|
HC ORCHARD GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
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 ORCHARD GRASS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
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 ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$76.99
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$69.29 |
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna Medicare |
$20.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.06
|
| Rate for Payer: BCBS Complete |
$14.25
|
| Rate for Payer: BCBS MAPPO |
$19.25
|
| Rate for Payer: BCBS Trust/PPO |
$63.29
|
| Rate for Payer: BCN Commercial |
$63.29
|
| Rate for Payer: BCN Medicare Advantage |
$19.25
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.25
|
| Rate for Payer: Healthscope Commercial |
$69.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.74
|
| Rate for Payer: Mclaren Medicaid |
$13.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.21
|
| Rate for Payer: Meridian Medicaid |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PACE Senior Care Partners |
$18.29
|
| Rate for Payer: PACE SWMI |
$19.25
|
| Rate for Payer: PHP Commercial |
$65.44
|
| Rate for Payer: PHP Medicare Advantage |
$19.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.98
|
| Rate for Payer: Priority Health Medicare |
$19.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.59
|
| Rate for Payer: Railroad Medicare Medicare |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.75
|
| Rate for Payer: UHC Core |
$64.29
|
| Rate for Payer: UHC Exchange |
$19.25
|
| Rate for Payer: UHC Medicaid |
$13.57
|
| Rate for Payer: UHC Medicare Advantage |
$19.25
|
| Rate for Payer: UHCCP Medicaid |
$13.57
|
| Rate for Payer: VA VA |
$19.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.74
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$76.99
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$69.29 |
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$63.59
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Healthscope Commercial |
$69.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PHP Commercial |
$65.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.75
|
| Rate for Payer: UHC Core |
$64.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.74
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
IP
|
$219.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.42 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$186.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.87
|
| Rate for Payer: BCN Commercial |
$180.87
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$188.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.20
|
| Rate for Payer: Healthscope Commercial |
$197.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.15
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.25
|
| Rate for Payer: PHP Commercial |
$186.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.72
|
| Rate for Payer: UHC Core |
$182.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.25
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
OP
|
$219.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$186.15
|
| Rate for Payer: Aetna Medicare |
$56.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.44
|
| Rate for Payer: BCBS Complete |
$40.54
|
| Rate for Payer: BCBS MAPPO |
$54.75
|
| Rate for Payer: BCBS Trust/PPO |
$180.04
|
| Rate for Payer: BCN Commercial |
$180.04
|
| Rate for Payer: BCN Medicare Advantage |
$54.75
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$188.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.75
|
| Rate for Payer: Healthscope Commercial |
$197.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.25
|
| Rate for Payer: Mclaren Medicaid |
$38.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.49
|
| Rate for Payer: Meridian Medicaid |
$40.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.15
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.25
|
| Rate for Payer: PACE Senior Care Partners |
$52.01
|
| Rate for Payer: PACE SWMI |
$54.75
|
| Rate for Payer: PHP Commercial |
$186.15
|
| Rate for Payer: PHP Medicare Advantage |
$54.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.53
|
| Rate for Payer: Priority Health Medicare |
$55.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.42
|
| Rate for Payer: Railroad Medicare Medicare |
$54.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.72
|
| Rate for Payer: UHC Core |
$182.87
|
| Rate for Payer: UHC Exchange |
$54.75
|
| Rate for Payer: UHC Medicaid |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$54.75
|
| Rate for Payer: UHCCP Medicaid |
$38.61
|
| Rate for Payer: VA VA |
$54.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.25
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
OP
|
$65.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$16.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.31
|
| Rate for Payer: BCBS Complete |
$12.03
|
| Rate for Payer: BCBS MAPPO |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.44
|
| Rate for Payer: BCN Commercial |
$53.44
|
| Rate for Payer: BCN Medicare Advantage |
