|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
OP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$98.08 |
| Max. Negotiated Rate |
$371.67 |
| Rate for Payer: Aetna Commercial |
$351.02
|
| Rate for Payer: Aetna Medicare |
$107.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.05
|
| Rate for Payer: BCBS Complete |
$165.19
|
| Rate for Payer: BCBS MAPPO |
$103.24
|
| Rate for Payer: BCBS Trust/PPO |
$339.50
|
| Rate for Payer: BCN Commercial |
$321.08
|
| Rate for Payer: BCN Medicare Advantage |
$103.24
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.24
|
| Rate for Payer: Healthscope Commercial |
$371.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Nomi Health Commercial |
$338.64
|
| Rate for Payer: PACE Senior Care Partners |
$98.08
|
| Rate for Payer: PACE SWMI |
$103.24
|
| Rate for Payer: PHP Commercial |
$351.02
|
| Rate for Payer: PHP Medicare Advantage |
$103.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.43
|
| Rate for Payer: Priority Health HMO/PPO |
$359.28
|
| Rate for Payer: Priority Health Medicare |
$104.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.69
|
| Rate for Payer: Railroad Medicare Medicare |
$103.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.41
|
| Rate for Payer: UHC Core |
$344.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.24
|
| Rate for Payer: UHC Exchange |
$103.24
|
| Rate for Payer: UHC Medicare Advantage |
$103.24
|
| Rate for Payer: VA VA |
$103.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.73
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
IP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.43 |
| Max. Negotiated Rate |
$371.67 |
| Rate for Payer: Aetna Commercial |
$351.02
|
| Rate for Payer: BCBS Trust/PPO |
$337.11
|
| Rate for Payer: BCN Commercial |
$319.14
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Commercial |
$355.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$371.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Nomi Health Commercial |
$338.64
|
| Rate for Payer: PHP Commercial |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.43
|
| Rate for Payer: Priority Health HMO/PPO |
$359.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.41
|
| Rate for Payer: UHC Core |
$344.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.73
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
IP
|
$3,226.85
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,097.45 |
| Max. Negotiated Rate |
$2,904.16 |
| Rate for Payer: Aetna Commercial |
$2,742.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,634.08
|
| Rate for Payer: BCN Commercial |
$2,493.71
|
| Rate for Payer: Cash Price |
$2,581.48
|
| Rate for Payer: Cofinity Commercial |
$2,775.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,581.48
|
| Rate for Payer: Healthscope Commercial |
$2,904.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,420.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,742.82
|
| Rate for Payer: Nomi Health Commercial |
$2,646.02
|
| Rate for Payer: PHP Commercial |
$2,742.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,097.45
|
| Rate for Payer: Priority Health HMO/PPO |
$2,807.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,161.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,839.63
|
| Rate for Payer: UHC Core |
$2,694.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,420.14
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
OP
|
$3,226.85
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$766.38 |
| Max. Negotiated Rate |
$2,904.16 |
| Rate for Payer: Aetna Commercial |
$2,742.82
|
| Rate for Payer: Aetna Medicare |
$838.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.39
|
| Rate for Payer: BCBS Complete |
$1,290.74
|
| Rate for Payer: BCBS MAPPO |
$806.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,652.79
|
| Rate for Payer: BCN Commercial |
$2,508.88
|
| Rate for Payer: BCN Medicare Advantage |
$806.71
|
| Rate for Payer: Cash Price |
$2,581.48
|
| Rate for Payer: Cofinity Commercial |
$2,775.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,581.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.71
|
| Rate for Payer: Healthscope Commercial |
$2,904.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,420.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$847.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,742.82
|
| Rate for Payer: Nomi Health Commercial |
$2,646.02
|
| Rate for Payer: PACE Senior Care Partners |
$766.38
|
| Rate for Payer: PACE SWMI |
$806.71
|
| Rate for Payer: PHP Commercial |
$2,742.82
|
| Rate for Payer: PHP Medicare Advantage |
$806.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,097.45
|
| Rate for Payer: Priority Health HMO/PPO |
$2,807.36
|
| Rate for Payer: Priority Health Medicare |
$814.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,161.99
|
| Rate for Payer: Railroad Medicare Medicare |
