| Rate for Payer: Healthscope Commercial |
$1,277.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,064.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,206.16
|
| Rate for Payer: Nomi Health Commercial |
$1,163.59
|
| Rate for Payer: PHP Commercial |
$1,206.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,234.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$950.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,248.73
|
| Rate for Payer: UHC Core |
$1,184.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,064.26
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
OP
|
$1,419.01
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.64 |
| Max. Negotiated Rate |
$1,277.11 |
| Rate for Payer: Aetna Commercial |
$1,206.16
|
| Rate for Payer: Aetna Medicare |
$368.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.44
|
| Rate for Payer: BCBS Complete |
$316.75
|
| Rate for Payer: BCBS MAPPO |
$354.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.57
|
| Rate for Payer: BCN Commercial |
$1,103.28
|
| Rate for Payer: BCN Medicare Advantage |
$354.75
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cash Price |
$1,135.21
|
| Rate for Payer: Cofinity Commercial |
$1,220.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,135.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.75
|
| Rate for Payer: Healthscope Commercial |
$1,277.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,064.26
|
| Rate for Payer: Mclaren Medicaid |
$301.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$372.49
|
| Rate for Payer: Meridian Medicaid |
$316.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,206.16
|
| Rate for Payer: Nomi Health Commercial |
$1,163.59
|
| Rate for Payer: PACE Senior Care Partners |
$337.01
|
| Rate for Payer: PACE SWMI |
$354.75
|
| Rate for Payer: PHP Commercial |
$1,206.16
|
| Rate for Payer: PHP Medicare Advantage |
$354.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,234.54
|
| Rate for Payer: Priority Health Medicare |
$358.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$950.74
|
| Rate for Payer: Railroad Medicare Medicare |
$354.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,248.73
|
| Rate for Payer: UHC Core |
$1,184.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.75
|
| Rate for Payer: UHC Exchange |
$354.75
|
| Rate for Payer: UHC Medicare Advantage |
$354.75
|
| Rate for Payer: UHCCP Medicaid |
$301.64
|
| Rate for Payer: VA VA |
$354.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,064.26
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$257.36
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$231.62 |
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: Aetna Medicare |
$66.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.42
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$64.34
|
| Rate for Payer: BCBS Trust/PPO |
$211.58
|
| Rate for Payer: BCN Commercial |
$200.10
|
| Rate for Payer: BCN Medicare Advantage |
$64.34
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$221.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.34
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.02
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.56
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: Nomi Health Commercial |
$211.04
|
| Rate for Payer: PACE Senior Care Partners |
$61.12
|
| Rate for Payer: PACE SWMI |
$64.34
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: PHP Medicare Advantage |
$64.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health HMO/PPO |
$223.90
|
| Rate for Payer: Priority Health Medicare |
$64.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.43
|
| Rate for Payer: Railroad Medicare Medicare |
$64.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.48
|
| Rate for Payer: UHC Core |
$214.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.34
|
| Rate for Payer: UHC Exchange |
$64.34
|
| Rate for Payer: UHC Medicare Advantage |
$64.34
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.02
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
IP
|
$257.36
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$231.62 |
| Rate for Payer: Aetna Commercial |
$218.76
|
| Rate for Payer: BCBS Trust/PPO |
$210.08
|
| Rate for Payer: BCN Commercial |
$198.89
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$221.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Healthscope Commercial |
$231.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: Nomi Health Commercial |
$211.04
|
| Rate for Payer: PHP Commercial |
$218.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health HMO/PPO |
$223.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.48
|
| Rate for Payer: UHC Core |
$214.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.02
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
IP
|
$903.62
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$587.35 |
| Max. Negotiated Rate |
$813.26 |
| Rate for Payer: Aetna Commercial |
$768.08
|
| Rate for Payer: BCBS Trust/PPO |
$737.63
|
| Rate for Payer: BCN Commercial |
$698.32
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cofinity Commercial |
$777.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.90
|
| Rate for Payer: Healthscope Commercial |
$813.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.08
|
| Rate for Payer: Nomi Health Commercial |
$740.97
|
| Rate for Payer: PHP Commercial |
$768.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.35
|
| Rate for Payer: Priority Health HMO/PPO |
$786.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$605.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.19
|
| Rate for Payer: UHC Core |
$754.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.72
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
OP
|
$903.62
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.14 |
| Max. Negotiated Rate |
$813.26 |
| Rate for Payer: Aetna Commercial |
$768.08
|
| Rate for Payer: Aetna Medicare |
$234.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.38
|
| Rate for Payer: BCBS Complete |
$205.96
|
| Rate for Payer: BCBS MAPPO |
$225.90
|
| Rate for Payer: BCBS Trust/PPO |
$742.87
|
| Rate for Payer: BCN Commercial |
$702.56
|
| Rate for Payer: BCN Medicare Advantage |
$225.90
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cofinity Commercial |
$777.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.90
