|
HC MICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: BCBS Trust/PPO |
$164.03
|
| Rate for Payer: BCN Commercial |
$155.29
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC MICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$52.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.79
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS MAPPO |
$50.23
|
| Rate for Payer: BCBS Trust/PPO |
$165.19
|
| Rate for Payer: BCN Commercial |
$156.23
|
| Rate for Payer: BCN Medicare Advantage |
$50.23
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PACE Senior Care Partners |
$47.72
|
| Rate for Payer: PACE SWMI |
$50.23
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: PHP Medicare Advantage |
$50.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: Railroad Medicare Medicare |
$50.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.23
|
| Rate for Payer: UHC Exchange |
$50.23
|
| Rate for Payer: UHC Medicare Advantage |
$50.23
|
| Rate for Payer: VA VA |
$50.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC MILK IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200047
|
|
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
|
|
|
HC MILK IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200047
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| 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: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MINI BAL PROCEDURE
|
Facility
|
OP
|
$309.26
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$73.45 |
| Max. Negotiated Rate |
$278.33 |
| Rate for Payer: Aetna Commercial |
$262.87
|
| Rate for Payer: Aetna Medicare |
$80.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.64
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$77.31
|
| Rate for Payer: BCBS Trust/PPO |
$254.24
|
| Rate for Payer: BCN Commercial |
$240.45
|
| Rate for Payer: BCN Medicare Advantage |
$77.31
|
| Rate for Payer: Cash Price |
$247.41
|
| Rate for Payer: Cash Price |
$247.41
|
| Rate for Payer: Cofinity Commercial |
$265.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.31
|
| Rate for Payer: Healthscope Commercial |
$278.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.94
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.18
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.87
|
| Rate for Payer: Nomi Health Commercial |
$253.59
|
| Rate for Payer: PACE Senior Care Partners |
$73.45
|
| Rate for Payer: PACE SWMI |
$77.31
|
| Rate for Payer: PHP Commercial |
$262.87
|
| Rate for Payer: PHP Medicare Advantage |
$77.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.02
|
| Rate for Payer: Priority Health HMO/PPO |
$269.06
|
| Rate for Payer: Priority Health Medicare |
$78.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.20
|
| Rate for Payer: Railroad Medicare Medicare |
$77.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.15
|
| Rate for Payer: UHC Core |
$258.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.31
|
| Rate for Payer: UHC Exchange |
$77.31
|
| Rate for Payer: UHC Medicare Advantage |
$77.31
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$77.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.94
|
|
|
HC MINI BAL PROCEDURE
|
Facility
|
IP
|
$309.26
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$201.02 |
| Max. Negotiated Rate |
$278.33 |
| Rate for Payer: Aetna Commercial |
$262.87
|
| Rate for Payer: BCBS Trust/PPO |
$252.45
|
| Rate for Payer: BCN Commercial |
$239.00
|
| Rate for Payer: Cash Price |
$247.41
|
| Rate for Payer: Cofinity Commercial |
$265.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.41
|
| Rate for Payer: Healthscope Commercial |
$278.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.87
|
| Rate for Payer: Nomi Health Commercial |
$253.59
|
| Rate for Payer: PHP Commercial |
$262.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.02
|
| Rate for Payer: Priority Health HMO/PPO |
$269.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.15
|
| Rate for Payer: UHC Core |
$258.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.94
|
|
|
HC MINIMUM BACTERICIDAL CONCENTRA
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
30600103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$5.04
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.16
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$4.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: Meridian Medicaid |
$5.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Exchange |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| Rate for Payer: UHCCP Medicaid |
$4.80
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC MINIMUM BACTERICIDAL CONCENTRA
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 87188
|
| Hospital Charge Code |
30600103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$24.98
|
| Rate for Payer: BCN Commercial |
$23.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC MINIMUM LETHAL CONCENTRATION (MLC)
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 87187
|
| Hospital Charge Code |
30600102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$30.50
|
| Rate for Payer: BCBS MAPPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.71
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.71
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$29.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$30.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.71
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.71
|
| Rate for Payer: UHC Exchange |
$11.71
|
| Rate for Payer: UHC Medicare Advantage |
$11.71
|
| Rate for Payer: UHCCP Medicaid |
$29.04
|
| Rate for Payer: VA VA |
$11.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC MINIMUM LETHAL CONCENTRATION (MLC)
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 87187
|
| Hospital Charge Code |
30600102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.22
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
IP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$345.50 |
| Max. Negotiated Rate |
$478.39 |
| Rate for Payer: Aetna Commercial |
$451.81
|
| Rate for Payer: BCBS Trust/PPO |
$433.90
|
| Rate for Payer: BCN Commercial |
$410.77
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$457.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Healthscope Commercial |
