|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,575.76
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$611.74 |
| Max. Negotiated Rate |
$2,318.18 |
| Rate for Payer: Aetna Commercial |
$2,189.40
|
| Rate for Payer: Aetna Medicare |
$669.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$804.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$804.92
|
| Rate for Payer: BCBS Complete |
$978.06
|
| Rate for Payer: BCBS MAPPO |
$643.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,002.65
|
| Rate for Payer: BCN Commercial |
$2,002.65
|
| Rate for Payer: BCN Medicare Advantage |
$643.94
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cofinity Commercial |
$2,215.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,060.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.94
|
| Rate for Payer: Healthscope Commercial |
$2,318.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,931.82
|
| Rate for Payer: Mclaren Medicaid |
$931.49
|
| Rate for Payer: Meridian Medicaid |
$978.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$676.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$740.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,189.40
|
| Rate for Payer: PACE Senior Care Partners |
$611.74
|
| Rate for Payer: PACE SWMI |
$643.94
|
| Rate for Payer: PHP Commercial |
$2,189.40
|
| Rate for Payer: PHP Medicare Advantage |
$643.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.91
|
| Rate for Payer: Priority Health Medicare |
$643.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,570.96
|
| Rate for Payer: Railroad Medicare Medicare |
$643.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,266.67
|
| Rate for Payer: UHC Core |
$2,150.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.94
|
| Rate for Payer: UHC Medicare Advantage |
$663.26
|
| Rate for Payer: VA VA |
$643.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,931.82
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,575.76
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,570.96 |
| Max. Negotiated Rate |
$2,318.18 |
| Rate for Payer: Aetna Commercial |
$2,189.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,990.55
|
| Rate for Payer: BCN Commercial |
$1,990.55
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cofinity Commercial |
$2,215.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,060.61
|
| Rate for Payer: Healthscope Commercial |
$2,318.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,931.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,189.40
|
| Rate for Payer: PHP Commercial |
$2,189.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,570.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,266.67
|
| Rate for Payer: UHC Core |
$2,150.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,931.82
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,768.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,908.00 |
| Max. Negotiated Rate |
$4,291.20 |
| Rate for Payer: Aetna Commercial |
$4,052.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,684.71
|
| Rate for Payer: BCN Commercial |
$3,684.71
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cofinity Commercial |
$4,100.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,814.40
|
| Rate for Payer: Healthscope Commercial |
$4,291.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,576.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,052.80
|
| Rate for Payer: PHP Commercial |
$4,052.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,337.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,148.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,908.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,195.84
|
| Rate for Payer: UHC Core |
$3,981.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,576.00
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$4,291.20 |
| Rate for Payer: Aetna Commercial |
$4,052.80
|
| Rate for Payer: Aetna Medicare |
$1,239.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.00
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,192.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,707.12
|
| Rate for Payer: BCN Commercial |
$3,707.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.00
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cofinity Commercial |
$4,100.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,814.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.00
|
| Rate for Payer: Healthscope Commercial |
$4,291.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,576.00
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,251.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,370.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,052.80
|
| Rate for Payer: PACE Senior Care Partners |
$1,132.40
|
| Rate for Payer: PACE SWMI |
$1,192.00
|
| Rate for Payer: PHP Commercial |
$4,052.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,337.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,148.16
|
| Rate for Payer: Priority Health Medicare |
$1,192.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,908.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,195.84
|
| Rate for Payer: UHC Core |
$3,981.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,227.76
|
| Rate for Payer: VA VA |
$1,192.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,576.00
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,243.20
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,587.93 |
| Max. Negotiated Rate |
$3,818.88 |
| Rate for Payer: Aetna Commercial |
$3,606.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,279.14
|
| Rate for Payer: BCN Commercial |
$3,279.14
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cofinity Commercial |
$3,649.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.56
|
| Rate for Payer: Healthscope Commercial |
