|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,221.18
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$3,184.40 |
| Max. Negotiated Rate |
$4,699.06 |
| Rate for Payer: Aetna Commercial |
$4,438.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,034.93
|
| Rate for Payer: BCN Commercial |
$4,034.93
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cofinity Commercial |
$4,490.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,176.94
|
| Rate for Payer: Healthscope Commercial |
$4,699.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,915.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,438.00
|
| Rate for Payer: PHP Commercial |
$4,438.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,654.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,542.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,184.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,594.64
|
| Rate for Payer: UHC Core |
$4,359.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,915.88
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,221.18
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$4,438.00
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,034.93
|
| Rate for Payer: BCN Commercial |
$4,034.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cofinity Commercial |
$4,490.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,176.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$4,699.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,915.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,438.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$4,438.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,654.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,542.43
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,184.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,594.64
|
| Rate for Payer: UHC Core |
$4,359.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,915.88
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.01
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$19.81 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$17.11
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$19.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.71
|
| Rate for Payer: PACE Senior Care Partners |
$5.23
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$18.71
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.15
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.37
|
| Rate for Payer: UHC Core |
$18.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$5.67
|
| Rate for Payer: VA VA |
$5.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.51
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.01
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$19.81 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: BCBS Trust/PPO |
$17.01
|
| Rate for Payer: BCN Commercial |
$17.01
|
| Rate for Payer: Cash Price |
$17.61
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.61
|
| Rate for Payer: Healthscope Commercial |
$19.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.71
|
| Rate for Payer: PHP Commercial |
$18.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.37
|
| Rate for Payer: UHC Core |
$18.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.51
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$162.05
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$145.84 |
| Rate for Payer: Aetna Commercial |
$137.74
|
| Rate for Payer: BCBS Trust/PPO |
$125.23
|
| Rate for Payer: BCN Commercial |
$125.23
|
| Rate for Payer: Cash Price |
$129.64
|
| Rate for Payer: Cofinity Commercial |
$139.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.64
|
| Rate for Payer: Healthscope Commercial |
$145.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.74
|
| Rate for Payer: PHP Commercial |
$137.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.60
|
| Rate for Payer: UHC Core |
$135.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.54
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$162.05
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$145.84 |
| Rate for Payer: Aetna Commercial |
$137.74
|
| Rate for Payer: Aetna Medicare |
$42.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.64
|
| Rate for Payer: BCBS Complete |
$18.26
|
| Rate for Payer: BCBS MAPPO |
$40.51
|
| Rate for Payer: BCBS Trust/PPO |
$125.99
|
| Rate for Payer: BCN Commercial |
$125.99
|
| Rate for Payer: BCN Medicare Advantage |
$40.51
|
| Rate for Payer: Cash Price |
$129.64
|
| Rate for Payer: Cash Price |
$129.64
|
| Rate for Payer: Cofinity Commercial |
$139.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.51
|
| Rate for Payer: Healthscope Commercial |
$145.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.54
|
| Rate for Payer: Mclaren Medicaid |
$17.39
|
| Rate for Payer: Meridian Medicaid |
$18.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.74
|
| Rate for Payer: PACE Senior Care Partners |
$38.49
|
| Rate for Payer: PACE SWMI |
$40.51
|
| Rate for Payer: PHP Commercial |
$137.74
|
| Rate for Payer: PHP Medicare Advantage |
$40.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.98
|
| Rate for Payer: Priority Health Medicare |
$40.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.83
|
| Rate for Payer: Railroad Medicare Medicare |
$40.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.60