$806.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,839.63
|
| Rate for Payer: UHC Core |
$2,694.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.71
|
| Rate for Payer: UHC Exchange |
$806.71
|
| Rate for Payer: UHC Medicare Advantage |
$806.71
|
| Rate for Payer: VA VA |
$806.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,420.14
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.01 |
| Max. Negotiated Rate |
$1,114.15 |
| Rate for Payer: Aetna Commercial |
$1,052.25
|
| Rate for Payer: Aetna Medicare |
$321.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$386.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$386.86
|
| Rate for Payer: BCBS Complete |
$495.18
|
| Rate for Payer: BCBS MAPPO |
$309.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,017.71
|
| Rate for Payer: BCN Commercial |
$962.50
|
| Rate for Payer: BCN Medicare Advantage |
$309.48
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Commercial |
$1,064.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.48
|
| Rate for Payer: Healthscope Commercial |
$1,114.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Nomi Health Commercial |
$1,015.11
|
| Rate for Payer: PACE Senior Care Partners |
$294.01
|
| Rate for Payer: PACE SWMI |
$309.48
|
| Rate for Payer: PHP Commercial |
$1,052.25
|
| Rate for Payer: PHP Medicare Advantage |
$309.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.66
|
| Rate for Payer: Priority Health HMO/PPO |
$1,077.01
|
| Rate for Payer: Priority Health Medicare |
$312.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$829.42
|
| Rate for Payer: Railroad Medicare Medicare |
$309.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.39
|
| Rate for Payer: UHC Core |
$1,033.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.48
|
| Rate for Payer: UHC Exchange |
$309.48
|
| Rate for Payer: UHC Medicare Advantage |
$309.48
|
| Rate for Payer: VA VA |
$309.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.46
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$804.66 |
| Max. Negotiated Rate |
$1,114.15 |
| Rate for Payer: Aetna Commercial |
$1,052.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.53
|
| Rate for Payer: BCN Commercial |
$956.68
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Commercial |
$1,064.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Healthscope Commercial |
$1,114.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Nomi Health Commercial |
$1,015.11
|
| Rate for Payer: PHP Commercial |
$1,052.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.66
|
| Rate for Payer: Priority Health HMO/PPO |
$1,077.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$829.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.39
|
| Rate for Payer: UHC Core |
$1,033.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.46
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
OP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$908.99 |
| Max. Negotiated Rate |
$3,444.60 |
| Rate for Payer: Aetna Commercial |
$3,253.23
|
| Rate for Payer: Aetna Medicare |
$995.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,196.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,196.04
|
| Rate for Payer: BCBS Complete |
$1,530.93
|
| Rate for Payer: BCBS MAPPO |
$956.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,146.45
|
| Rate for Payer: BCN Commercial |
$2,975.75
|
| Rate for Payer: BCN Medicare Advantage |
$956.83
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Commercial |
$3,291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.83
|
| Rate for Payer: Healthscope Commercial |
$3,444.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,870.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,100.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Nomi Health Commercial |
$3,138.41
|
| Rate for Payer: PACE Senior Care Partners |
$908.99
|
| Rate for Payer: PACE SWMI |
$956.83
|
| Rate for Payer: PHP Commercial |
$3,253.23
|
| Rate for Payer: PHP Medicare Advantage |
$956.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3,329.78
|
| Rate for Payer: Priority Health Medicare |
$966.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,564.31
|
| Rate for Payer: Railroad Medicare Medicare |
$956.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,368.05
|
| Rate for Payer: UHC Core |
$3,195.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.83
|
| Rate for Payer: UHC Exchange |
$956.83
|
| Rate for Payer: UHC Medicare Advantage |
$956.83
|
| Rate for Payer: VA VA |
$956.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,870.50
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
IP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,487.76 |
| Max. Negotiated Rate |
$3,444.60 |
| Rate for Payer: Aetna Commercial |
$3,253.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,124.25
|
| Rate for Payer: BCN Commercial |