|
| Rate for Payer: Healthscope Commercial |
$813.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.72
|
| Rate for Payer: Mclaren Medicaid |
$196.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.20
|
| Rate for Payer: Meridian Medicaid |
$205.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.08
|
| Rate for Payer: Nomi Health Commercial |
$740.97
|
| Rate for Payer: PACE Senior Care Partners |
$214.61
|
| Rate for Payer: PACE SWMI |
$225.90
|
| Rate for Payer: PHP Commercial |
$768.08
|
| Rate for Payer: PHP Medicare Advantage |
$225.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.35
|
| Rate for Payer: Priority Health HMO/PPO |
$786.15
|
| Rate for Payer: Priority Health Medicare |
$228.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$605.43
|
| Rate for Payer: Railroad Medicare Medicare |
$225.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.19
|
| Rate for Payer: UHC Core |
$754.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.90
|
| Rate for Payer: UHC Exchange |
$225.90
|
| Rate for Payer: UHC Medicare Advantage |
$225.90
|
| Rate for Payer: UHCCP Medicaid |
$196.14
|
| Rate for Payer: VA VA |
$225.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.72
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$512.06
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.18 |
| Max. Negotiated Rate |
$460.85 |
| Rate for Payer: Aetna Commercial |
$435.25
|
| Rate for Payer: Aetna Medicare |
$133.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.02
|
| Rate for Payer: BCBS Complete |
$117.80
|
| Rate for Payer: BCBS MAPPO |
$128.02
|
| Rate for Payer: BCBS Trust/PPO |
$420.96
|
| Rate for Payer: BCN Commercial |
$398.13
|
| Rate for Payer: BCN Medicare Advantage |
$128.02
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cofinity Commercial |
$440.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.02
|
| Rate for Payer: Healthscope Commercial |
$460.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.04
|
| Rate for Payer: Mclaren Medicaid |
$112.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.42
|
| Rate for Payer: Meridian Medicaid |
$117.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.25
|
| Rate for Payer: Nomi Health Commercial |
$419.89
|
| Rate for Payer: PACE Senior Care Partners |
$121.61
|
| Rate for Payer: PACE SWMI |
$128.02
|
| Rate for Payer: PHP Commercial |
$435.25
|
| Rate for Payer: PHP Medicare Advantage |
$128.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health HMO/PPO |
$445.49
|
| Rate for Payer: Priority Health Medicare |
$129.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.08
|
| Rate for Payer: Railroad Medicare Medicare |
$128.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.61
|
| Rate for Payer: UHC Core |
$427.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.02
|
| Rate for Payer: UHC Exchange |
$128.02
|
| Rate for Payer: UHC Medicare Advantage |
$128.02
|
| Rate for Payer: UHCCP Medicaid |
$112.18
|
| Rate for Payer: VA VA |
$128.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.04
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
IP
|
$512.06
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.84 |
| Max. Negotiated Rate |
$460.85 |
| Rate for Payer: Aetna Commercial |
$435.25
|
| Rate for Payer: BCBS Trust/PPO |
$417.99
|
| Rate for Payer: BCN Commercial |
$395.72
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cofinity Commercial |
$440.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.65
|
| Rate for Payer: Healthscope Commercial |
$460.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.25
|
| Rate for Payer: Nomi Health Commercial |
$419.89
|
| Rate for Payer: PHP Commercial |
$435.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health HMO/PPO |
$445.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.61
|
| Rate for Payer: UHC Core |
$427.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.04
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$3,021.16 |
| Rate for Payer: Aetna Commercial |
$2,853.31
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,740.19
|
| Rate for Payer: BCN Commercial |
$2,594.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$2,886.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$3,021.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,517.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: Nomi Health Commercial |
$2,752.61
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$2,853.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: Priority Health HMO/PPO |
$2,920.45
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,249.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,954.02
|
| Rate for Payer: UHC Core |
$2,802.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,517.63
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.02 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$179.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.82
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS MAPPO |
$172.65
|
| Rate for Payer: BCBS Trust/PPO |
$567.75
|
| Rate for Payer: BCN Commercial |
$536.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.65
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.65
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: PACE Senior Care Partners |
$164.02
|
| Rate for Payer: PACE SWMI |
$172.65
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: PHP Medicare Advantage |
$172.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health HMO/PPO |
$600.83
|
| Rate for Payer: Priority Health Medicare |
$174.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.71
|
| Rate for Payer: Railroad Medicare Medicare |
$172.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.65
|
| Rate for Payer: UHC Exchange |
$172.65
|
| Rate for Payer: UHC Medicare Advantage |
$172.65
|
| Rate for Payer: VA VA |
$172.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.90 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: BCBS Trust/PPO |
$563.74
|
| Rate for Payer: BCN Commercial |
$533.70
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health HMO/PPO |
$600.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.90 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: BCBS Trust/PPO |
$563.74
|
| Rate for Payer: BCN Commercial |
$533.70
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health HMO/PPO |
