|
HC OPIOID DRUG PANEL URN.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$28.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.77
|
| Rate for Payer: BCBS Complete |
$20.59
|
| Rate for Payer: BCBS MAPPO |
$27.81
|
| Rate for Payer: BCBS Trust/PPO |
$91.46
|
| Rate for Payer: BCN Commercial |
$91.46
|
| Rate for Payer: BCN Medicare Advantage |
$27.81
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.81
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Mclaren Medicaid |
$19.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.20
|
| Rate for Payer: Meridian Medicaid |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Senior Care Partners |
$26.42
|
| Rate for Payer: PACE SWMI |
$27.81
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$27.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.79
|
| Rate for Payer: Priority Health Medicare |
$28.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.43
|
| Rate for Payer: Railroad Medicare Medicare |
$27.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.90
|
| Rate for Payer: UHC Core |
$92.89
|
| Rate for Payer: UHC Exchange |
$27.81
|
| Rate for Payer: UHC Medicaid |
$19.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.81
|
| Rate for Payer: UHCCP Medicaid |
$19.61
|
| Rate for Payer: VA VA |
$27.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: BCBS Trust/PPO |
$79.63
|
| Rate for Payer: BCN Commercial |
$79.63
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.85
|
| Rate for Payer: UHC Core |
$80.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.31
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: Aetna Medicare |
$25.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.13
|
| Rate for Payer: BCBS Complete |
$17.85
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$79.27
|
| Rate for Payer: BCN Commercial |
$79.27
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.31
|
| Rate for Payer: Mclaren Medicaid |
$17.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.31
|
| Rate for Payer: Meridian Medicaid |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PACE Senior Care Partners |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.89
|
| Rate for Payer: Priority Health Medicare |
$24.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.11
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.85
|
| Rate for Payer: UHC Core |
$80.51
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicaid |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$17.00
|
| Rate for Payer: VA VA |
$24.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.31
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.64 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Aetna Commercial |
$1,777.35
|
| Rate for Payer: Aetna Medicare |
$543.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$653.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$653.44
|
| Rate for Payer: BCBS Complete |
$387.04
|
| Rate for Payer: BCBS MAPPO |
$522.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.01
|
| Rate for Payer: BCN Commercial |
$1,719.01
|
| Rate for Payer: BCN Medicare Advantage |
$522.75
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,798.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.75
|
| Rate for Payer: Healthscope Commercial |
$1,881.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.25
|
| Rate for Payer: Mclaren Medicaid |
$368.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.89
|
| Rate for Payer: Meridian Medicaid |
$387.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$575.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Nomi Health Commercial |
$1,714.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: PACE Senior Care Partners |
$496.61
|
| Rate for Payer: PACE SWMI |
$522.75
|
| Rate for Payer: PHP Commercial |
$1,777.35
|
| Rate for Payer: PHP Medicare Advantage |
$522.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,819.17
|
| Rate for Payer: Priority Health Medicare |
$527.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,455.34
|
| Rate for Payer: Railroad Medicare Medicare |
$522.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,840.08
|
| Rate for Payer: UHC Core |
$1,745.98
|
| Rate for Payer: UHC Exchange |
$522.75
|
| Rate for Payer: UHC Medicaid |
$368.64
|
| Rate for Payer: UHC Medicare Advantage |
$522.75
|
| Rate for Payer: UHCCP Medicaid |
$368.64
|
| Rate for Payer: VA VA |
$522.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.25
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,455.34 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Aetna Commercial |
$1,777.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.96
|
| Rate for Payer: BCN Commercial |
$1,726.96
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,798.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Healthscope Commercial |
$1,881.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Nomi Health Commercial |
$1,714.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: PHP Commercial |
$1,777.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,819.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,455.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,840.08
|
| Rate for Payer: UHC Core |
$1,745.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.25
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$63.16
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$56.84 |
| Rate for Payer: Aetna Commercial |
$53.69
|
| Rate for Payer: Aetna Medicare |
$16.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.74
|
| Rate for Payer: BCBS Complete |
$11.69
|
| Rate for Payer: BCBS MAPPO |
$15.79
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: BCN Medicare Advantage |
$15.79
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$54.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$56.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.37
|
| Rate for Payer: Mclaren Medicaid |
$11.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.58
|
| Rate for Payer: Meridian Medicaid |
$11.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.69
|
| Rate for Payer: Nomi Health Commercial |
$51.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.37
|
| Rate for Payer: PACE Senior Care Partners |
$15.00
|
| Rate for Payer: PACE SWMI |
$15.79
|
| Rate for Payer: PHP Commercial |
$53.69
|
| Rate for Payer: PHP Medicare Advantage |
$15.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.95
|
| Rate for Payer: Priority Health Medicare |
$15.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.96
|
| Rate for Payer: Railroad Medicare Medicare |
$15.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.58
|
| Rate for Payer: UHC Core |
$52.74
|
| Rate for Payer: UHC Exchange |
$15.79
|
| Rate for Payer: UHC Medicaid |
$11.14
|
| Rate for Payer: UHC Medicare Advantage |
$15.79
|
| Rate for Payer: UHCCP Medicaid |
$11.14
|
| Rate for Payer: VA VA |