$2,957.76
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Commercial |
$3,291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Healthscope Commercial |
$3,444.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,870.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Nomi Health Commercial |
$3,138.41
|
| Rate for Payer: PHP Commercial |
$3,253.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.76
|
| Rate for Payer: Priority Health HMO/PPO |
$3,329.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,564.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,368.05
|
| Rate for Payer: UHC Core |
$3,195.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,870.50
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$967.13 |
| Max. Negotiated Rate |
$1,339.10 |
| Rate for Payer: Aetna Commercial |
$1,264.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,214.56
|
| Rate for Payer: BCN Commercial |
$1,149.84
|
| Rate for Payer: Cash Price |
$1,190.31
|
| Rate for Payer: Cofinity Commercial |
$1,279.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.31
|
| Rate for Payer: Healthscope Commercial |
$1,339.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Nomi Health Commercial |
$1,220.07
|
| Rate for Payer: PHP Commercial |
$1,264.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,294.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$996.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.34
|
| Rate for Payer: UHC Core |
$1,242.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.92
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$353.37 |
| Max. Negotiated Rate |
$1,339.10 |
| Rate for Payer: Aetna Commercial |
$1,264.71
|
| Rate for Payer: Aetna Medicare |
$386.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.97
|
| Rate for Payer: BCBS Complete |
$595.16
|
| Rate for Payer: BCBS MAPPO |
$371.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,223.19
|
| Rate for Payer: BCN Commercial |
$1,156.83
|
| Rate for Payer: BCN Medicare Advantage |
$371.97
|
| Rate for Payer: Cash Price |
$1,190.31
|
| Rate for Payer: Cofinity Commercial |
$1,279.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.97
|
| Rate for Payer: Healthscope Commercial |
$1,339.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Nomi Health Commercial |
$1,220.07
|
| Rate for Payer: PACE Senior Care Partners |
$353.37
|
| Rate for Payer: PACE SWMI |
$371.97
|
| Rate for Payer: PHP Commercial |
$1,264.71
|
| Rate for Payer: PHP Medicare Advantage |
$371.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,294.46
|
| Rate for Payer: Priority Health Medicare |
$375.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$996.89
|
| Rate for Payer: Railroad Medicare Medicare |
$371.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.34
|
| Rate for Payer: UHC Core |
$1,242.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.97
|
| Rate for Payer: UHC Exchange |
$371.97
|
| Rate for Payer: UHC Medicare Advantage |
$371.97
|
| Rate for Payer: VA VA |
$371.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.92
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
OP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,082.17 |
| Max. Negotiated Rate |
$4,100.85 |
| Rate for Payer: Aetna Commercial |
$3,873.02
|
| Rate for Payer: Aetna Medicare |
$1,184.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,423.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,423.91
|
| Rate for Payer: BCBS Complete |
$1,822.60
|
| Rate for Payer: BCBS MAPPO |
$1,139.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,745.90
|
| Rate for Payer: BCN Commercial |
$3,542.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,139.12
|
| Rate for Payer: Cash Price |
$3,645.20
|
| Rate for Payer: Cofinity Commercial |
$3,918.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,139.12
|
| Rate for Payer: Healthscope Commercial |
$4,100.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,196.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,309.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,873.02
|
| Rate for Payer: Nomi Health Commercial |
$3,736.33
|
| Rate for Payer: PACE Senior Care Partners |
$1,082.17
|
| Rate for Payer: PACE SWMI |
$1,139.12
|
| Rate for Payer: PHP Commercial |
$3,873.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,139.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,964.16
|
| Rate for Payer: Priority Health Medicare |
$1,150.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,052.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,139.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,009.72
|
| Rate for Payer: UHC Core |
$3,804.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,139.12
|
| Rate for Payer: UHC Exchange |
$1,139.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,139.12
|
| Rate for Payer: VA VA |
