|
HC MMR VACCINE
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.14
|
| Rate for Payer: BCBS Complete |
$43.70
|
| Rate for Payer: BCBS MAPPO |
$27.31
|
| Rate for Payer: BCBS Trust/PPO |
$89.81
|
| Rate for Payer: BCN Commercial |
$84.93
|
| Rate for Payer: BCN Medicare Advantage |
$27.31
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.31
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Senior Care Partners |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.31
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$27.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Medicare |
$27.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: Railroad Medicare Medicare |
$27.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.31
|
| Rate for Payer: UHC Exchange |
$27.31
|
| Rate for Payer: UHC Medicare Advantage |
$27.31
|
| Rate for Payer: VA VA |
$27.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$89.17
|
| Rate for Payer: BCN Commercial |
$84.42
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$46.44 |
| Rate for Payer: Aetna Commercial |
$43.86
|
| Rate for Payer: BCBS Trust/PPO |
$42.12
|
| Rate for Payer: BCN Commercial |
$39.88
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$46.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: Nomi Health Commercial |
$42.31
|
| Rate for Payer: PHP Commercial |
$43.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: Priority Health HMO/PPO |
$44.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.41
|
| Rate for Payer: UHC Core |
$43.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.70
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$46.44 |
| Rate for Payer: Aetna Commercial |
$43.86
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$20.64
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.42
|
| Rate for Payer: BCN Commercial |
$40.12
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$44.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$46.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: Nomi Health Commercial |
$42.31
|
| Rate for Payer: PACE Senior Care Partners |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$43.86
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: Priority Health HMO/PPO |
$44.89
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.57
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.41
|
| Rate for Payer: UHC Core |
$43.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Exchange |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: VA VA |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.70
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$60.53
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$54.48 |
| Rate for Payer: Aetna Commercial |
$51.45
|
| Rate for Payer: Aetna Medicare |
$15.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.92
|
| Rate for Payer: BCBS Complete |
$24.21
|
| Rate for Payer: BCBS MAPPO |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$49.76
|
| Rate for Payer: BCN Commercial |
$47.06
|
| Rate for Payer: BCN Medicare Advantage |
$15.13
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.13
|
| Rate for Payer: Healthscope Commercial |
$54.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.45
|
| Rate for Payer: Nomi Health Commercial |
$49.63
|
| Rate for Payer: PACE Senior Care Partners |
$14.38
|
| Rate for Payer: PACE SWMI |
$15.13
|
| Rate for Payer: PHP Commercial |
$51.45
|
| Rate for Payer: PHP Medicare Advantage |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.34
|
| Rate for Payer: Priority Health HMO/PPO |
$52.66
|
| Rate for Payer: Priority Health Medicare |
$15.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.56
|
| Rate for Payer: Railroad Medicare Medicare |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.27
|
| Rate for Payer: UHC Core |
$50.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.13
|
| Rate for Payer: UHC Exchange |
$15.13
|
| Rate for Payer: UHC Medicare Advantage |
$15.13
|
| Rate for Payer: VA VA |
$15.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.40
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$60.53
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$54.48 |
| Rate for Payer: Aetna Commercial |
$51.45
|
| Rate for Payer: BCBS Trust/PPO |
$49.41
|
| Rate for Payer: BCN Commercial |
$46.78
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.42
|
| Rate for Payer: Healthscope Commercial |
$54.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.45
|
| Rate for Payer: Nomi Health Commercial |
$49.63
|
| Rate for Payer: PHP Commercial |
$51.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.34
|
| Rate for Payer: Priority Health HMO/PPO |
$52.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.27
|
| Rate for Payer: UHC Core |
$50.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.40
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$138.66
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$90.13 |
| Max. Negotiated Rate |
$124.79 |
| Rate for Payer: Aetna Commercial |
$117.86
|
| Rate for Payer: BCBS Trust/PPO |
$113.19
|
| Rate for Payer: BCN Commercial |
$107.16
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cofinity Commercial |
$119.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.93
|
| Rate for Payer: Healthscope Commercial |
$124.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.86
|
| Rate for Payer: Nomi Health Commercial |
$113.70
|
| Rate for Payer: PHP Commercial |
$117.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.13
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.02
|
| Rate for Payer: UHC Core |
$115.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.00
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$138.66
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$124.79 |
| Rate for Payer: Aetna Commercial |
$117.86
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.99
|
| Rate for Payer: BCN Commercial |
$107.81
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cofinity Commercial |
$119.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.86
|
| Rate for Payer: Nomi Health Commercial |
$113.70
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.13
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.02
|
| Rate for Payer: UHC Core |
$115.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.66
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.00
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$122.56
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$110.30 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: Aetna Medicare |
$31.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.30
|
| Rate for Payer: BCBS Complete |