$16.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Mclaren Medicaid |
$11.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.06
|
| Rate for Payer: Meridian Medicaid |
$12.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE Senior Care Partners |
$15.44
|
| Rate for Payer: PACE SWMI |
$16.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$16.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.55
|
| Rate for Payer: Priority Health Medicare |
$16.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.24
|
| Rate for Payer: Railroad Medicare Medicare |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.27
|
| Rate for Payer: UHC Exchange |
$16.25
|
| Rate for Payer: UHC Medicaid |
$11.46
|
| Rate for Payer: UHC Medicare Advantage |
$16.25
|
| Rate for Payer: UHCCP Medicaid |
$11.46
|
| Rate for Payer: VA VA |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
IP
|
$65.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.68
|
| Rate for Payer: BCN Commercial |
$53.68
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
OP
|
$643.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Aetna Commercial |
$546.55
|
| Rate for Payer: Aetna Medicare |
$167.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.94
|
| Rate for Payer: BCBS Complete |
$119.02
|
| Rate for Payer: BCBS MAPPO |
$160.75
|
| Rate for Payer: BCBS Trust/PPO |
$528.61
|
| Rate for Payer: BCN Commercial |
$528.61
|
| Rate for Payer: BCN Medicare Advantage |
$160.75
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$552.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$578.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.25
|
| Rate for Payer: Mclaren Medicaid |
$113.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.79
|
| Rate for Payer: Meridian Medicaid |
$119.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.55
|
| Rate for Payer: Nomi Health Commercial |
$527.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.25
|
| Rate for Payer: PACE Senior Care Partners |
$152.71
|
| Rate for Payer: PACE SWMI |
$160.75
|
| Rate for Payer: PHP Commercial |
$546.55
|
| Rate for Payer: PHP Medicare Advantage |
$160.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$559.41
|
| Rate for Payer: Priority Health Medicare |
$162.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.53
|
| Rate for Payer: Railroad Medicare Medicare |
$160.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.84
|
| Rate for Payer: UHC Core |
$536.90
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicaid |
$113.36
|
| Rate for Payer: UHC Medicare Advantage |
$160.75
|
| Rate for Payer: UHCCP Medicaid |
$113.36
|
| Rate for Payer: VA VA |
$160.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.25
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
IP
|
$643.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$447.53 |
| Max. Negotiated Rate |
$578.70 |
| Rate for Payer: Aetna Commercial |
$546.55
|
| Rate for Payer: BCBS Trust/PPO |
$531.05
|
| Rate for Payer: BCN Commercial |
$531.05
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$552.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.40
|
| Rate for Payer: Healthscope Commercial |
$578.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.55
|
| Rate for Payer: Nomi Health Commercial |
$527.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.25
|
| Rate for Payer: PHP Commercial |
$546.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$559.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.84
|
| Rate for Payer: UHC Core |
$536.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.25
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Aetna Medicare |
$25.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.31
|
| Rate for Payer: BCBS Complete |
$17.95
|
| Rate for Payer: BCBS MAPPO |
$24.25
|
| Rate for Payer: BCBS Trust/PPO |
$79.74
|
| Rate for Payer: BCN Commercial |
$79.74
|
| Rate for Payer: BCN Medicare Advantage |
$24.25
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.25
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.75
|
| Rate for Payer: Mclaren Medicaid |
$17.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.46
|
| Rate for Payer: Meridian Medicaid |
$17.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PACE Senior Care Partners |
$23.04
|
| Rate for Payer: PACE SWMI |
$24.25
|
| Rate for Payer: PHP Commercial |
$82.45
|
| Rate for Payer: PHP Medicare Advantage |
$24.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.39
|
| Rate for Payer: Priority Health Medicare |
$24.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.51
|
| Rate for Payer: Railroad Medicare Medicare |
$24.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.36
|
| Rate for Payer: UHC Core |
$81.00
|
| Rate for Payer: UHC Exchange |
$24.25
|
| Rate for Payer: UHC Medicaid |
$17.10
|
| Rate for Payer: UHC Medicare Advantage |
$24.25
|
| Rate for Payer: UHCCP Medicaid |
$17.10
|
| Rate for Payer: VA VA |
$24.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.75
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.51 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: BCBS Trust/PPO |