$3,818.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.72
|
| Rate for Payer: PHP Commercial |
$3,606.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,691.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,587.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,734.02
|
| Rate for Payer: UHC Core |
$3,543.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,182.40
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,243.20
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,007.76 |
| Max. Negotiated Rate |
$3,818.88 |
| Rate for Payer: Aetna Commercial |
$3,606.72
|
| Rate for Payer: Aetna Medicare |
$1,103.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,326.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,060.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,299.09
|
| Rate for Payer: BCN Commercial |
$3,299.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,060.80
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cofinity Commercial |
$3,649.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,060.80
|
| Rate for Payer: Healthscope Commercial |
$3,818.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,182.40
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,113.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,219.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.72
|
| Rate for Payer: PACE Senior Care Partners |
$1,007.76
|
| Rate for Payer: PACE SWMI |
$1,060.80
|
| Rate for Payer: PHP Commercial |
$3,606.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,060.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,691.58
|
| Rate for Payer: Priority Health Medicare |
$1,060.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,587.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,060.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,734.02
|
| Rate for Payer: UHC Core |
$3,543.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,060.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,092.62
|
| Rate for Payer: VA VA |
$1,060.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,182.40
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,590.62
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,409.72 |
| Max. Negotiated Rate |
$5,031.56 |
| Rate for Payer: Aetna Commercial |
$4,752.03
|
| Rate for Payer: BCBS Trust/PPO |
$4,320.43
|
| Rate for Payer: BCN Commercial |
$4,320.43
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cofinity Commercial |
$4,807.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,472.50
|
| Rate for Payer: Healthscope Commercial |
$5,031.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,752.03
|
| Rate for Payer: PHP Commercial |
$4,752.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,913.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,863.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,409.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,919.75
|
| Rate for Payer: UHC Core |
$4,668.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,192.96
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,590.62
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$5,031.56 |
| Rate for Payer: Aetna Commercial |
$4,752.03
|
| Rate for Payer: Aetna Medicare |
$1,453.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,747.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,747.07
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,397.66
|
| Rate for Payer: BCBS Trust/PPO |
$4,346.71
|
| Rate for Payer: BCN Commercial |
$4,346.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,397.66
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cofinity Commercial |
$4,807.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,472.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,397.66
|
| Rate for Payer: Healthscope Commercial |
$5,031.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,192.96
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,467.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,607.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,752.03
|
| Rate for Payer: PACE Senior Care Partners |
$1,327.77
|
| Rate for Payer: PACE SWMI |
$1,397.66
|
| Rate for Payer: PHP Commercial |
$4,752.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,397.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,913.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,863.84
|
| Rate for Payer: Priority Health Medicare |
$1,397.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,409.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,397.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,919.75
|
| Rate for Payer: UHC Core |
$4,668.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,397.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,439.58
|
| Rate for Payer: VA VA |
$1,397.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,192.96
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$8,367.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,026.27 |
| Max. Negotiated Rate |
$7,530.30 |
| Rate for Payer: Aetna Commercial |
$7,111.95
|
| Rate for Payer: Aetna Commercial |
$6,151.36
|
| Rate for Payer: Aetna Medicare |
$1,881.59
|
| Rate for Payer: Aetna Medicare |
$2,175.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,614.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,261.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,614.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,261.53
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS Complete |
$1,077.58
|
| Rate for Payer: BCBS MAPPO |
$1,809.22
|
| Rate for Payer: BCBS MAPPO |
$2,091.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,626.69
|
| Rate for Payer: BCBS Trust/PPO |
$6,505.34
|
| Rate for Payer: BCN Commercial |
$5,626.69
|
| Rate for Payer: BCN Commercial |
$6,505.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,809.22