$15.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.37
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$63.16
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$56.84 |
| Rate for Payer: Aetna Commercial |
$53.69
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Commercial |
$52.16
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$54.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.53
|
| Rate for Payer: Healthscope Commercial |
$56.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.69
|
| Rate for Payer: Nomi Health Commercial |
$51.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.37
|
| Rate for Payer: PHP Commercial |
$53.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.58
|
| Rate for Payer: UHC Core |
$52.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.37
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$24.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.18
|
| Rate for Payer: BCBS Complete |
$17.29
|
| Rate for Payer: BCBS MAPPO |
$23.35
|
| Rate for Payer: BCBS Trust/PPO |
$76.78
|
| Rate for Payer: BCN Commercial |
$76.78
|
| Rate for Payer: BCN Medicare Advantage |
$23.35
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.35
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Mclaren Medicaid |
$16.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.51
|
| Rate for Payer: Meridian Medicaid |
$17.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PACE Senior Care Partners |
$22.18
|
| Rate for Payer: PACE SWMI |
$23.35
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$23.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$23.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: Railroad Medicare Medicare |
$23.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: UHC Exchange |
$23.35
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHC Medicare Advantage |
$23.35
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$77.13
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$24.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.18
|
| Rate for Payer: BCBS Complete |
$17.29
|
| Rate for Payer: BCBS MAPPO |
$23.35
|
| Rate for Payer: BCBS Trust/PPO |
$76.78
|
| Rate for Payer: BCN Commercial |
$76.78
|
| Rate for Payer: BCN Medicare Advantage |
$23.35
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.35
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Mclaren Medicaid |
$16.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.51
|
| Rate for Payer: Meridian Medicaid |
$17.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PACE Senior Care Partners |
$22.18
|
| Rate for Payer: PACE SWMI |
$23.35
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$23.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$23.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: Railroad Medicare Medicare |
$23.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: UHC Exchange |
$23.35
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHC Medicare Advantage |
$23.35
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$77.13
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$24.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.18
|
| Rate for Payer: BCBS Complete |
$17.29
|
| Rate for Payer: BCBS MAPPO |
$23.35
|
| Rate for Payer: BCBS Trust/PPO |
$76.78
|
| Rate for Payer: BCN Commercial |
$76.78
|
| Rate for Payer: BCN Medicare Advantage |
$23.35
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.35
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Mclaren Medicaid |
$16.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.51
|
| Rate for Payer: Meridian Medicaid |
$17.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PACE Senior Care Partners |
$22.18
|
| Rate for Payer: PACE SWMI |
$23.35
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$23.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$23.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: Railroad Medicare Medicare |
$23.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: UHC Exchange |
$23.35
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHC Medicare Advantage |
$23.35
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OPTISON 3RD ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$77.13
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna Medicare |
$40.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.33
|
| Rate for Payer: BCBS Complete |
$28.63
|
| Rate for Payer: BCBS MAPPO |
$38.66
|
| Rate for Payer: BCBS Trust/PPO |
$127.14
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$127.14
|
| Rate for Payer: BCN Medicare Advantage |
$38.66
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.66
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: Meridian Medicaid |
$28.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.99
|
| Rate for Payer: PACE Senior Care Partners |
$36.73
|
| Rate for Payer: PACE SWMI |
$38.66
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: PHP Medicare Advantage |
$38.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$39.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.64
|
| Rate for Payer: Railroad Medicare Medicare |
$38.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.09
|
| Rate for Payer: UHC Core |
$129.13
|
| Rate for Payer: UHC Exchange |
$38.66
|
| Rate for Payer: UHC Medicaid |
$27.26
|
| Rate for Payer: UHC Medicare Advantage |
$38.66
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
| Rate for Payer: VA VA |
$38.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: BCBS Trust/PPO |
$127.73
|
| Rate for Payer: BCN Commercial |
$127.73
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.99
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.09
|
| Rate for Payer: UHC Core |
$129.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: BCBS Trust/PPO |
$143.78
|
| Rate for Payer: BCN Commercial |
$143.78
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.20
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: Aetna Medicare |
$45.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.40
|
| Rate for Payer: BCBS Complete |
$32.22
|
| Rate for Payer: BCBS MAPPO |
$43.52
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Medicare Advantage |
$43.52
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.52
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Mclaren Medicaid |
$30.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.70
|
| Rate for Payer: Meridian Medicaid |
$32.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PACE Senior Care Partners |
$41.35
|
| Rate for Payer: PACE SWMI |
$43.52
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: PHP Medicare Advantage |
$43.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.46
|
| Rate for Payer: Priority Health Medicare |
$43.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.17
|
| Rate for Payer: Railroad Medicare Medicare |
$43.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.20