$80.11
|
| Rate for Payer: BCN Commercial |
$80.11
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PHP Commercial |
$82.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.36
|
| Rate for Payer: UHC Core |
$81.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.75
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$596.47 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: BCBS Trust/PPO |
$707.80
|
| Rate for Payer: BCN Commercial |
$707.80
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Nomi Health Commercial |
$702.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.75
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$745.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$596.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.16
|
| Rate for Payer: UHC Core |
$715.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.09 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: Aetna Medicare |
$222.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$267.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$267.81
|
| Rate for Payer: BCBS Complete |
$158.63
|
| Rate for Payer: BCBS MAPPO |
$214.25
|
| Rate for Payer: BCBS Trust/PPO |
$704.54
|
| Rate for Payer: BCN Commercial |
$704.54
|
| Rate for Payer: BCN Medicare Advantage |
$214.25
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.25
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: Mclaren Medicaid |
$151.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.96
|
| Rate for Payer: Meridian Medicaid |
$158.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$235.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Nomi Health Commercial |
$702.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.75
|
| Rate for Payer: PACE Senior Care Partners |
$203.54
|
| Rate for Payer: PACE SWMI |
$214.25
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: PHP Medicare Advantage |
$214.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$745.59
|
| Rate for Payer: Priority Health Medicare |
$216.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$596.47
|
| Rate for Payer: Railroad Medicare Medicare |
$214.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.16
|
| Rate for Payer: UHC Core |
$715.60
|
| Rate for Payer: UHC Exchange |
$214.25
|
| Rate for Payer: UHC Medicaid |
$151.09
|
| Rate for Payer: UHC Medicare Advantage |
$214.25
|
| Rate for Payer: UHCCP Medicaid |
$151.09
|
| Rate for Payer: VA VA |
$214.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.17 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$89.20
|
| Rate for Payer: BCN Commercial |
$89.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.80
|
| Rate for Payer: Nomi Health Commercial |
$88.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.00
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.04
|
| Rate for Payer: UHC Core |
$90.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$28.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.75
|
| Rate for Payer: BCBS Complete |
$19.99
|
| Rate for Payer: BCBS MAPPO |
$27.00
|
| Rate for Payer: BCBS Trust/PPO |
$88.79
|
| Rate for Payer: BCN Commercial |
$88.79
|
| Rate for Payer: BCN Medicare Advantage |
$27.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$92.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.00
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.00
|
| Rate for Payer: Mclaren Medicaid |
$19.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.35
|
| Rate for Payer: Meridian Medicaid |
$19.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.80
|
| Rate for Payer: Nomi Health Commercial |
$88.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.00
|
| Rate for Payer: PACE Senior Care Partners |
$25.65
|
| Rate for Payer: PACE SWMI |
$27.00
|
| Rate for Payer: PHP Commercial |
$91.80
|
| Rate for Payer: PHP Medicare Advantage |
$27.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.96
|
| Rate for Payer: Priority Health Medicare |
$27.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: Railroad Medicare Medicare |
$27.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.04
|
| Rate for Payer: UHC Core |
$90.18
|
| Rate for Payer: UHC Exchange |
$27.00
|
| Rate for Payer: UHC Medicaid |
$19.04
|
| Rate for Payer: UHC Medicare Advantage |
$27.00
|
| Rate for Payer: UHCCP Medicaid |
$19.04
|
| Rate for Payer: VA VA |
$27.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.00
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
OP
|
$1,372.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: Aetna Medicare |
$356.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$428.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$428.75
|
| Rate for Payer: BCBS Complete |
$253.96
|
| Rate for Payer: BCBS MAPPO |
$343.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.92
|
| Rate for Payer: BCN Commercial |
$1,127.92
|
| Rate for Payer: BCN Medicare Advantage |
$343.00
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.00
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: Mclaren Medicaid |
$241.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.15