$1,139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.38
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
IP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,961.72 |
| Max. Negotiated Rate |
$4,100.85 |
| Rate for Payer: Aetna Commercial |
$3,873.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,719.47
|
| Rate for Payer: BCN Commercial |
$3,521.26
|
| Rate for Payer: Cash Price |
$3,645.20
|
| Rate for Payer: Cofinity Commercial |
$3,918.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.20
|
| Rate for Payer: Healthscope Commercial |
$4,100.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,873.02
|
| Rate for Payer: Nomi Health Commercial |
$3,736.33
|
| Rate for Payer: PHP Commercial |
$3,873.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,964.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,052.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,009.72
|
| Rate for Payer: UHC Core |
$3,804.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.38
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,077.75 |
| Max. Negotiated Rate |
$1,492.26 |
| Rate for Payer: Aetna Commercial |
$1,409.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.48
|
| Rate for Payer: BCN Commercial |
$1,281.36
|
| Rate for Payer: Cash Price |
$1,326.46
|
| Rate for Payer: Cofinity Commercial |
$1,425.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.46
|
| Rate for Payer: Healthscope Commercial |
$1,492.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.36
|
| Rate for Payer: Nomi Health Commercial |
$1,359.62
|
| Rate for Payer: PHP Commercial |
$1,409.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,442.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,459.10
|
| Rate for Payer: UHC Core |
$1,384.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.55
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$393.79 |
| Max. Negotiated Rate |
$1,492.26 |
| Rate for Payer: Aetna Commercial |
$1,409.36
|
| Rate for Payer: Aetna Medicare |
$431.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$518.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$518.15
|
| Rate for Payer: BCBS Complete |
$663.23
|
| Rate for Payer: BCBS MAPPO |
$414.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.10
|
| Rate for Payer: BCN Commercial |
$1,289.15
|
| Rate for Payer: BCN Medicare Advantage |
$414.52
|
| Rate for Payer: Cash Price |
$1,326.46
|
| Rate for Payer: Cofinity Commercial |
$1,425.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.52
|
| Rate for Payer: Healthscope Commercial |
$1,492.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.36
|
| Rate for Payer: Nomi Health Commercial |
$1,359.62
|
| Rate for Payer: PACE Senior Care Partners |
$393.79
|
| Rate for Payer: PACE SWMI |
$414.52
|
| Rate for Payer: PHP Commercial |
$1,409.36
|
| Rate for Payer: PHP Medicare Advantage |
$414.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,442.52
|
| Rate for Payer: Priority Health Medicare |
$418.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.91
|
| Rate for Payer: Railroad Medicare Medicare |
$414.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,459.10
|
| Rate for Payer: UHC Core |
$1,384.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.52
|
| Rate for Payer: UHC Exchange |
$414.52
|
| Rate for Payer: UHC Medicare Advantage |
$414.52
|
| Rate for Payer: VA VA |
$414.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.55
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
OP
|
$5,084.43
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,207.55 |
| Max. Negotiated Rate |
$4,575.99 |
| Rate for Payer: Aetna Commercial |
$4,321.77
|
| Rate for Payer: Aetna Medicare |
$1,321.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,588.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,588.88
|
| Rate for Payer: BCBS Complete |
$2,033.77
|
| Rate for Payer: BCBS MAPPO |
$1,271.11
|
| Rate for Payer: BCBS Trust/PPO |
$4,179.91
|
| Rate for Payer: BCN Commercial |
$3,953.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,271.11
|
| Rate for Payer: Cash Price |
$4,067.54
|
| Rate for Payer: Cofinity Commercial |
$4,372.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,067.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,271.11
|
| Rate for Payer: Healthscope Commercial |
$4,575.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,813.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,334.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,461.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,321.77
|
| Rate for Payer: Nomi Health Commercial |
$4,169.23
|
| Rate for Payer: PACE Senior Care Partners |
$1,207.55
|
| Rate for Payer: PACE SWMI |
$1,271.11
|
| Rate for Payer: PHP Commercial |
$4,321.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,271.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,304.88
|
| Rate for Payer: Priority Health HMO/PPO |