|
| Rate for Payer: BCN Medicare Advantage |
$2,091.75
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cofinity Commercial |
$6,223.73
|
| Rate for Payer: Cofinity Commercial |
$7,195.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,693.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,809.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,091.75
|
| Rate for Payer: Healthscope Commercial |
$6,513.21
|
| Rate for Payer: Healthscope Commercial |
$7,530.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,275.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,427.68
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Mclaren Medicaid |
$1,026.27
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Medicaid |
$1,077.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,196.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,899.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,080.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,405.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,111.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,151.36
|
| Rate for Payer: PACE Senior Care Partners |
$1,718.76
|
| Rate for Payer: PACE Senior Care Partners |
$1,987.16
|
| Rate for Payer: PACE SWMI |
$1,809.22
|
| Rate for Payer: PACE SWMI |
$2,091.75
|
| Rate for Payer: PHP Commercial |
$6,151.36
|
| Rate for Payer: PHP Commercial |
$7,111.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,091.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,809.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,065.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,856.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,279.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,296.10
|
| Rate for Payer: Priority Health Medicare |
$1,809.22
|
| Rate for Payer: Priority Health Medicare |
$2,091.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,413.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,103.03
|
| Rate for Payer: Railroad Medicare Medicare |
$2,091.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,809.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,362.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,368.47
|
| Rate for Payer: UHC Core |
$6,986.44
|
| Rate for Payer: UHC Core |
$6,042.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,091.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,809.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,863.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,154.50
|
| Rate for Payer: VA VA |
$1,809.22
|
| Rate for Payer: VA VA |
$2,091.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,427.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,275.25
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,413.79 |
| Max. Negotiated Rate |
$6,513.21 |
| Rate for Payer: Aetna Commercial |
$6,151.36
|
| Rate for Payer: Aetna Commercial |
$7,111.95
|
| Rate for Payer: BCBS Trust/PPO |
$5,592.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,466.02
|
| Rate for Payer: BCN Commercial |
$5,592.68
|
| Rate for Payer: BCN Commercial |
$6,466.02
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cofinity Commercial |
$7,195.62
|
| Rate for Payer: Cofinity Commercial |
$6,223.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,693.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Healthscope Commercial |
$6,513.21
|
| Rate for Payer: Healthscope Commercial |
$7,530.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,427.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,275.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,111.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,151.36
|
| Rate for Payer: PHP Commercial |
$6,151.36
|
| Rate for Payer: PHP Commercial |
$7,111.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,065.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,856.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,296.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,279.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,413.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,103.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,362.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,368.47
|
| Rate for Payer: UHC Core |
$6,042.81
|
| Rate for Payer: UHC Core |
$6,986.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,427.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,275.25
|
|
|
HC PFO
|
Facility
|
OP
|
$25,737.20
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,112.58 |
| Max. Negotiated Rate |
$23,163.48 |
| Rate for Payer: Aetna Commercial |
$21,876.62
|
| Rate for Payer: Aetna Medicare |
$6,691.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,042.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,042.88
|
| Rate for Payer: BCBS Complete |
$12,078.04
|
| Rate for Payer: BCBS MAPPO |
$6,434.30
|
| Rate for Payer: BCBS Trust/PPO |
$20,010.67
|
| Rate for Payer: BCN Commercial |
$20,010.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,434.30
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cofinity Commercial |
$22,133.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,589.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,434.30
|
| Rate for Payer: Healthscope Commercial |
$23,163.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,302.90
|
| Rate for Payer: Mclaren Medicaid |
$11,502.90
|
| Rate for Payer: Meridian Medicaid |
$12,078.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,756.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,399.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,876.62
|
| Rate for Payer: PACE Senior Care Partners |
$6,112.58
|
| Rate for Payer: PACE SWMI |
$6,434.30
|
| Rate for Payer: PHP Commercial |
$21,876.62
|
| Rate for Payer: PHP Medicare Advantage |
