|
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 |
$3,873.03
|
| 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 |
$3,873.03
|
| 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 |
$3,873.03
|
| 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 |
$3,873.03
|
| 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 |
$3,873.03
|
| Rate for Payer: Nomi Health Commercial |
$3,736.33
|
| Rate for Payer: PHP Commercial |
$3,873.03
|
| 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
|
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 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 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 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 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
|
OP
|
$183.60
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.38
|
| Rate for Payer: BCBS Complete |
$14.06
|
| Rate for Payer: BCBS MAPPO |
$45.90
|
| Rate for Payer: BCBS Trust/PPO |
$150.94
|
| Rate for Payer: BCN Commercial |
$142.75
|
| Rate for Payer: BCN Medicare Advantage |
$45.90
|
| Rate for Payer: Cash Price |
$146.88
|
| 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: Health Alliance Plan Medicare Advantage |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.70
|
| Rate for Payer: Mclaren Medicaid |
$13.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.20
|
| Rate for Payer: Meridian Medicaid |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| Rate for Payer: PACE Senior Care Partners |
$43.60
|
| Rate for Payer: PACE SWMI |
$45.90
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: PHP Medicare Advantage |
$45.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health HMO/PPO |
$159.73
|
| Rate for Payer: Priority Health Medicare |
$46.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.01
|
| Rate for Payer: Railroad Medicare Medicare |
$45.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.57
|
| Rate for Payer: UHC Core |
$153.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.90
|
| Rate for Payer: UHC Exchange |
$45.90
|
| Rate for Payer: UHC Medicare Advantage |
$45.90
|
| Rate for Payer: UHCCP Medicaid |
$13.39
|
| Rate for Payer: VA VA |
$45.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.70
|
|
|
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
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$79.07
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$71.16 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: BCBS Trust/PPO |
$64.54
|
| Rate for Payer: BCN Commercial |
$61.11
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$68.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.26
|
| Rate for Payer: Healthscope Commercial |
$71.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.21
|
| Rate for Payer: Nomi Health Commercial |
$64.84
|
| Rate for Payer: PHP Commercial |
$67.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.40
|
| Rate for Payer: Priority Health HMO/PPO |
$68.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.58
|
| Rate for Payer: UHC Core |
$66.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.30
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$79.07
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$71.16 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Aetna Medicare |
$20.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.71
|
| Rate for Payer: BCBS Complete |
$14.06
|
| Rate for Payer: BCBS MAPPO |
$19.77
|
| Rate for Payer: BCBS Trust/PPO |
$65.00
|
| Rate for Payer: BCN Commercial |
$61.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.77
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$68.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.77
|
| Rate for Payer: Healthscope Commercial |
$71.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.30
|
| Rate for Payer: Mclaren Medicaid |
$13.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.76
|
| Rate for Payer: Meridian Medicaid |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.21
|
| Rate for Payer: Nomi Health Commercial |
$64.84
|
| Rate for Payer: PACE Senior Care Partners |
$18.78
|
| Rate for Payer: PACE SWMI |
$19.77
|
| Rate for Payer: PHP Commercial |
$67.21
|
| Rate for Payer: PHP Medicare Advantage |
$19.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.40
|
| Rate for Payer: Priority Health HMO/PPO |
$68.79
|
| Rate for Payer: Priority Health Medicare |
$19.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.58
|
| Rate for Payer: UHC Core |
$66.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.77
|
| Rate for Payer: UHC Exchange |
$19.77
|
| Rate for Payer: UHC Medicare Advantage |
$19.77
|
| Rate for Payer: UHCCP Medicaid |
$13.39
|
| Rate for Payer: VA VA |
$19.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.30
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$16.57
|
| Rate for Payer: BCBS Trust/PPO |
$54.51
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.57
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.57
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: PHP Medicare Advantage |
$16.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.57