$4,423.45
|
| Rate for Payer: Priority Health Medicare |
$1,283.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,406.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,271.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,474.30
|
| Rate for Payer: UHC Core |
$4,245.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,271.11
|
| Rate for Payer: UHC Exchange |
$1,271.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,271.11
|
| Rate for Payer: VA VA |
$1,271.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,813.32
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
IP
|
$5,084.43
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,304.88 |
| Max. Negotiated Rate |
$4,575.99 |
| Rate for Payer: Aetna Commercial |
$4,321.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,150.42
|
| Rate for Payer: BCN Commercial |
$3,929.25
|
| Rate for Payer: Cash Price |
$4,067.54
|
| Rate for Payer: Cofinity Commercial |
$4,372.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,067.54
|
| Rate for Payer: Healthscope Commercial |
$4,575.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,813.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,321.77
|
| Rate for Payer: Nomi Health Commercial |
$4,169.23
|
| Rate for Payer: PHP Commercial |
$4,321.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,304.88
|
| Rate for Payer: Priority Health HMO/PPO |
$4,423.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,406.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,474.30
|
| Rate for Payer: UHC Core |
$4,245.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,813.32
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
OP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$493.65 |
| Max. Negotiated Rate |
$1,870.67 |
| Rate for Payer: Aetna Commercial |
$1,766.74
|
| Rate for Payer: Aetna Medicare |
$540.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.54
|
| Rate for Payer: BCBS Complete |
$831.41
|
| Rate for Payer: BCBS MAPPO |
$519.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.75
|
| Rate for Payer: BCN Commercial |
$1,616.05
|
| Rate for Payer: BCN Medicare Advantage |
$519.63
|
| Rate for Payer: Cash Price |
$1,662.82
|
| Rate for Payer: Cofinity Commercial |
$1,787.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,662.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.63
|
| Rate for Payer: Healthscope Commercial |
$1,870.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,558.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,766.74
|
| Rate for Payer: Nomi Health Commercial |
$1,704.39
|
| Rate for Payer: PACE Senior Care Partners |
$493.65
|
| Rate for Payer: PACE SWMI |
$519.63
|
| Rate for Payer: PHP Commercial |
$1,766.74
|
| Rate for Payer: PHP Medicare Advantage |
$519.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,808.31
|
| Rate for Payer: Priority Health Medicare |
$524.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,392.61
|
| Rate for Payer: Railroad Medicare Medicare |
$519.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,829.10
|
| Rate for Payer: UHC Core |
$1,735.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.63
|
| Rate for Payer: UHC Exchange |
$519.63
|
| Rate for Payer: UHC Medicare Advantage |
$519.63
|
| Rate for Payer: VA VA |
$519.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,558.89
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
IP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,351.04 |
| Max. Negotiated Rate |
$1,870.67 |
| Rate for Payer: Aetna Commercial |
$1,766.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.70
|
| Rate for Payer: BCN Commercial |
$1,606.28
|
| Rate for Payer: Cash Price |
$1,662.82
|
| Rate for Payer: Cofinity Commercial |
$1,787.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,662.82
|
| Rate for Payer: Healthscope Commercial |
$1,870.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,558.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,766.74
|
| Rate for Payer: Nomi Health Commercial |
$1,704.39
|
| Rate for Payer: PHP Commercial |
$1,766.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,808.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,392.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,829.10
|
| Rate for Payer: UHC Core |
$1,735.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,558.89
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.91 |
| Max. Negotiated Rate |
$69.11 |
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: BCBS Trust/PPO |
$62.68
|
| Rate for Payer: BCN Commercial |
$59.34
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Healthscope Commercial |
$69.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: Nomi Health Commercial |
$62.97
|
| Rate for Payer: PHP Commercial |
$65.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: Priority Health HMO/PPO |
