|
HC PCP SCREEN URIN
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: Aetna Medicare |
$25.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.13
|
| Rate for Payer: BCBS Complete |
$17.85
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$79.27
|
| Rate for Payer: BCN Commercial |
$79.27
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.31
|
| Rate for Payer: Mclaren Medicaid |
$17.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.31
|
| Rate for Payer: Meridian Medicaid |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PACE Senior Care Partners |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.89
|
| Rate for Payer: Priority Health Medicare |
$24.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.11
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.85
|
| Rate for Payer: UHC Core |
$80.51
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicaid |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$17.00
|
| Rate for Payer: VA VA |
$24.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.31
|
|
|
HC PCP SCREEN URIN
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Aetna Commercial |
$81.96
|
| Rate for Payer: BCBS Trust/PPO |
$79.63
|
| Rate for Payer: BCN Commercial |
$79.63
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PHP Commercial |
$81.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.85
|
| Rate for Payer: UHC Core |
$80.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.31
|
|
|
HC PCP SCREEN URN.
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.27
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$34.90
|
| Rate for Payer: BCN Commercial |
$34.90
|
| Rate for Payer: BCN Medicare Advantage |
$10.61
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.61
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Mclaren Medicaid |
$7.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.14
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Senior Care Partners |
$10.08
|
| Rate for Payer: PACE SWMI |
$10.61
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$10.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.93
|
| Rate for Payer: Priority Health Medicare |
$10.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.55
|
| Rate for Payer: Railroad Medicare Medicare |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.36
|
| Rate for Payer: UHC Core |
$35.45
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Medicaid |
$7.48
|
| Rate for Payer: UHC Medicare Advantage |
$10.61
|
| Rate for Payer: UHCCP Medicaid |
$7.48
|
| Rate for Payer: VA VA |
$10.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC PCP SCREEN URN.
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: BCBS Trust/PPO |
$35.06
|
| Rate for Payer: BCN Commercial |
$35.06
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.36
|
| Rate for Payer: UHC Core |
$35.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$402.63
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.23 |
| Max. Negotiated Rate |
$362.37 |
| Rate for Payer: Aetna Commercial |
$342.24
|
| Rate for Payer: BCBS Trust/PPO |
$332.53
|
| Rate for Payer: BCN Commercial |
$332.53
|
| Rate for Payer: Cash Price |
$322.10
|
| Rate for Payer: Cofinity Commercial |
$346.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.10
|
| Rate for Payer: Healthscope Commercial |
$362.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.24
|
| Rate for Payer: Nomi Health Commercial |
$330.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.97
|
| Rate for Payer: PHP Commercial |
$342.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$350.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.31
|
| Rate for Payer: UHC Core |
$336.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.97
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$402.63
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$362.37 |
| Rate for Payer: Aetna Commercial |
$342.24
|
| Rate for Payer: Aetna Medicare |
$104.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.82
|
| Rate for Payer: BCBS Complete |
$74.53
|
| Rate for Payer: BCBS MAPPO |
$100.66
|
| Rate for Payer: BCBS Trust/PPO |
$331.00
|
| Rate for Payer: BCN Commercial |
$331.00
|
| Rate for Payer: BCN Medicare Advantage |
$100.66
|
| Rate for Payer: Cash Price |
$322.10
|
| Rate for Payer: Cofinity Commercial |
$346.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.66
|
| Rate for Payer: Healthscope Commercial |
$362.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.97
|
| Rate for Payer: Mclaren Medicaid |
$70.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.69
|
| Rate for Payer: Meridian Medicaid |
$74.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.24
|
| Rate for Payer: Nomi Health Commercial |
$330.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.97
|
| Rate for Payer: PACE Senior Care Partners |
$95.62
|
| Rate for Payer: PACE SWMI |
$100.66
|
| Rate for Payer: PHP Commercial |
$342.24
|
| Rate for Payer: PHP Medicare Advantage |
$100.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$350.29
|
| Rate for Payer: Priority Health Medicare |
$101.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$280.23
|
| Rate for Payer: Railroad Medicare Medicare |
$100.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.31
|
| Rate for Payer: UHC Core |
$336.20
|
| Rate for Payer: UHC Exchange |
$100.66
|
| Rate for Payer: UHC Medicaid |
$70.98
|
| Rate for Payer: UHC Medicare Advantage |
$100.66
|
| Rate for Payer: UHCCP Medicaid |
$70.98
|
| Rate for Payer: VA VA |
$100.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.97
|
|
|
HC PEAK FLOW METER
|
Facility
|
IP
|
$29.73
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: BCBS Trust/PPO |
$24.55
|
| Rate for Payer: BCN Commercial |
$24.55
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cofinity Commercial |
$25.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.78
|
| Rate for Payer: Healthscope Commercial |
$26.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.27
|
| Rate for Payer: Nomi Health Commercial |
$24.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.30
|
| Rate for Payer: PHP Commercial |
$25.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.16
|
| Rate for Payer: UHC Core |
$24.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.30
|
|
|
HC PEAK FLOW METER
|
Facility
|
OP
|
$29.73
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Medicare |
$7.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.29