|
| Rate for Payer: UHC Core |
$135.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.51
|
| Rate for Payer: UHC Medicare Advantage |
$41.73
|
| Rate for Payer: VA VA |
$40.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.54
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
OP
|
$88.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$79.51 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Medicare |
$22.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.61
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$22.08
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$68.68
|
| Rate for Payer: BCN Medicare Advantage |
$22.08
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cofinity Commercial |
$75.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.08
|
| Rate for Payer: Healthscope Commercial |
$79.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.09
|
| Rate for Payer: PACE Senior Care Partners |
$20.98
|
| Rate for Payer: PACE SWMI |
$22.08
|
| Rate for Payer: PHP Commercial |
$75.09
|
| Rate for Payer: PHP Medicare Advantage |
$22.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Medicare |
$22.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.88
|
| Rate for Payer: Railroad Medicare Medicare |
$22.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.74
|
| Rate for Payer: UHC Core |
$73.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.08
|
| Rate for Payer: UHC Medicare Advantage |
$22.75
|
| Rate for Payer: VA VA |
$22.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$88.34
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$79.51 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.27
|
| Rate for Payer: BCN Commercial |
$68.27
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cofinity Commercial |
$75.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.67
|
| Rate for Payer: Healthscope Commercial |
$79.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.09
|
| Rate for Payer: PHP Commercial |
$75.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.74
|
| Rate for Payer: UHC Core |
$73.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
OP
|
$263.80
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$237.42 |
| Rate for Payer: Aetna Commercial |
$224.23
|
| Rate for Payer: Aetna Medicare |
$68.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.44
|
| Rate for Payer: BCBS Complete |
$29.24
|
| Rate for Payer: BCBS MAPPO |
$65.95
|
| Rate for Payer: BCBS Trust/PPO |
$205.10
|
| Rate for Payer: BCN Commercial |
$205.10
|
| Rate for Payer: BCN Medicare Advantage |
$65.95
|
| Rate for Payer: Cash Price |
$211.04
|
| Rate for Payer: Cash Price |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$226.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.95
|
| Rate for Payer: Healthscope Commercial |
$237.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.85
|
| Rate for Payer: Mclaren Medicaid |
$27.84
|
| Rate for Payer: Meridian Medicaid |
$29.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.23
|
| Rate for Payer: PACE Senior Care Partners |
$62.65
|
| Rate for Payer: PACE SWMI |
$65.95
|
| Rate for Payer: PHP Commercial |
$224.23
|
| Rate for Payer: PHP Medicare Advantage |
$65.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.51
|
| Rate for Payer: Priority Health Medicare |
$65.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.89
|
| Rate for Payer: Railroad Medicare Medicare |
$65.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.14
|
| Rate for Payer: UHC Core |
$220.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.95
|
| Rate for Payer: UHC Medicare Advantage |
$67.93
|
| Rate for Payer: VA VA |
$65.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.85
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
IP
|
$263.80
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$160.89 |
| Max. Negotiated Rate |
$237.42 |
| Rate for Payer: Aetna Commercial |
$224.23
|
| Rate for Payer: BCBS Trust/PPO |
$203.86
|
| Rate for Payer: BCN Commercial |
$203.86
|
| Rate for Payer: Cash Price |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$226.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.04
|
| Rate for Payer: Healthscope Commercial |
$237.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.23
|
| Rate for Payer: PHP Commercial |
$224.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.14
|
| Rate for Payer: UHC Core |
$220.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.85
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$263.80
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$237.42 |
| Rate for Payer: Aetna Commercial |
$224.23
|
| Rate for Payer: Aetna Medicare |
$68.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.44
|
| Rate for Payer: BCBS Complete |
$29.24
|
| Rate for Payer: BCBS MAPPO |
$65.95
|
| Rate for Payer: BCBS Trust/PPO |
$205.10
|
| Rate for Payer: BCN Commercial |
$205.10
|
| Rate for Payer: BCN Medicare Advantage |
$65.95
|
| Rate for Payer: Cash Price |
$211.04
|
| Rate for Payer: Cash Price |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$226.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.95
|
| Rate for Payer: Healthscope Commercial |
$237.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.85
|
| Rate for Payer: Mclaren Medicaid |
$27.84
|
| Rate for Payer: Meridian Medicaid |