|
| Rate for Payer: Meridian Medicaid |
$253.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$394.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$377.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.20
|
| Rate for Payer: Nomi Health Commercial |
$1,125.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.00
|
| Rate for Payer: PACE Senior Care Partners |
$325.85
|
| Rate for Payer: PACE SWMI |
$343.00
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: PHP Medicare Advantage |
$343.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,193.64
|
| Rate for Payer: Priority Health Medicare |
$346.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$954.91
|
| Rate for Payer: Railroad Medicare Medicare |
$343.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.36
|
| Rate for Payer: UHC Core |
$1,145.62
|
| Rate for Payer: UHC Exchange |
$343.00
|
| Rate for Payer: UHC Medicaid |
$241.88
|
| Rate for Payer: UHC Medicare Advantage |
$343.00
|
| Rate for Payer: UHCCP Medicaid |
$241.88
|
| Rate for Payer: VA VA |
$343.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
IP
|
$1,372.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$954.91 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.13
|
| Rate for Payer: BCN Commercial |
$1,133.13
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.20
|
| Rate for Payer: Nomi Health Commercial |
$1,125.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.00
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,193.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$954.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.36
|
| Rate for Payer: UHC Core |
$1,145.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
OP
|
$118.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$100.30
|
| Rate for Payer: Aetna Medicare |
$30.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.88
|
| Rate for Payer: BCBS Complete |
$21.84
|
| Rate for Payer: BCBS MAPPO |
$29.50
|
| Rate for Payer: BCBS Trust/PPO |
$97.01
|
| Rate for Payer: BCN Commercial |
$97.01
|
| Rate for Payer: BCN Medicare Advantage |
$29.50
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$101.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.50
|
| Rate for Payer: Healthscope Commercial |
$106.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.50
|
| Rate for Payer: Mclaren Medicaid |
$20.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.98
|
| Rate for Payer: Meridian Medicaid |
$21.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.30
|
| Rate for Payer: Nomi Health Commercial |
$96.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.50
|
| Rate for Payer: PACE Senior Care Partners |
$28.02
|
| Rate for Payer: PACE SWMI |
$29.50
|
| Rate for Payer: PHP Commercial |
$100.30
|
| Rate for Payer: PHP Medicare Advantage |
$29.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.66
|
| Rate for Payer: Priority Health Medicare |
$29.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.13
|
| Rate for Payer: Railroad Medicare Medicare |
$29.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.84
|
| Rate for Payer: UHC Core |
$98.53
|
| Rate for Payer: UHC Exchange |
$29.50
|
| Rate for Payer: UHC Medicaid |
$20.80
|
| Rate for Payer: UHC Medicare Advantage |
$29.50
|
| Rate for Payer: UHCCP Medicaid |
$20.80
|
| Rate for Payer: VA VA |
$29.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.50
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
IP
|
$118.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$100.30
|
| Rate for Payer: BCBS Trust/PPO |
$97.46
|
| Rate for Payer: BCN Commercial |
$97.46
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$101.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$106.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.30
|
| Rate for Payer: Nomi Health Commercial |
$96.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.50
|
| Rate for Payer: PHP Commercial |
$100.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.84
|
| Rate for Payer: UHC Core |
$98.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.50
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
OP
|
$2,188.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.74 |
| Max. Negotiated Rate |
$1,969.20 |
| Rate for Payer: Aetna Commercial |
$1,859.80
|
| Rate for Payer: Aetna Medicare |
$568.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$683.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$683.75
|
| Rate for Payer: BCBS Complete |
$405.00
|
| Rate for Payer: BCBS MAPPO |
$547.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.75
|
| Rate for Payer: BCN Commercial |
$1,798.75
|
| Rate for Payer: BCN Medicare Advantage |
$547.00
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cofinity Commercial |
$1,881.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,750.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.00
|
| Rate for Payer: Healthscope Commercial |
$1,969.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,641.00
|
| Rate for Payer: Mclaren Medicaid |
$385.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.35
|
