|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$141.11
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna Commercial |
$119.94
|
| Rate for Payer: BCBS Trust/PPO |
$109.05
|
| Rate for Payer: BCN Commercial |
$109.05
|
| Rate for Payer: Cash Price |
$112.89
|
| Rate for Payer: Cofinity Commercial |
$121.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.89
|
| Rate for Payer: Healthscope Commercial |
$127.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.94
|
| Rate for Payer: PHP Commercial |
$119.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.18
|
| Rate for Payer: UHC Core |
$117.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.83
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OAK IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC OAK IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$53.13
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$47.82 |
| Rate for Payer: Aetna Commercial |
$45.16
|
| Rate for Payer: BCBS Trust/PPO |
$41.06
|
| Rate for Payer: BCN Commercial |
$41.06
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cofinity Commercial |
$45.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$47.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.16
|
| Rate for Payer: PHP Commercial |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.75
|
| Rate for Payer: UHC Core |
$44.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.85
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$53.13
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$47.82 |
| Rate for Payer: Aetna Commercial |
$45.16
|
| Rate for Payer: Aetna Medicare |
$13.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$41.31
|
| Rate for Payer: BCN Commercial |
$41.31
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cofinity Commercial |
$45.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$47.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.16
|
| Rate for Payer: PACE Senior Care Partners |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$45.16
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.22
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.40
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.75
|
| Rate for Payer: UHC Core |
$44.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.68
|
| Rate for Payer: VA VA |
$13.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.85
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$31.29
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: BCBS Trust/PPO |
$24.18
|
| Rate for Payer: BCN Commercial |
$24.18
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.60
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.54
|
| Rate for Payer: UHC Core |
$26.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.33
|
| Rate for Payer: BCN Commercial |
$24.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.60
|
| Rate for Payer: PACE Senior Care Partners |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.22
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.54
|
| Rate for Payer: UHC Core |
$26.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
HC OAT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC OAT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,563.34
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,173.28 |
| Max. Negotiated Rate |
$3,207.01 |
| Rate for Payer: Aetna Commercial |
$3,028.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,753.75
|
| Rate for Payer: BCN Commercial |
$2,753.75
|
| Rate for Payer: Cash Price |
$2,850.67
|
| Rate for Payer: Cofinity Commercial |
$3,064.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,850.67
|
| Rate for Payer: Healthscope Commercial |
$3,207.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,672.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,028.84
|
| Rate for Payer: PHP Commercial |
$3,028.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,494.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,100.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,173.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,135.74
|
| Rate for Payer: UHC Core |
$2,975.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,672.50
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,775.22
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,082.71 |
| Max. Negotiated Rate |
$1,597.70 |
| Rate for Payer: Aetna Commercial |
$1,508.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,371.89
|
| Rate for Payer: BCN Commercial |
$1,371.89
|
| Rate for Payer: Cash Price |
$1,420.18
|
| Rate for Payer: Cofinity Commercial |
$1,526.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,420.18
|
| Rate for Payer: Healthscope Commercial |
$1,597.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,331.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,508.94
|
| Rate for Payer: PHP Commercial |
$1,508.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,082.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,562.19
|
| Rate for Payer: UHC Core |
$1,482.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,331.42
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$3,905.86
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,382.18 |
| Max. Negotiated Rate |
$3,515.27 |
| Rate for Payer: Aetna Commercial |
$3,319.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,018.45
|
| Rate for Payer: BCN Commercial |
$3,018.45
|
| Rate for Payer: Cash Price |
$3,124.69
|
| Rate for Payer: Cofinity Commercial |
$3,359.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,124.69
|
| Rate for Payer: Healthscope Commercial |
$3,515.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,929.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,319.98
|
| Rate for Payer: PHP Commercial |
$3,319.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,734.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,398.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,382.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,437.16
|
| Rate for Payer: UHC Core |
$3,261.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,929.40
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OB POSTPARTUM R&B
|
Facility
|
IP
|
$2,510.09
|
|
| Hospital Charge Code |
11200002
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,530.90 |
| Max. Negotiated Rate |
$2,259.08 |
| Rate for Payer: Aetna Commercial |
$2,133.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,939.80
|
| Rate for Payer: BCN Commercial |
$1,939.80
|
| Rate for Payer: Cash Price |
$2,008.07
|
| Rate for Payer: Cofinity Commercial |
$2,158.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.07
|
| Rate for Payer: Healthscope Commercial |
$2,259.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,882.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,133.58
|
| Rate for Payer: PHP Commercial |
$2,133.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,757.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,183.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,530.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,208.88
|
| Rate for Payer: UHC Core |
$2,095.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,882.57
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OBSERVATION OVERFLOW PER HOUR
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
76900005
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200023
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC OBS OVERFLOW PER HR
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
76900002
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