$29.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.23
|
| Rate for Payer: PACE Senior Care Partners |
$62.65
|
| Rate for Payer: PACE SWMI |
$65.95
|
| Rate for Payer: PHP Commercial |
$224.23
|
| Rate for Payer: PHP Medicare Advantage |
$65.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.51
|
| Rate for Payer: Priority Health Medicare |
$65.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.89
|
| Rate for Payer: Railroad Medicare Medicare |
$65.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.14
|
| Rate for Payer: UHC Core |
$220.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.95
|
| Rate for Payer: UHC Medicare Advantage |
$67.93
|
| Rate for Payer: VA VA |
$65.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.85
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$263.80
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$160.89 |
| Max. Negotiated Rate |
$237.42 |
| Rate for Payer: Aetna Commercial |
$224.23
|
| Rate for Payer: BCBS Trust/PPO |
$203.86
|
| Rate for Payer: BCN Commercial |
$203.86
|
| Rate for Payer: Cash Price |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$226.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.04
|
| Rate for Payer: Healthscope Commercial |
$237.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.23
|
| Rate for Payer: PHP Commercial |
$224.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.14
|
| Rate for Payer: UHC Core |
$220.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.85
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.89 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna Medicare |
$511.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$615.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$615.31
|
| Rate for Payer: BCBS Complete |
$379.99
|
| Rate for Payer: BCBS MAPPO |
$492.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,530.90
|
| Rate for Payer: BCN Commercial |
$1,530.90
|
| Rate for Payer: BCN Medicare Advantage |
$492.25
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$492.25
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Mclaren Medicaid |
$361.89
|
| Rate for Payer: Meridian Medicaid |
$379.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$516.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$566.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PACE Senior Care Partners |
$467.64
|
| Rate for Payer: PACE SWMI |
$492.25
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: PHP Medicare Advantage |
$492.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,713.03
|
| Rate for Payer: Priority Health Medicare |
$492.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,200.89
|
| Rate for Payer: Railroad Medicare Medicare |
$492.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,732.72
|
| Rate for Payer: UHC Core |
$1,644.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$492.25
|
| Rate for Payer: UHC Medicare Advantage |
$507.02
|
| Rate for Payer: VA VA |
$492.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,200.89 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,521.64
|
| Rate for Payer: BCN Commercial |
$1,521.64
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,575.20
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,476.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,713.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,200.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,732.72
|
| Rate for Payer: UHC Core |
$1,644.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,476.75
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$809.36
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$728.42 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Medicare |
$210.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.92
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$202.34
|
| Rate for Payer: BCBS Trust/PPO |
$629.28
|
| Rate for Payer: BCN Commercial |
$629.28
|
| Rate for Payer: BCN Medicare Advantage |
$202.34
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cofinity Commercial |
$696.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.34
|
| Rate for Payer: Healthscope Commercial |
$728.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.02
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$212.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.96
|
| Rate for Payer: PACE Senior Care Partners |
$192.22
|
| Rate for Payer: PACE SWMI |
$202.34
|
| Rate for Payer: PHP Commercial |
$687.96
|
| Rate for Payer: PHP Medicare Advantage |
$202.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.14
|
| Rate for Payer: Priority Health Medicare |
$202.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.63
|
| Rate for Payer: Railroad Medicare Medicare |
$202.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.24
|
| Rate for Payer: UHC Core |
$675.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.34
|
| Rate for Payer: UHC Medicare Advantage |
$208.41
|
| Rate for Payer: VA VA |
$202.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.02
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$809.36
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$493.63 |
| Max. Negotiated Rate |
$728.42 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: BCBS Trust/PPO |
$625.47
|
| Rate for Payer: BCN Commercial |
$625.47