$478.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: Nomi Health Commercial |
$435.86
|
| Rate for Payer: PHP Commercial |
$451.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: Priority Health HMO/PPO |
$462.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.76
|
| Rate for Payer: UHC Core |
$443.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.65
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
OP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$478.39 |
| Rate for Payer: Aetna Commercial |
$451.81
|
| Rate for Payer: Aetna Medicare |
$138.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.11
|
| Rate for Payer: BCBS Complete |
$212.62
|
| Rate for Payer: BCBS MAPPO |
$132.88
|
| Rate for Payer: BCBS Trust/PPO |
$436.98
|
| Rate for Payer: BCN Commercial |
$413.27
|
| Rate for Payer: BCN Medicare Advantage |
$132.88
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$457.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.88
|
| Rate for Payer: Healthscope Commercial |
$478.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: Nomi Health Commercial |
$435.86
|
| Rate for Payer: PACE Senior Care Partners |
$126.24
|
| Rate for Payer: PACE SWMI |
$132.88
|
| Rate for Payer: PHP Commercial |
$451.81
|
| Rate for Payer: PHP Medicare Advantage |
$132.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: Priority Health HMO/PPO |
$462.44
|
| Rate for Payer: Priority Health Medicare |
$134.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.13
|
| Rate for Payer: Railroad Medicare Medicare |
$132.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.76
|
| Rate for Payer: UHC Core |
$443.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.88
|
| Rate for Payer: UHC Exchange |
$132.88
|
| Rate for Payer: UHC Medicare Advantage |
$132.88
|
| Rate for Payer: VA VA |
$132.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.65
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
IP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$400.35 |
| Max. Negotiated Rate |
$554.33 |
| Rate for Payer: Aetna Commercial |
$523.53
|
| Rate for Payer: BCBS Trust/PPO |
$502.78
|
| Rate for Payer: BCN Commercial |
$475.98
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Healthscope Commercial |
$554.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: Nomi Health Commercial |
$505.05
|
| Rate for Payer: PHP Commercial |
$523.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: Priority Health HMO/PPO |
$535.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.01
|
| Rate for Payer: UHC Core |
$514.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.94
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
OP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$554.33 |
| Rate for Payer: Aetna Commercial |
$523.53
|
| Rate for Payer: Aetna Medicare |
$160.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.47
|
| Rate for Payer: BCBS Complete |
$246.37
|
| Rate for Payer: BCBS MAPPO |
$153.98
|
| Rate for Payer: BCBS Trust/PPO |
$506.35
|
| Rate for Payer: BCN Commercial |
$478.88
|
| Rate for Payer: BCN Medicare Advantage |
$153.98
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.98
|
| Rate for Payer: Healthscope Commercial |
$554.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: Nomi Health Commercial |
$505.05
|
| Rate for Payer: PACE Senior Care Partners |
$146.28
|
| Rate for Payer: PACE SWMI |
$153.98
|
| Rate for Payer: PHP Commercial |
$523.53
|
| Rate for Payer: PHP Medicare Advantage |
$153.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: Priority Health HMO/PPO |
$535.85
|
| Rate for Payer: Priority Health Medicare |
$155.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.67
|
| Rate for Payer: Railroad Medicare Medicare |
$153.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.01
|
| Rate for Payer: UHC Core |
$514.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.98
|
| Rate for Payer: UHC Exchange |
$153.98
|
| Rate for Payer: UHC Medicare Advantage |
$153.98
|
| Rate for Payer: VA VA |
$153.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.94
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
IP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna Commercial |
$99.89
|
| Rate for Payer: BCBS Trust/PPO |
$95.93
|
| Rate for Payer: BCN Commercial |
$90.82
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.89
|
| Rate for Payer: Nomi Health Commercial |
$96.37
|
| Rate for Payer: PHP Commercial |
$99.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.39
|
| Rate for Payer: Priority Health HMO/PPO |
$102.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.42
|
| Rate for Payer: UHC Core |
$98.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.14
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
OP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$105.77 |
| Rate for Payer: Aetna Commercial |
$99.89
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$96.61
|
| Rate for Payer: BCN Commercial |
$91.37
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$101.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$105.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.14
|
| Rate for Payer: Mclaren Medicaid |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.89
|
| Rate for Payer: Nomi Health Commercial |
$96.37
|
| Rate for Payer: PACE Senior Care Partners |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$99.89
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.39
|
| Rate for Payer: Priority Health HMO/PPO |
$102.24
|
| Rate for Payer: Priority Health Medicare |
$29.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.74
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.42
|
| Rate for Payer: UHC Core |
$98.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$29.38
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$13.48
|
| Rate for Payer: VA VA |
$29.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.14
|
|
|
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 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 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 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 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
|
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
|
|
