|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$303.99
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.58 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Aetna Commercial |
$258.39
|
| Rate for Payer: BCBS Trust/PPO |
$251.07
|
| Rate for Payer: BCN Commercial |
$251.07
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cofinity Commercial |
$261.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.19
|
| Rate for Payer: Healthscope Commercial |
$273.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.39
|
| Rate for Payer: Nomi Health Commercial |
$249.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.99
|
| Rate for Payer: PHP Commercial |
$258.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.51
|
| Rate for Payer: UHC Core |
$253.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.99
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$303.99
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$273.59 |
| Rate for Payer: Aetna Commercial |
$258.39
|
| Rate for Payer: Aetna Medicare |
$79.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.00
|
| Rate for Payer: BCBS Complete |
$56.27
|
| Rate for Payer: BCBS MAPPO |
$76.00
|
| Rate for Payer: BCBS Trust/PPO |
$249.91
|
| Rate for Payer: BCN Commercial |
$249.91
|
| Rate for Payer: BCN Medicare Advantage |
$76.00
|
| Rate for Payer: Cash Price |
$243.19
|
| Rate for Payer: Cofinity Commercial |
$261.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$273.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.99
|
| Rate for Payer: Mclaren Medicaid |
$53.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.80
|
| Rate for Payer: Meridian Medicaid |
$56.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.39
|
| Rate for Payer: Nomi Health Commercial |
$249.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.99
|
| Rate for Payer: PACE Senior Care Partners |
$72.20
|
| Rate for Payer: PACE SWMI |
$76.00
|
| Rate for Payer: PHP Commercial |
$258.39
|
| Rate for Payer: PHP Medicare Advantage |
$76.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$264.47
|
| Rate for Payer: Priority Health Medicare |
$76.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.58
|
| Rate for Payer: Railroad Medicare Medicare |
$76.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.51
|
| Rate for Payer: UHC Core |
$253.83
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicaid |
$53.59
|
| Rate for Payer: UHC Medicare Advantage |
$76.00
|
| Rate for Payer: UHCCP Medicaid |
$53.59
|
| Rate for Payer: VA VA |
$76.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.99
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$236.28
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$212.65 |
| Rate for Payer: Aetna Commercial |
$200.84
|
| Rate for Payer: Aetna Medicare |
$61.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.84
|
| Rate for Payer: BCBS Complete |
$43.74
|
| Rate for Payer: BCBS MAPPO |
$59.07
|
| Rate for Payer: BCBS Trust/PPO |
$194.25
|
| Rate for Payer: BCN Commercial |
$194.25
|
| Rate for Payer: BCN Medicare Advantage |
$59.07
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.07
|
| Rate for Payer: Healthscope Commercial |
$212.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.21
|
| Rate for Payer: Mclaren Medicaid |
$41.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.02
|
| Rate for Payer: Meridian Medicaid |
$43.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.84
|
| Rate for Payer: Nomi Health Commercial |
$193.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: PACE Senior Care Partners |
$56.12
|
| Rate for Payer: PACE SWMI |
$59.07
|
| Rate for Payer: PHP Commercial |
$200.84
|
| Rate for Payer: PHP Medicare Advantage |
$59.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.56
|
| Rate for Payer: Priority Health Medicare |
$59.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.45
|
| Rate for Payer: Railroad Medicare Medicare |
$59.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.93
|
| Rate for Payer: UHC Core |
$197.29
|
| Rate for Payer: UHC Exchange |
$59.07
|
| Rate for Payer: UHC Medicaid |
$41.66
|
| Rate for Payer: UHC Medicare Advantage |
$59.07
|
| Rate for Payer: UHCCP Medicaid |
$41.66
|
| Rate for Payer: VA VA |
$59.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.21
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$236.28
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$212.65 |
| Rate for Payer: Aetna Commercial |
$200.84
|
| Rate for Payer: BCBS Trust/PPO |
$195.14
|
| Rate for Payer: BCN Commercial |
$195.14
|
| Rate for Payer: Cash Price |
$189.02
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.02
|
| Rate for Payer: Healthscope Commercial |
$212.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.84
|
| Rate for Payer: Nomi Health Commercial |
$193.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.21
|
| Rate for Payer: PHP Commercial |
$200.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.93
|
| Rate for Payer: UHC Core |
$197.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.21
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$165.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$149.24 |
| Rate for Payer: Aetna Commercial |
$140.95
|
| Rate for Payer: Aetna Medicare |
$43.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.82
|
| Rate for Payer: BCBS Complete |
$30.69
|
| Rate for Payer: BCBS MAPPO |
$41.45
|
| Rate for Payer: BCBS Trust/PPO |
$136.32
|
| Rate for Payer: BCN Commercial |
$136.32
|
| Rate for Payer: BCN Medicare Advantage |
$41.45
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cofinity Commercial |
$142.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.45
|
| Rate for Payer: Healthscope Commercial |
$149.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.36
|
| Rate for Payer: Mclaren Medicaid |
$29.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.53
|
| Rate for Payer: Meridian Medicaid |
$30.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.95
|
| Rate for Payer: Nomi Health Commercial |
$135.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.36
|
| Rate for Payer: PACE Senior Care Partners |
$39.38
|
| Rate for Payer: PACE SWMI |
$41.45
|