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cofinity Commercial |
$696.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.49
|
| Rate for Payer: Healthscope Commercial |
$728.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.96
|
| Rate for Payer: PHP Commercial |
$687.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.24
|
| Rate for Payer: UHC Core |
$675.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.02
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$889.83 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.49
|
| Rate for Payer: BCN Commercial |
$1,127.49
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$889.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.89
|
| Rate for Payer: UHC Core |
$1,218.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,458.97
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$346.51 |
| Max. Negotiated Rate |
$1,313.07 |
| Rate for Payer: Aetna Commercial |
$1,240.12
|
| Rate for Payer: Aetna Medicare |
$379.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$455.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$455.93
|
| Rate for Payer: BCBS Complete |
$551.50
|
| Rate for Payer: BCBS MAPPO |
$364.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.35
|
| Rate for Payer: BCN Commercial |
$1,134.35
|
| Rate for Payer: BCN Medicare Advantage |
$364.74
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cash Price |
$1,167.18
|
| Rate for Payer: Cofinity Commercial |
$1,254.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,167.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.74
|
| Rate for Payer: Healthscope Commercial |
$1,313.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,094.23
|
| Rate for Payer: Mclaren Medicaid |
$525.24
|
| Rate for Payer: Meridian Medicaid |
$551.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$382.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,240.12
|
| Rate for Payer: PACE Senior Care Partners |
$346.51
|
| Rate for Payer: PACE SWMI |
$364.74
|
| Rate for Payer: PHP Commercial |
$1,240.12
|
| Rate for Payer: PHP Medicare Advantage |
$364.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.30
|
| Rate for Payer: Priority Health Medicare |
$364.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$889.83
|
| Rate for Payer: Railroad Medicare Medicare |
$364.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.89
|
| Rate for Payer: UHC Core |
$1,218.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$364.74
|
| Rate for Payer: UHC Medicare Advantage |
$375.68
|
| Rate for Payer: VA VA |
$364.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,094.23
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$153.31
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$137.98 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: Aetna Medicare |
$39.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.91
|
| Rate for Payer: BCBS Complete |
$61.32
|
| Rate for Payer: BCBS MAPPO |
$38.33
|
| Rate for Payer: BCBS Trust/PPO |
$119.20
|
| Rate for Payer: BCN Commercial |
$119.20
|
| Rate for Payer: BCN Medicare Advantage |
$38.33
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$131.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.33
|
| Rate for Payer: Healthscope Commercial |
$137.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: PACE Senior Care Partners |
$36.41
|
| Rate for Payer: PACE SWMI |
$38.33
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: PHP Medicare Advantage |
$38.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.38
|
| Rate for Payer: Priority Health Medicare |
$38.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.50
|
| Rate for Payer: Railroad Medicare Medicare |
$38.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.91
|
| Rate for Payer: UHC Core |
$128.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.33
|
| Rate for Payer: UHC Medicare Advantage |
$39.48
|
| Rate for Payer: VA VA |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.98
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$153.31
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$137.98 |
| Rate for Payer: Aetna Commercial |
$130.31
|
| Rate for Payer: BCBS Trust/PPO |
$118.48
|
| Rate for Payer: BCN Commercial |
$118.48
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$131.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$137.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: PHP Commercial |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.91
|
| Rate for Payer: UHC Core |
$128.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.98
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,491.66
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$354.27 |
| Max. Negotiated Rate |
$1,342.49 |
| Rate for Payer: Aetna Commercial |
$1,267.91
|
| Rate for Payer: Aetna Medicare |
$387.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.14
|
| Rate for Payer: BCBS Complete |
$431.64
|
| Rate for Payer: BCBS MAPPO |
$372.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.77
|
| Rate for Payer: BCN Commercial |
$1,159.77
|
| Rate for Payer: BCN Medicare Advantage |
$372.92
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cofinity Commercial |
$1,282.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.92
|
| Rate for Payer: Healthscope Commercial |