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$7.43
|
| Rate for Payer: BCBS Trust/PPO |
$24.44
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Medicare Advantage |
$7.43
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cofinity Commercial |
$25.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.43
|
| Rate for Payer: Healthscope Commercial |
$26.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.30
|
| Rate for Payer: Mclaren Medicaid |
$5.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.80
|
| Rate for Payer: Meridian Medicaid |
$5.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.27
|
| Rate for Payer: Nomi Health Commercial |
$24.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.30
|
| Rate for Payer: PACE Senior Care Partners |
$7.06
|
| Rate for Payer: PACE SWMI |
$7.43
|
| Rate for Payer: PHP Commercial |
$25.27
|
| Rate for Payer: PHP Medicare Advantage |
$7.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.87
|
| Rate for Payer: Priority Health Medicare |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.69
|
| Rate for Payer: Railroad Medicare Medicare |
$7.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.16
|
| Rate for Payer: UHC Core |
$24.82
|
| Rate for Payer: UHC Exchange |
$7.43
|
| Rate for Payer: UHC Medicaid |
$5.24
|
| Rate for Payer: UHC Medicare Advantage |
$7.43
|
| Rate for Payer: UHCCP Medicaid |
$5.24
|
| Rate for Payer: VA VA |
$7.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.30
|
|
|
HC PEANUT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 PEANUT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 PECAN NUT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 PECAN NUT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 PED MINOR TREATMENT RM
|
Facility
|
IP
|
$131.60
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$108.69
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
OP
|
$131.60
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$34.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.12
|
| Rate for Payer: BCBS Complete |
$24.36
|
| Rate for Payer: BCBS MAPPO |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$108.19
|
| Rate for Payer: BCN Commercial |
$108.19
|
| Rate for Payer: BCN Medicare Advantage |
$32.90
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Mclaren Medicaid |
$23.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.55
|
| Rate for Payer: Meridian Medicaid |
$24.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PACE Senior Care Partners |
$31.25
|
| Rate for Payer: PACE SWMI |
$32.90
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: PHP Medicare Advantage |
$32.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Medicare |
$33.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.59
|
| Rate for Payer: Railroad Medicare Medicare |
$32.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: UHC Exchange |
$32.90
|
| Rate for Payer: UHC Medicaid |
$23.20
|
| Rate for Payer: UHC Medicare Advantage |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$23.20
|
| Rate for Payer: VA VA |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$168.88
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$117.54 |
| Max. Negotiated Rate |
$151.99 |
| Rate for Payer: Aetna Commercial |
$143.55
|
| Rate for Payer: BCBS Trust/PPO |
$139.48
|
| Rate for Payer: BCN Commercial |
$139.48
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cofinity Commercial |
$145.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.10
|
| Rate for Payer: Healthscope Commercial |
$151.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.55
|
| Rate for Payer: Nomi Health Commercial |
$138.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.66
|
| Rate for Payer: PHP Commercial |
$143.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.61
|
| Rate for Payer: UHC Core |
$141.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.66
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
OP
|
$168.88
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$143.55
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.77
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$138.84
|
| Rate for Payer: BCN Commercial |
$138.84
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cofinity Commercial |
$145.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$151.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.66
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.55
|
| Rate for Payer: Nomi Health Commercial |
$138.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.66
|
| Rate for Payer: PACE Senior Care Partners |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$143.55
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.93
|
| Rate for Payer: Priority Health Medicare |
$42.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.54
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.61
|
| Rate for Payer: UHC Core |
$141.01
|
| Rate for Payer: UHC Exchange |
$42.22
|
| Rate for Payer: UHC Medicaid |
$29.77
|
| Rate for Payer: UHC Medicare Advantage |
$42.22
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$42.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.66
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,432.11
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$4,888.90 |
| Rate for Payer: Aetna Commercial |
$4,617.29
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,486.38
|
| Rate for Payer: BCN Commercial |
$4,486.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cofinity Commercial |
$4,671.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$4,888.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,074.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.29
|
| Rate for Payer: Nomi Health Commercial |
$4,454.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,074.08
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$4,617.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,725.94
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,780.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,780.26
|
| Rate for Payer: UHC Core |
$4,535.81
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,074.08
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,432.11
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$4,888.90 |
| Rate for Payer: Aetna Commercial |
$4,617.29
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,486.38
|
| Rate for Payer: BCN Commercial |
$4,486.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cofinity Commercial |