$66.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.58
|
| Rate for Payer: UHC Core |
$64.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.59
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$69.11 |
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Medicare |
$19.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.00
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS MAPPO |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$63.13
|
| Rate for Payer: BCN Commercial |
$59.70
|
| Rate for Payer: BCN Medicare Advantage |
$19.20
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$69.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.59
|
| Rate for Payer: Mclaren Medicaid |
$9.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.16
|
| Rate for Payer: Meridian Medicaid |
$10.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: Nomi Health Commercial |
$62.97
|
| Rate for Payer: PACE Senior Care Partners |
$18.24
|
| Rate for Payer: PACE SWMI |
$19.20
|
| Rate for Payer: PHP Commercial |
$65.27
|
| Rate for Payer: PHP Medicare Advantage |
$19.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: Priority Health HMO/PPO |
$66.81
|
| Rate for Payer: Priority Health Medicare |
$19.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.45
|
| Rate for Payer: Railroad Medicare Medicare |
$19.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.58
|
| Rate for Payer: UHC Core |
$64.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.20
|
| Rate for Payer: UHC Exchange |
$19.20
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: UHCCP Medicaid |
$9.58
|
| Rate for Payer: VA VA |
$19.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.59
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,500.37 |
| Max. Negotiated Rate |
$3,462.05 |
| Rate for Payer: Aetna Commercial |
$3,269.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,140.08
|
| Rate for Payer: BCN Commercial |
$2,972.75
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$3,308.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Healthscope Commercial |
$3,462.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,885.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: Nomi Health Commercial |
$3,154.31
|
| Rate for Payer: PHP Commercial |
$3,269.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3,346.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,577.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,385.11
|
| Rate for Payer: UHC Core |
$3,212.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,885.04
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$913.60 |
| Max. Negotiated Rate |
$3,462.05 |
| Rate for Payer: Aetna Commercial |
$3,269.71
|
| Rate for Payer: Aetna Medicare |
$1,000.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,202.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,202.10
|
| Rate for Payer: BCBS Complete |
$1,538.69
|
| Rate for Payer: BCBS MAPPO |
$961.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,162.39
|
| Rate for Payer: BCN Commercial |
$2,990.82
|
| Rate for Payer: BCN Medicare Advantage |
$961.68
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$3,308.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$961.68
|
| Rate for Payer: Healthscope Commercial |
$3,462.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,885.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,009.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,105.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: Nomi Health Commercial |
$3,154.31
|
| Rate for Payer: PACE Senior Care Partners |
$913.60
|
| Rate for Payer: PACE SWMI |
$961.68
|
| Rate for Payer: PHP Commercial |
$3,269.71
|
| Rate for Payer: PHP Medicare Advantage |
$961.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3,346.65
|
| Rate for Payer: Priority Health Medicare |
$971.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,577.30
|
| Rate for Payer: Railroad Medicare Medicare |
$961.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,385.11
|
| Rate for Payer: UHC Core |
$3,212.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$961.68
|
| Rate for Payer: UHC Exchange |
$961.68
|
| Rate for Payer: UHC Medicare Advantage |
$961.68
|
| Rate for Payer: VA VA |
$961.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,885.04
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$14.06
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$13.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$13.39
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC LH PEDS, S
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: BCBS Trust/PPO |
$149.87
|
| Rate for Payer: BCN Commercial |
$141.89
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health HMO/PPO |
$159.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.57
|
| Rate for Payer: UHC Core |
$153.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