$1,342.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,118.74
|
| Rate for Payer: Mclaren Medicaid |
$411.09
|
| Rate for Payer: Meridian Medicaid |
$431.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$391.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$428.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.91
|
| Rate for Payer: PACE Senior Care Partners |
$354.27
|
| Rate for Payer: PACE SWMI |
$372.92
|
| Rate for Payer: PHP Commercial |
$1,267.91
|
| Rate for Payer: PHP Medicare Advantage |
$372.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,297.74
|
| Rate for Payer: Priority Health Medicare |
$372.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$909.76
|
| Rate for Payer: Railroad Medicare Medicare |
$372.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,312.66
|
| Rate for Payer: UHC Core |
$1,245.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.92
|
| Rate for Payer: UHC Medicare Advantage |
$384.10
|
| Rate for Payer: VA VA |
$372.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,118.74
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,491.66
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$909.76 |
| Max. Negotiated Rate |
$1,342.49 |
| Rate for Payer: Aetna Commercial |
$1,267.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.75
|
| Rate for Payer: BCN Commercial |
$1,152.75
|
| Rate for Payer: Cash Price |
$1,193.33
|
| Rate for Payer: Cofinity Commercial |
$1,282.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.33
|
| Rate for Payer: Healthscope Commercial |
$1,342.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,118.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,267.91
|
| Rate for Payer: PHP Commercial |
$1,267.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,297.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$909.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,312.66
|
| Rate for Payer: UHC Core |
$1,245.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,118.74
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,289.42
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$786.42 |
| Max. Negotiated Rate |
$1,160.48 |
| Rate for Payer: Aetna Commercial |
$1,096.01
|
| Rate for Payer: BCBS Trust/PPO |
$996.46
|
| Rate for Payer: BCN Commercial |
$996.46
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cofinity Commercial |
$1,108.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.54
|
| Rate for Payer: Healthscope Commercial |
$1,160.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,096.01
|
| Rate for Payer: PHP Commercial |
$1,096.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,121.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$786.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.69
|
| Rate for Payer: UHC Core |
$1,076.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.06
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,289.42
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$306.24 |
| Max. Negotiated Rate |
$1,160.48 |
| Rate for Payer: Aetna Commercial |
$1,096.01
|
| Rate for Payer: Aetna Medicare |
$335.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$402.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$402.94
|
| Rate for Payer: BCBS Complete |
$431.64
|
| Rate for Payer: BCBS MAPPO |
$322.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.52
|
| Rate for Payer: BCN Commercial |
$1,002.52
|
| Rate for Payer: BCN Medicare Advantage |
$322.36
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cash Price |
$1,031.54
|
| Rate for Payer: Cofinity Commercial |
$1,108.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.36
|
| Rate for Payer: Healthscope Commercial |
$1,160.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.06
|
| Rate for Payer: Mclaren Medicaid |
$411.09
|
| Rate for Payer: Meridian Medicaid |
$431.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$338.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,096.01
|
| Rate for Payer: PACE Senior Care Partners |
$306.24
|
| Rate for Payer: PACE SWMI |
$322.36
|
| Rate for Payer: PHP Commercial |
$1,096.01
|
| Rate for Payer: PHP Medicare Advantage |
$322.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,121.80
|
| Rate for Payer: Priority Health Medicare |
$322.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$786.42
|
| Rate for Payer: Railroad Medicare Medicare |
$322.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.69
|
| Rate for Payer: UHC Core |
$1,076.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.36
|
| Rate for Payer: UHC Medicare Advantage |
$332.03
|
| Rate for Payer: VA VA |
$322.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.06
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,187.11
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.02 |
| Max. Negotiated Rate |
$1,068.40 |
| Rate for Payer: Aetna Commercial |
$1,009.04
|
| Rate for Payer: BCBS Trust/PPO |
$917.40
|
| Rate for Payer: BCN Commercial |
$917.40
|
| Rate for Payer: Cash Price |
$949.69
|
| Rate for Payer: Cofinity Commercial |
$1,020.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,068.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.04
|
| Rate for Payer: PHP Commercial |
$1,009.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.66
|
| Rate for Payer: UHC Core |
$991.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.33
|
|