|
| Rate for Payer: UHC Exchange |
$16.57
|
| Rate for Payer: UHC Medicare Advantage |
$16.57
|
| Rate for Payer: UHCCP Medicaid |
$10.62
|
| Rate for Payer: VA VA |
$16.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: BCBS Trust/PPO |
$54.12
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
IP
|
$375.77
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$244.25 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$319.40
|
| Rate for Payer: BCBS Trust/PPO |
$306.74
|
| Rate for Payer: BCN Commercial |
$290.40
|
| Rate for Payer: Cash Price |
$300.62
|
| Rate for Payer: Cofinity Commercial |
$323.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.62
|
| Rate for Payer: Healthscope Commercial |
$338.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.40
|
| Rate for Payer: Nomi Health Commercial |
$308.13
|
| Rate for Payer: PHP Commercial |
$319.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.25
|
| Rate for Payer: Priority Health HMO/PPO |
$326.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.68
|
| Rate for Payer: UHC Core |
$313.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.83
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
OP
|
$375.77
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$319.40
|
| Rate for Payer: Aetna Medicare |
$97.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.43
|
| Rate for Payer: BCBS Complete |
$150.31
|
| Rate for Payer: BCBS MAPPO |
$93.94
|
| Rate for Payer: BCBS Trust/PPO |
$308.92
|
| Rate for Payer: BCN Commercial |
$292.16
|
| Rate for Payer: BCN Medicare Advantage |
$93.94
|
| Rate for Payer: Cash Price |
$300.62
|
| Rate for Payer: Cofinity Commercial |
$323.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.94
|
| Rate for Payer: Healthscope Commercial |
$338.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.40
|
| Rate for Payer: Nomi Health Commercial |
$308.13
|
| Rate for Payer: PACE Senior Care Partners |
$89.25
|
| Rate for Payer: PACE SWMI |
$93.94
|
| Rate for Payer: PHP Commercial |
$319.40
|
| Rate for Payer: PHP Medicare Advantage |
$93.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.25
|
| Rate for Payer: Priority Health HMO/PPO |
$326.92
|
| Rate for Payer: Priority Health Medicare |
$94.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.77
|
| Rate for Payer: Railroad Medicare Medicare |
$93.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.68
|
| Rate for Payer: UHC Core |
$313.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.94
|
| Rate for Payer: UHC Exchange |
$93.94
|
| Rate for Payer: UHC Medicare Advantage |
$93.94
|
| Rate for Payer: VA VA |
$93.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.83
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
IP
|
$126.23
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$113.61 |
| Rate for Payer: Aetna Commercial |
$107.30
|
| Rate for Payer: BCBS Trust/PPO |
$103.04
|
| Rate for Payer: BCN Commercial |
$97.55
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cofinity Commercial |
$108.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.98
|
| Rate for Payer: Healthscope Commercial |
$113.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.30
|
| Rate for Payer: Nomi Health Commercial |
$103.51
|
| Rate for Payer: PHP Commercial |
$107.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.05
|
| Rate for Payer: Priority Health HMO/PPO |
$109.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.08
|
| Rate for Payer: UHC Core |
$105.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.67
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
OP
|
$126.23
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$113.61 |
| Rate for Payer: Aetna Commercial |
$107.30
|
| Rate for Payer: Aetna Medicare |
$32.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.45
|
| Rate for Payer: BCBS Complete |
$50.49
|
| Rate for Payer: BCBS MAPPO |
$31.56
|
| Rate for Payer: BCBS Trust/PPO |
$103.77
|
| Rate for Payer: BCN Commercial |
$98.14
|
| Rate for Payer: BCN Medicare Advantage |
$31.56
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cofinity Commercial |
$108.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.56
|
| Rate for Payer: Healthscope Commercial |
$113.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.30
|
| Rate for Payer: Nomi Health Commercial |
$103.51
|
| Rate for Payer: PACE Senior Care Partners |
$29.98
|
| Rate for Payer: PACE SWMI |
$31.56
|
| Rate for Payer: PHP Commercial |
$107.30
|
| Rate for Payer: PHP Medicare Advantage |
$31.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.05
|
| Rate for Payer: Priority Health HMO/PPO |
$109.82
|
| Rate for Payer: Priority Health Medicare |
$31.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.57
|
| Rate for Payer: Railroad Medicare Medicare |
$31.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.08
|
| Rate for Payer: UHC Core |
$105.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.56
|
| Rate for Payer: UHC Exchange |
$31.56
|
| Rate for Payer: UHC Medicare Advantage |
$31.56
|
| Rate for Payer: VA VA |
$31.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.67
|
|