| Rate for Payer: PHP Commercial |
$140.95
|
| Rate for Payer: PHP Medicare Advantage |
$41.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.26
|
| Rate for Payer: Priority Health Medicare |
$41.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.41
|
| Rate for Payer: Railroad Medicare Medicare |
$41.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.92
|
| Rate for Payer: UHC Core |
$138.46
|
| Rate for Payer: UHC Exchange |
$41.45
|
| Rate for Payer: UHC Medicaid |
$29.23
|
| Rate for Payer: UHC Medicare Advantage |
$41.45
|
| Rate for Payer: UHCCP Medicaid |
$29.23
|
| Rate for Payer: VA VA |
$41.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.36
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$165.82
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.41 |
| Max. Negotiated Rate |
$149.24 |
| Rate for Payer: Aetna Commercial |
$140.95
|
| Rate for Payer: BCBS Trust/PPO |
$136.95
|
| Rate for Payer: BCN Commercial |
$136.95
|
| Rate for Payer: Cash Price |
$132.66
|
| Rate for Payer: Cofinity Commercial |
$142.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$149.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.95
|
| Rate for Payer: Nomi Health Commercial |
$135.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.36
|
| Rate for Payer: PHP Commercial |
$140.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.92
|
| Rate for Payer: UHC Core |
$138.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.36
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$146.81
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$132.13 |
| Rate for Payer: Aetna Commercial |
$124.79
|
| Rate for Payer: BCBS Trust/PPO |
$121.25
|
| Rate for Payer: BCN Commercial |
$121.25
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cofinity Commercial |
$126.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.45
|
| Rate for Payer: Healthscope Commercial |
$132.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.79
|
| Rate for Payer: Nomi Health Commercial |
$120.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.11
|
| Rate for Payer: PHP Commercial |
$124.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$127.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.19
|
| Rate for Payer: UHC Core |
$122.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.11
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$146.81
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$132.13 |
| Rate for Payer: Aetna Commercial |
$124.79
|
| Rate for Payer: Aetna Medicare |
$38.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.88
|
| Rate for Payer: BCBS Complete |
$27.17
|
| Rate for Payer: BCBS MAPPO |
$36.70
|
| Rate for Payer: BCBS Trust/PPO |
$120.69
|
| Rate for Payer: BCN Commercial |
$120.69
|
| Rate for Payer: BCN Medicare Advantage |
$36.70
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cofinity Commercial |
$126.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.70
|
| Rate for Payer: Healthscope Commercial |
$132.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.11
|
| Rate for Payer: Mclaren Medicaid |
$25.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.54
|
| Rate for Payer: Meridian Medicaid |
$27.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.79
|
| Rate for Payer: Nomi Health Commercial |
$120.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.11
|
| Rate for Payer: PACE Senior Care Partners |
$34.87
|
| Rate for Payer: PACE SWMI |
$36.70
|
| Rate for Payer: PHP Commercial |
$124.79
|
| Rate for Payer: PHP Medicare Advantage |
$36.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$127.72
|
| Rate for Payer: Priority Health Medicare |
$37.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.18
|
| Rate for Payer: Railroad Medicare Medicare |
$36.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.19
|
| Rate for Payer: UHC Core |
$122.59
|
| Rate for Payer: UHC Exchange |
$36.70
|
| Rate for Payer: UHC Medicaid |
$25.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$25.88
|
| Rate for Payer: VA VA |
$36.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.11
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.54
|
| Rate for Payer: BCN Commercial |
$131.54
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC OAK IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC OAK IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$55.27
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$49.74 |
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: BCBS Trust/PPO |
$45.65
|
| Rate for Payer: BCN Commercial |
$45.65
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Commercial |
$47.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$49.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.98
|
| Rate for Payer: Nomi Health Commercial |
$45.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.45
|
| Rate for Payer: PHP Commercial |
$46.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.64
|
| Rate for Payer: UHC Core |
$46.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.45
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$55.27
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$49.74 |
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Aetna Medicare |
$14.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.27
|
| Rate for Payer: BCBS Complete |
$10.23
|
| Rate for Payer: BCBS MAPPO |
$13.82
|
| Rate for Payer: BCBS Trust/PPO |
$45.44
|
| Rate for Payer: BCN Commercial |
$45.44
|
| Rate for Payer: BCN Medicare Advantage |
$13.82
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Commercial |
$47.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$49.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.45
|
| Rate for Payer: Mclaren Medicaid |
$9.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.51
|
| Rate for Payer: Meridian Medicaid |
$10.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.98
|
| Rate for Payer: Nomi Health Commercial |
$45.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.45
|
| Rate for Payer: PACE Senior Care Partners |
$13.13
|
| Rate for Payer: PACE SWMI |
$13.82
|
| Rate for Payer: PHP Commercial |
$46.98
|
| Rate for Payer: PHP Medicare Advantage |