$6,434.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,502.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,016.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,391.36
|
| Rate for Payer: Priority Health Medicare |
$6,434.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,697.12
|
| Rate for Payer: Railroad Medicare Medicare |
$6,434.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,648.74
|
| Rate for Payer: UHC Core |
$21,490.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,434.30
|
| Rate for Payer: UHC Medicare Advantage |
$6,627.33
|
| Rate for Payer: VA VA |
$6,434.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,302.90
|
|
|
HC PFO
|
Facility
|
IP
|
$25,737.20
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,697.12 |
| Max. Negotiated Rate |
$23,163.48 |
| Rate for Payer: Aetna Commercial |
$21,876.62
|
| Rate for Payer: BCBS Trust/PPO |
$19,889.71
|
| Rate for Payer: BCN Commercial |
$19,889.71
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cofinity Commercial |
$22,133.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,589.76
|
| Rate for Payer: Healthscope Commercial |
$23,163.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,302.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,876.62
|
| Rate for Payer: PHP Commercial |
$21,876.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,016.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,391.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15,697.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,648.74
|
| Rate for Payer: UHC Core |
$21,490.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,302.90
|
|
|
HC PFO OCCLUDER
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.81 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| Rate for Payer: Aetna Medicare |
$2,923.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,514.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,514.22
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: BCBS MAPPO |
$2,811.38
|
| Rate for Payer: BCBS Trust/PPO |
$8,743.38
|
| Rate for Payer: BCN Commercial |
$8,743.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,811.38
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,811.38
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,951.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,233.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: PACE Senior Care Partners |
$2,670.81
|
| Rate for Payer: PACE SWMI |
$2,811.38
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,811.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,783.58
|
| Rate for Payer: Priority Health Medicare |
$2,811.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,858.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,811.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,896.04
|
| Rate for Payer: UHC Core |
$9,389.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,811.38
|
| Rate for Payer: UHC Medicare Advantage |
$2,895.72
|
| Rate for Payer: VA VA |
$2,811.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,858.63 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| Rate for Payer: BCBS Trust/PPO |
$8,690.52
|
| Rate for Payer: BCN Commercial |
$8,690.52
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,996.40
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,434.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,783.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,858.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,896.04
|
| Rate for Payer: UHC Core |
$9,389.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,434.12
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
IP
|
$3,802.52
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,319.16 |
| Max. Negotiated Rate |
$3,422.27 |
| Rate for Payer: Aetna Commercial |
$3,232.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,938.59
|
| Rate for Payer: BCN Commercial |
$2,938.59
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$3,270.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,042.02
|
| Rate for Payer: Healthscope Commercial |
$3,422.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,851.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: PHP Commercial |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,308.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,319.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,346.22
|
| Rate for Payer: UHC Core |
$3,175.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,851.89
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
OP
|
$3,802.52
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$903.10 |
| Max. Negotiated Rate |
$3,422.27 |
| Rate for Payer: Aetna Commercial |
$3,232.14
|
| Rate for Payer: Aetna Medicare |
$988.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,188.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,188.29
|
| Rate for Payer: BCBS Complete |
$1,521.01
|
| Rate for Payer: BCBS MAPPO |
$950.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,956.46
|
| Rate for Payer: BCN Commercial |
$2,956.46
|
| Rate for Payer: BCN Medicare Advantage |
$950.63
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$3,270.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,042.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$950.63
|
| Rate for Payer: Healthscope Commercial |
$3,422.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,851.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$998.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,093.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: PACE Senior Care Partners |
$903.10
|
| Rate for Payer: PACE SWMI |
$950.63
|
| Rate for Payer: PHP Commercial |
$3,232.14
|
| Rate for Payer: PHP Medicare Advantage |
$950.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,308.19
|
| Rate for Payer: Priority Health Medicare |