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: UHC Exchange |
$43.52
|
| Rate for Payer: UHC Medicaid |
$30.69
|
| Rate for Payer: UHC Medicare Advantage |
$43.52
|
| Rate for Payer: UHCCP Medicaid |
$30.69
|
| Rate for Payer: VA VA |
$43.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
IP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.03 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: BCBS Trust/PPO |
$174.47
|
| Rate for Payer: BCN Commercial |
$174.47
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Nomi Health Commercial |
$173.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.44
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$183.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.90
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
OP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna Medicare |
$54.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.02
|
| Rate for Payer: BCBS Complete |
$39.10
|
| Rate for Payer: BCBS MAPPO |
$52.81
|
| Rate for Payer: BCBS Trust/PPO |
$173.67
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$173.67
|
| Rate for Payer: BCN Medicare Advantage |
$52.81
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.81
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Mclaren Medicaid |
$37.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.45
|
| Rate for Payer: Meridian Medicaid |
$39.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Nomi Health Commercial |
$173.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.44
|
| Rate for Payer: PACE Senior Care Partners |
$50.17
|
| Rate for Payer: PACE SWMI |
$52.81
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: PHP Medicare Advantage |
$52.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$183.79
|
| Rate for Payer: Priority Health Medicare |
$53.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.03
|
| Rate for Payer: Railroad Medicare Medicare |
$52.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.90
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: UHC Exchange |
$52.81
|
| Rate for Payer: UHC Medicaid |
$37.24
|
| Rate for Payer: UHC Medicare Advantage |
$52.81
|
| Rate for Payer: UHCCP Medicaid |
$37.24
|
| Rate for Payer: VA VA |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
IP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.15 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: BCBS Trust/PPO |
$250.55
|
| Rate for Payer: BCN Commercial |
$250.55
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.53
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.97
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
OP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$78.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.80
|
| Rate for Payer: BCBS Complete |
$56.15
|
| Rate for Payer: BCBS MAPPO |
$75.84
|
| Rate for Payer: BCBS Trust/PPO |
$249.40
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$249.40
|
| Rate for Payer: BCN Medicare Advantage |
$75.84
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.84
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Mclaren Medicaid |
$53.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.63
|
| Rate for Payer: Meridian Medicaid |
$56.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.53
|
| Rate for Payer: PACE Senior Care Partners |
$72.05
|
| Rate for Payer: PACE SWMI |
$75.84
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: PHP Medicare Advantage |
$75.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.93
|
| Rate for Payer: Priority Health Medicare |
$76.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.15
|
| Rate for Payer: Railroad Medicare Medicare |
$75.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.97
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: UHC Exchange |
$75.84
|
| Rate for Payer: UHC Medicaid |
$53.48
|
| Rate for Payer: UHC Medicare Advantage |
$75.84
|
| Rate for Payer: UHCCP Medicaid |
$53.48
|
| Rate for Payer: VA VA |
$75.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
OP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$93.50
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCBS Trust/PPO |
$415.28
|
| Rate for Payer: BCN Commercial |
$415.28
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Mclaren Medicaid |
$89.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$93.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Nomi Health Commercial |
$414.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.86
|
| Rate for Payer: PACE Senior Care Partners |
$119.97
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$439.47
|
| Rate for Payer: Priority Health Medicare |
$127.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.58
|
| Rate for Payer: Railroad Medicare Medicare |
$126.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.52
|
| Rate for Payer: UHC Core |
$421.79
|
| Rate for Payer: UHC Exchange |
$126.28
|
| Rate for Payer: UHC Medicaid |
$89.06
|
| Rate for Payer: UHC Medicare Advantage |
$126.28
|
| Rate for Payer: UHCCP Medicaid |
$89.06
|
| Rate for Payer: VA VA |
$126.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
IP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.58 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: BCBS Trust/PPO |
$417.20
|
| Rate for Payer: BCN Commercial |
$417.20
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Nomi Health Commercial |
$414.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.86
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$439.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.52
|
| Rate for Payer: UHC Core |
$421.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$35.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.10
|
| Rate for Payer: BCBS Complete |
$24.93
|
| Rate for Payer: BCBS MAPPO |
$33.68
|
| Rate for Payer: BCBS Trust/PPO |
$110.75
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$110.75
|
| Rate for Payer: BCN Medicare Advantage |
$33.68
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.68
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Mclaren Medicaid |
$23.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: Meridian Medicaid |
$24.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PACE Senior Care Partners |
$31.99
|
| Rate for Payer: PACE SWMI |
$33.68
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Medicare |
$34.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.76
|
| Rate for Payer: Railroad Medicare Medicare |
$33.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: UHC Exchange |
$33.68
|
| Rate for Payer: UHC Medicaid |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$33.68
|
| Rate for Payer: UHCCP Medicaid |
$23.75
|
| Rate for Payer: VA VA |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.76 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$111.26
|
| Rate for Payer: BCN Commercial |
$111.26
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