$49.02
|
| Rate for Payer: BCBS MAPPO |
$30.64
|
| Rate for Payer: BCBS Trust/PPO |
$100.76
|
| Rate for Payer: BCN Commercial |
$95.29
|
| Rate for Payer: BCN Medicare Advantage |
$30.64
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$105.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.64
|
| Rate for Payer: Healthscope Commercial |
$110.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.18
|
| Rate for Payer: Nomi Health Commercial |
$100.50
|
| Rate for Payer: PACE Senior Care Partners |
$29.11
|
| Rate for Payer: PACE SWMI |
$30.64
|
| Rate for Payer: PHP Commercial |
$104.18
|
| Rate for Payer: PHP Medicare Advantage |
$30.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.66
|
| Rate for Payer: Priority Health HMO/PPO |
$106.63
|
| Rate for Payer: Priority Health Medicare |
$30.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.12
|
| Rate for Payer: Railroad Medicare Medicare |
$30.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.85
|
| Rate for Payer: UHC Core |
$102.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.64
|
| Rate for Payer: UHC Exchange |
$30.64
|
| Rate for Payer: UHC Medicare Advantage |
$30.64
|
| Rate for Payer: VA VA |
$30.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.92
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$122.56
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$79.66 |
| Max. Negotiated Rate |
$110.30 |
| Rate for Payer: Aetna Commercial |
$104.18
|
| Rate for Payer: BCBS Trust/PPO |
$100.05
|
| Rate for Payer: BCN Commercial |
$94.71
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$105.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.05
|
| Rate for Payer: Healthscope Commercial |
$110.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.18
|
| Rate for Payer: Nomi Health Commercial |
$100.50
|
| Rate for Payer: PHP Commercial |
$104.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.66
|
| Rate for Payer: Priority Health HMO/PPO |
$106.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.85
|
| Rate for Payer: UHC Core |
$102.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.92
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$535.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna Medicare |
$139.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.34
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$133.88
|
| Rate for Payer: BCBS Trust/PPO |
$440.23
|
| Rate for Payer: BCN Commercial |
$416.35
|
| Rate for Payer: BCN Medicare Advantage |
$133.88
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.88
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.62
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.57
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.11
|
| Rate for Payer: PACE Senior Care Partners |
$127.18
|
| Rate for Payer: PACE SWMI |
$133.88
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: PHP Medicare Advantage |
$133.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health HMO/PPO |
$465.88
|
| Rate for Payer: Priority Health Medicare |
$135.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.78
|
| Rate for Payer: Railroad Medicare Medicare |
$133.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.24
|
| Rate for Payer: UHC Core |
$447.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.88
|
| Rate for Payer: UHC Exchange |
$133.88
|
| Rate for Payer: UHC Medicare Advantage |
$133.88
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$133.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.62
|
|
|
HC MOG FACS, S
|
Facility
|
IP
|
$535.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$348.08 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: BCBS Trust/PPO |
$437.13
|
| Rate for Payer: BCN Commercial |
$413.83
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.11
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health HMO/PPO |
$465.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.24
|
| Rate for Payer: UHC Core |
$447.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.62
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.89
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Exchange |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.12
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$62.45
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$755.95
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$491.37 |
| Max. Negotiated Rate |
$680.36 |
| Rate for Payer: Aetna Commercial |
$642.56
|
| Rate for Payer: BCBS Trust/PPO |
$617.08
|
| Rate for Payer: BCN Commercial |
$584.20
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cofinity Commercial |
$650.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.76
|
| Rate for Payer: Healthscope Commercial |
$680.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$566.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.56
|
| Rate for Payer: Nomi Health Commercial |
$619.88
|
| Rate for Payer: PHP Commercial |
$642.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.37
|
| Rate for Payer: Priority Health HMO/PPO |
$657.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$665.24
|
| Rate for Payer: UHC Core |
$631.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$566.96
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$755.95
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$680.36 |
| Rate for Payer: Aetna Commercial |
$642.56
|
| Rate for Payer: Aetna Medicare |
$196.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.23
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$188.99
|
| Rate for Payer: BCBS Trust/PPO |
$621.47
|
| Rate for Payer: BCN Commercial |
$587.75
|
| Rate for Payer: BCN Medicare Advantage |
$188.99
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cofinity Commercial |
$650.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.99
|
| Rate for Payer: Healthscope Commercial |
$680.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$566.96
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.44
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.56
|
| Rate for Payer: Nomi Health Commercial |
$619.88
|
| Rate for Payer: PACE Senior Care Partners |
$179.54
|
| Rate for Payer: PACE SWMI |
$188.99
|
| Rate for Payer: PHP Commercial |
$642.56
|
| Rate for Payer: PHP Medicare Advantage |
$188.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.37
|
| Rate for Payer: Priority Health HMO/PPO |
$657.68
|
| Rate for Payer: Priority Health Medicare |
$190.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.49
|
| Rate for Payer: Railroad Medicare Medicare |
$188.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$665.24
|
| Rate for Payer: UHC Core |