$950.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,319.16
|
| Rate for Payer: Railroad Medicare Medicare |
$950.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,346.22
|
| Rate for Payer: UHC Core |
$3,175.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$950.63
|
| Rate for Payer: UHC Medicare Advantage |
$979.15
|
| Rate for Payer: VA VA |
$950.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,851.89
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
OP
|
$271.39
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.46 |
| Max. Negotiated Rate |
$244.25 |
| Rate for Payer: Aetna Commercial |
$230.68
|
| Rate for Payer: Aetna Medicare |
$70.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.81
|
| Rate for Payer: BCBS Complete |
$126.56
|
| Rate for Payer: BCBS MAPPO |
$67.85
|
| Rate for Payer: BCBS Trust/PPO |
$211.01
|
| Rate for Payer: BCN Commercial |
$211.01
|
| Rate for Payer: BCN Medicare Advantage |
$67.85
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cofinity Commercial |
$233.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.85
|
| Rate for Payer: Healthscope Commercial |
$244.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.54
|
| Rate for Payer: Mclaren Medicaid |
$120.53
|
| Rate for Payer: Meridian Medicaid |
$126.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.68
|
| Rate for Payer: PACE Senior Care Partners |
$64.46
|
| Rate for Payer: PACE SWMI |
$67.85
|
| Rate for Payer: PHP Commercial |
$230.68
|
| Rate for Payer: PHP Medicare Advantage |
$67.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.11
|
| Rate for Payer: Priority Health Medicare |
$67.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.52
|
| Rate for Payer: Railroad Medicare Medicare |
$67.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.82
|
| Rate for Payer: UHC Core |
$226.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.85
|
| Rate for Payer: UHC Medicare Advantage |
$69.88
|
| Rate for Payer: VA VA |
$67.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.54
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
IP
|
$271.39
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.52 |
| Max. Negotiated Rate |
$244.25 |
| Rate for Payer: Aetna Commercial |
$230.68
|
| Rate for Payer: BCBS Trust/PPO |
$209.73
|
| Rate for Payer: BCN Commercial |
$209.73
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cofinity Commercial |
$233.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.11
|
| Rate for Payer: Healthscope Commercial |
$244.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.68
|
| Rate for Payer: PHP Commercial |
$230.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.82
|
| Rate for Payer: UHC Core |
$226.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.54
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.64
|
| Rate for Payer: BCN Commercial |
$38.64
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.88
|
| Rate for Payer: BCN Commercial |
$38.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PACE Senior Care Partners |
$11.88
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Medicare |
$12.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.81
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$6.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.44
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: BCN Medicare Advantage |
$6.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PACE Senior Care Partners |
$5.94
|
| Rate for Payer: PACE SWMI |
$6.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Medicare Advantage |
$6.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.75
|
| Rate for Payer: Priority Health Medicare |
$6.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.44
|
| Rate for Payer: VA VA |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC PH BLOOD
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.25
|
| Rate for Payer: BCBS Complete |
$8.52
|
| Rate for Payer: BCBS MAPPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$52.87
|
| Rate for Payer: BCN Commercial |
$52.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Mclaren Medicaid |
$8.12
|
| Rate for Payer: Meridian Medicaid |
$8.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Senior Care Partners |
$16.15
|
| Rate for Payer: PACE SWMI |
$17.00
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Medicare |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$17.51
|
| Rate for Payer: VA VA |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC PH BLOOD
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: BCBS Trust/PPO |
$52.55
|
| Rate for Payer: BCN Commercial |
$52.55
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$24.68
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.71
|
| Rate for Payer: BCBS Complete |
$2.77
|
| Rate for Payer: BCBS MAPPO |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$19.19
|
| Rate for Payer: BCN Commercial |
$19.19
|
| Rate for Payer: BCN Medicare Advantage |
$6.17
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.17
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.51
|
| Rate for Payer: Mclaren Medicaid |
$2.64
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.98
|
| Rate for Payer: PACE Senior Care Partners |
$5.86
|
| Rate for Payer: PACE SWMI |
$6.17
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: PHP Medicare Advantage |
$6.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.47
|
| Rate for Payer: Priority Health Medicare |
$6.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.05
|
| Rate for Payer: Railroad Medicare Medicare |
$6.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.72
|
| Rate for Payer: UHC Core |
$20.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.17
|
| Rate for Payer: UHC Medicare Advantage |
$6.36
|
| Rate for Payer: VA VA |
$6.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.51
|
|