| Rate for Payer: Meridian Medicaid |
$405.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$629.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$601.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,859.80
|
| Rate for Payer: Nomi Health Commercial |
$1,794.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.00
|
| Rate for Payer: PACE Senior Care Partners |
$519.65
|
| Rate for Payer: PACE SWMI |
$547.00
|
| Rate for Payer: PHP Commercial |
$1,859.80
|
| Rate for Payer: PHP Medicare Advantage |
$547.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,903.56
|
| Rate for Payer: Priority Health Medicare |
$552.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,522.85
|
| Rate for Payer: Railroad Medicare Medicare |
$547.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,925.44
|
| Rate for Payer: UHC Core |
$1,826.98
|
| Rate for Payer: UHC Exchange |
$547.00
|
| Rate for Payer: UHC Medicaid |
$385.74
|
| Rate for Payer: UHC Medicare Advantage |
$547.00
|
| Rate for Payer: UHCCP Medicaid |
$385.74
|
| Rate for Payer: VA VA |
$547.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,641.00
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
IP
|
$2,188.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,522.85 |
| Max. Negotiated Rate |
$1,969.20 |
| Rate for Payer: Aetna Commercial |
$1,859.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,807.07
|
| Rate for Payer: BCN Commercial |
$1,807.07
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cofinity Commercial |
$1,881.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,750.40
|
| Rate for Payer: Healthscope Commercial |
$1,969.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,641.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,859.80
|
| Rate for Payer: Nomi Health Commercial |
$1,794.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.00
|
| Rate for Payer: PHP Commercial |
$1,859.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,903.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,522.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,925.44
|
| Rate for Payer: UHC Core |
$1,826.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,641.00
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.88
|
| Rate for Payer: BCBS Complete |
$27.77
|
| Rate for Payer: BCBS MAPPO |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$123.31
|
| Rate for Payer: BCN Commercial |
$123.31
|
| Rate for Payer: BCN Medicare Advantage |
$37.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Mclaren Medicaid |
$26.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.38
|
| Rate for Payer: Meridian Medicaid |
$27.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.50
|
| Rate for Payer: Nomi Health Commercial |
$123.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.50
|
| Rate for Payer: PACE Senior Care Partners |
$35.62
|
| Rate for Payer: PACE SWMI |
$37.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$37.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.50
|
| Rate for Payer: Priority Health Medicare |
$37.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.40
|
| Rate for Payer: Railroad Medicare Medicare |
$37.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: UHC Exchange |
$37.50
|
| Rate for Payer: UHC Medicaid |
$26.45
|
| Rate for Payer: UHC Medicare Advantage |
$37.50
|
| Rate for Payer: UHCCP Medicaid |
$26.45
|
| Rate for Payer: VA VA |
$37.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$123.89
|
| Rate for Payer: BCN Commercial |
$123.89
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.50
|
| Rate for Payer: Nomi Health Commercial |
$123.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
OP
|
$30.77
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Aetna Commercial |
$26.15
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.70
|
| Rate for Payer: BCBS MAPPO |
$7.69
|
| Rate for Payer: BCBS Trust/PPO |
$25.30
|
| Rate for Payer: BCN Commercial |
$25.30
|
| Rate for Payer: BCN Medicare Advantage |
$7.69
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$26.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.69
|
| Rate for Payer: Healthscope Commercial |
$27.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.08
|
| Rate for Payer: Mclaren Medicaid |
$5.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.08
|
| Rate for Payer: Meridian Medicaid |
$5.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.08
|
| Rate for Payer: PACE Senior Care Partners |
$7.31
|
| Rate for Payer: PACE SWMI |
$7.69
|
| Rate for Payer: PHP Commercial |
$26.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.77
|
| Rate for Payer: Priority Health Medicare |
$7.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.42
|
| Rate for Payer: Railroad Medicare Medicare |
$7.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.08
|
| Rate for Payer: UHC Core |
$25.69
|
| Rate for Payer: UHC Exchange |
$7.69
|
| Rate for Payer: UHC Medicaid |
$5.42
|
| Rate for Payer: UHC Medicare Advantage |
$7.69
|
| Rate for Payer: UHCCP Medicaid |
$5.42
|
| Rate for Payer: VA VA |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.08
|
|