$631.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.99
|
| Rate for Payer: UHC Exchange |
$188.99
|
| Rate for Payer: UHC Medicare Advantage |
$188.99
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$188.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$566.96
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$58.17 |
| Max. Negotiated Rate |
$220.44 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: Aetna Medicare |
$63.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.54
|
| Rate for Payer: BCBS Complete |
$93.65
|
| Rate for Payer: BCBS MAPPO |
$61.23
|
| Rate for Payer: BCBS Trust/PPO |
$201.36
|
| Rate for Payer: BCN Commercial |
$190.43
|
| Rate for Payer: BCN Medicare Advantage |
$61.23
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.23
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.70
|
| Rate for Payer: Mclaren Medicaid |
$89.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.29
|
| Rate for Payer: Meridian Medicaid |
$93.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: PACE Senior Care Partners |
$58.17
|
| Rate for Payer: PACE SWMI |
$61.23
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: PHP Medicare Advantage |
$61.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO |
$213.09
|
| Rate for Payer: Priority Health Medicare |
$61.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.10
|
| Rate for Payer: Railroad Medicare Medicare |
$61.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.54
|
| Rate for Payer: UHC Core |
$204.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.23
|
| Rate for Payer: UHC Exchange |
$61.23
|
| Rate for Payer: UHC Medicare Advantage |
$61.23
|
| Rate for Payer: UHCCP Medicaid |
$89.19
|
| Rate for Payer: VA VA |
$61.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.70
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$220.44 |
| Rate for Payer: Aetna Commercial |
$208.19
|
| Rate for Payer: BCBS Trust/PPO |
$199.94
|
| Rate for Payer: BCN Commercial |
$189.28
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$210.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$220.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: PHP Commercial |
$208.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO |
$213.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.54
|
| Rate for Payer: UHC Core |
$204.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.70
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
OP
|
$437.50
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Aetna Commercial |
$371.88
|
| Rate for Payer: Aetna Medicare |
$113.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.72
|
| Rate for Payer: BCBS Complete |
$175.00
|
| Rate for Payer: BCBS MAPPO |
$109.38
|
| Rate for Payer: BCBS Trust/PPO |
$359.67
|
| Rate for Payer: BCN Commercial |
$340.16
|
| Rate for Payer: BCN Medicare Advantage |
$109.38
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$376.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.38
|
| Rate for Payer: Healthscope Commercial |
$393.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.88
|
| Rate for Payer: Nomi Health Commercial |
$358.75
|
| Rate for Payer: PACE Senior Care Partners |
$103.91
|
| Rate for Payer: PACE SWMI |
$109.38
|
| Rate for Payer: PHP Commercial |
$371.88
|
| Rate for Payer: PHP Medicare Advantage |
$109.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.38
|
| Rate for Payer: Priority Health HMO/PPO |
$380.62
|
| Rate for Payer: Priority Health Medicare |
$110.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.12
|
| Rate for Payer: Railroad Medicare Medicare |
$109.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.00
|
| Rate for Payer: UHC Core |
$365.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.38
|
| Rate for Payer: UHC Exchange |
$109.38
|
| Rate for Payer: UHC Medicare Advantage |
$109.38
|
| Rate for Payer: VA VA |
$109.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.12
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
IP
|
$437.50
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$284.38 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Aetna Commercial |
$371.88
|
| Rate for Payer: BCBS Trust/PPO |
$357.13
|
| Rate for Payer: BCN Commercial |
$338.10
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$376.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.00
|
| Rate for Payer: Healthscope Commercial |
$393.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.88
|
| Rate for Payer: Nomi Health Commercial |
$358.75
|
| Rate for Payer: PHP Commercial |
$371.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.38
|
| Rate for Payer: Priority Health HMO/PPO |
$380.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.00
|
| Rate for Payer: UHC Core |
$365.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.12
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$3.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$3.75
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$119.34
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.57 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: BCBS Trust/PPO |
$97.42
|
| Rate for Payer: BCN Commercial |
$92.23
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health HMO/PPO |
$103.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.02
|
| Rate for Payer: UHC Core |
$99.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.50
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$119.34
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: Aetna Medicare |
$31.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.29
|
| Rate for Payer: BCBS Complete |
$47.74
|
| Rate for Payer: BCBS MAPPO |
$29.84
|
| Rate for Payer: BCBS Trust/PPO |
$98.11
|
| Rate for Payer: BCN Commercial |
$92.79
|
| Rate for Payer: BCN Medicare Advantage |
$29.84
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.84
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: PACE Senior Care Partners |
$28.34
|
| Rate for Payer: PACE SWMI |
$29.84
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: PHP Medicare Advantage |
$29.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health HMO/PPO |
$103.83
|
| Rate for Payer: Priority Health Medicare |
$30.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.96
|
| Rate for Payer: Railroad Medicare Medicare |
$29.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.02
|
| Rate for Payer: UHC Core |
$99.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.84
|
| Rate for Payer: UHC Exchange |
$29.84
|
| Rate for Payer: UHC Medicare Advantage |
$29.84
|
| Rate for Payer: VA VA |
$29.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.50
|
|
|
HC MOUSE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