$13.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.08
|
| Rate for Payer: Priority Health Medicare |
$13.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.47
|
| Rate for Payer: Railroad Medicare Medicare |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.64
|
| Rate for Payer: UHC Core |
$46.15
|
| Rate for Payer: UHC Exchange |
$13.82
|
| Rate for Payer: UHC Medicaid |
$9.74
|
| Rate for Payer: UHC Medicare Advantage |
$13.82
|
| Rate for Payer: UHCCP Medicaid |
$9.74
|
| Rate for Payer: VA VA |
$13.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.45
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$32.56
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: BCBS Trust/PPO |
$26.89
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.05
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.68
|
| Rate for Payer: Nomi Health Commercial |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.42
|
| Rate for Payer: PHP Commercial |
$27.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.65
|
| Rate for Payer: UHC Core |
$27.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.42
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$32.56
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: Aetna Medicare |
$8.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.18
|
| Rate for Payer: BCBS Complete |
$6.03
|
| Rate for Payer: BCBS MAPPO |
$8.14
|
| Rate for Payer: BCBS Trust/PPO |
$26.77
|
| Rate for Payer: BCN Commercial |
$26.77
|
| Rate for Payer: BCN Medicare Advantage |
$8.14
|
| Rate for Payer: Cash Price |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.14
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.42
|
| Rate for Payer: Mclaren Medicaid |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.55
|
| Rate for Payer: Meridian Medicaid |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.68
|
| Rate for Payer: Nomi Health Commercial |
$26.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.42
|
| Rate for Payer: PACE Senior Care Partners |
$7.73
|
| Rate for Payer: PACE SWMI |
$8.14
|
| Rate for Payer: PHP Commercial |
$27.68
|
| Rate for Payer: PHP Medicare Advantage |
$8.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.33
|
| Rate for Payer: Priority Health Medicare |
$8.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.66
|
| Rate for Payer: Railroad Medicare Medicare |
$8.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.65
|
| Rate for Payer: UHC Core |
$27.19
|
| Rate for Payer: UHC Exchange |
$8.14
|
| Rate for Payer: UHC Medicaid |
$5.74
|
| Rate for Payer: UHC Medicare Advantage |
$8.14
|
| Rate for Payer: UHCCP Medicaid |
$5.74
|
| Rate for Payer: VA VA |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.42
|
|
|
HC OAT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC OAT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,707.30
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$3,336.57 |
| Rate for Payer: Aetna Commercial |
$3,151.20
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,061.86
|
| Rate for Payer: BCN Commercial |
$3,061.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$2,965.84
|
| Rate for Payer: Cash Price |
$2,965.84
|
| Rate for Payer: Cofinity Commercial |
$3,188.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,965.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$3,336.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,780.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,151.20
|
| Rate for Payer: Nomi Health Commercial |
$3,039.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,780.47
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$3,151.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,225.35
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,580.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,262.42
|
| Rate for Payer: UHC Core |
$3,095.60
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,780.47
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,846.93
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,285.46 |
| Max. Negotiated Rate |
$2,393.75 |
| Rate for Payer: Aetna Commercial |
$1,569.89
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.38
|
| Rate for Payer: BCN Commercial |
$1,525.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cofinity Commercial |
$1,588.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$1,662.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.89
|
| Rate for Payer: Nomi Health Commercial |
$1,514.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.20
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$1,569.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,606.83
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,285.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,625.30
|
| Rate for Payer: UHC Core |
$1,542.19
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.20
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$4,063.66
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$3,657.29 |
| Rate for Payer: Aetna Commercial |
$3,454.11
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,356.18
|
| Rate for Payer: BCN Commercial |
$3,356.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$3,250.93
|
| Rate for Payer: Cash Price |
$3,250.93
|
| Rate for Payer: Cofinity Commercial |
$3,494.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,250.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$3,657.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,047.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,454.11
|
| Rate for Payer: Nomi Health Commercial |
$3,332.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,047.74
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$3,454.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,535.38
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,828.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,576.02
|
| Rate for Payer: UHC Core |
$3,393.16
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,047.74
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC OB MED OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.54
|
| Rate for Payer: BCN Commercial |
$131.54
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