$600.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.02 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$179.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.82
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS MAPPO |
$172.65
|
| Rate for Payer: BCBS Trust/PPO |
$567.75
|
| Rate for Payer: BCN Commercial |
$536.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.65
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.65
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: PACE Senior Care Partners |
$164.02
|
| Rate for Payer: PACE SWMI |
$172.65
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: PHP Medicare Advantage |
$172.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health HMO/PPO |
$600.83
|
| Rate for Payer: Priority Health Medicare |
$174.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.71
|
| Rate for Payer: Railroad Medicare Medicare |
$172.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.65
|
| Rate for Payer: UHC Exchange |
$172.65
|
| Rate for Payer: UHC Medicare Advantage |
$172.65
|
| Rate for Payer: VA VA |
$172.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$14.27
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Mclaren Medicaid |
$13.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$14.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$13.59
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.09 |
| Max. Negotiated Rate |
$1,239.51 |
| Rate for Payer: Aetna Commercial |
$1,170.65
|
| Rate for Payer: Aetna Medicare |
$358.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$430.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$430.38
|
| Rate for Payer: BCBS Complete |
$550.89
|
| Rate for Payer: BCBS MAPPO |
$344.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.22
|
| Rate for Payer: BCN Commercial |
$1,070.80
|
| Rate for Payer: BCN Medicare Advantage |
$344.31
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,184.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.31
|
| Rate for Payer: Healthscope Commercial |
$1,239.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: Nomi Health Commercial |
$1,129.33
|
| Rate for Payer: PACE Senior Care Partners |
$327.09
|
| Rate for Payer: PACE SWMI |
$344.31
|
| Rate for Payer: PHP Commercial |
$1,170.65
|
| Rate for Payer: PHP Medicare Advantage |
$344.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,198.19
|
| Rate for Payer: Priority Health Medicare |
$347.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.74
|
| Rate for Payer: Railroad Medicare Medicare |
$344.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.96
|
| Rate for Payer: UHC Core |
$1,149.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.31
|
| Rate for Payer: UHC Exchange |
$344.31
|
| Rate for Payer: UHC Medicare Advantage |
$344.31
|
| Rate for Payer: VA VA |
$344.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.92
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.20 |
| Max. Negotiated Rate |
$1,239.51 |
| Rate for Payer: Aetna Commercial |
$1,170.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.23
|
| Rate for Payer: BCN Commercial |
$1,064.32
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,184.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Healthscope Commercial |
$1,239.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: Nomi Health Commercial |
$1,129.33
|
| Rate for Payer: PHP Commercial |
$1,170.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,198.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.96
|
| Rate for Payer: UHC Core |
$1,149.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.92
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
OP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.87 |
| Max. Negotiated Rate |
$2,152.71 |
| Rate for Payer: Aetna Commercial |
$2,033.12
|
| Rate for Payer: Aetna Medicare |
$621.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$747.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$747.47
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$597.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,966.38
|
| Rate for Payer: BCN Commercial |
$1,859.70
|
| Rate for Payer: BCN Medicare Advantage |
$597.98
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$2,057.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.98
|
| Rate for Payer: Healthscope Commercial |
$2,152.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,793.92
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.87
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$687.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.12
|
| Rate for Payer: Nomi Health Commercial |
$1,961.36
|
| Rate for Payer: PACE Senior Care Partners |
$568.08
|
| Rate for Payer: PACE SWMI |
$597.98
|
| Rate for Payer: PHP Commercial |
$2,033.12
|
| Rate for Payer: PHP Medicare Advantage |
$597.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2,080.95
|
| Rate for Payer: Priority Health Medicare |
$603.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,602.57
|
| Rate for Payer: Railroad Medicare Medicare |
$597.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,104.87
|
| Rate for Payer: UHC Core |
$1,997.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.98
|
| Rate for Payer: UHC Exchange |
$597.98
|
| Rate for Payer: UHC Medicare Advantage |
$597.98
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$597.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,793.92
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
IP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,554.74 |
| Max. Negotiated Rate |
$2,152.71 |
| Rate for Payer: Aetna Commercial |
$2,033.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,952.51
|
| Rate for Payer: BCN Commercial |
$1,848.46
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$2,057.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Healthscope Commercial |
$2,152.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,793.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.12
|
| Rate for Payer: Nomi Health Commercial |
$1,961.36
|
| Rate for Payer: PHP Commercial |
$2,033.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2,080.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,602.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,104.87
|
| Rate for Payer: UHC Core |
$1,997.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,793.92
|
|