$4,671.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$4,888.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,074.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.29
|
| Rate for Payer: Nomi Health Commercial |
$4,454.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,074.08
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$4,617.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,725.94
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,780.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,780.26
|
| Rate for Payer: UHC Core |
$4,535.81
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,074.08
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.90
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: BCBS Trust/PPO |
$18.91
|
| Rate for Payer: BCN Commercial |
$18.91
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.18
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.15
|
| Rate for Payer: UHC Core |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.18
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.90
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$5.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.16
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS MAPPO |
$5.72
|
| Rate for Payer: BCBS Trust/PPO |
$18.83
|
| Rate for Payer: BCN Commercial |
$18.83
|
| Rate for Payer: BCN Medicare Advantage |
$5.72
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.72
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.18
|
| Rate for Payer: Mclaren Medicaid |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.01
|
| Rate for Payer: Meridian Medicaid |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.18
|
| Rate for Payer: PACE Senior Care Partners |
$5.44
|
| Rate for Payer: PACE SWMI |
$5.72
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: PHP Medicare Advantage |
$5.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.92
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.15
|
| Rate for Payer: UHC Core |
$19.12
|
| Rate for Payer: UHC Exchange |
$5.72
|
| Rate for Payer: UHC Medicaid |
$4.04
|
| Rate for Payer: UHC Medicare Advantage |
$5.72
|
| Rate for Payer: UHCCP Medicaid |
$4.04
|
| Rate for Payer: VA VA |
$5.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.18
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$168.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$151.74 |
| Rate for Payer: Aetna Commercial |
$143.31
|
| Rate for Payer: Aetna Medicare |
$43.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.69
|
| Rate for Payer: BCBS Complete |
$31.21
|
| Rate for Payer: BCBS MAPPO |
$42.15
|
| Rate for Payer: BCBS Trust/PPO |
$138.61
|
| Rate for Payer: BCN Commercial |
$138.61
|
| Rate for Payer: BCN Medicare Advantage |
$42.15
|
| Rate for Payer: Cash Price |
$134.88
|
| Rate for Payer: Cofinity Commercial |
$145.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.15
|
| Rate for Payer: Healthscope Commercial |
$151.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.45
|
| Rate for Payer: Mclaren Medicaid |
$29.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.26
|
| Rate for Payer: Meridian Medicaid |
$31.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.31
|
| Rate for Payer: Nomi Health Commercial |
$138.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.45
|
| Rate for Payer: PACE Senior Care Partners |
$40.04
|
| Rate for Payer: PACE SWMI |
$42.15
|
| Rate for Payer: PHP Commercial |
$143.31
|
| Rate for Payer: PHP Medicare Advantage |
$42.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.68
|
| Rate for Payer: Priority Health Medicare |
$42.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.35
|
| Rate for Payer: Railroad Medicare Medicare |
$42.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.37
|
| Rate for Payer: UHC Core |
$140.78
|
| Rate for Payer: UHC Exchange |
$42.15
|
| Rate for Payer: UHC Medicaid |
$29.72
|
| Rate for Payer: UHC Medicare Advantage |
$42.15
|
| Rate for Payer: UHCCP Medicaid |
$29.72
|
| Rate for Payer: VA VA |
$42.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.45
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$168.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$117.35 |
| Max. Negotiated Rate |
$151.74 |
| Rate for Payer: Aetna Commercial |
$143.31
|
| Rate for Payer: BCBS Trust/PPO |
$139.25
|
| Rate for Payer: BCN Commercial |
$139.25
|
| Rate for Payer: Cash Price |
$134.88
|
| Rate for Payer: Cofinity Commercial |
$145.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.88
|
| Rate for Payer: Healthscope Commercial |
$151.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.31
|
| Rate for Payer: Nomi Health Commercial |
$138.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.45
|
| Rate for Payer: PHP Commercial |
$143.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.37
|
| Rate for Payer: UHC Core |
$140.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.45
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
OP
|
$91.91
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna Commercial |
$78.12
|
| Rate for Payer: Aetna Medicare |
$23.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.72
|
| Rate for Payer: BCBS Complete |
$17.01
|
| Rate for Payer: BCBS MAPPO |
$22.98
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: BCN Commercial |
$75.56
|
| Rate for Payer: BCN Medicare Advantage |
$22.98
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$82.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.93
|
| Rate for Payer: Mclaren Medicaid |
$16.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.13
|
| Rate for Payer: Meridian Medicaid |
$17.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: Nomi Health Commercial |
$75.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.93
|
| Rate for Payer: PACE Senior Care Partners |
$21.83
|
| Rate for Payer: PACE SWMI |
$22.98
|
| Rate for Payer: PHP Commercial |
$78.12
|
| Rate for Payer: PHP Medicare Advantage |
$22.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.96
|
| Rate for Payer: Priority Health Medicare |
$23.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.97
|
| Rate for Payer: Railroad Medicare Medicare |
$22.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.88
|
| Rate for Payer: UHC Core |
$76.74
|
| Rate for Payer: UHC Exchange |
$22.98
|
| Rate for Payer: UHC Medicaid |
$16.20
|
| Rate for Payer: UHC Medicare Advantage |
$22.98
|
| Rate for Payer: UHCCP Medicaid |
$16.20
|
| Rate for Payer: VA VA |
$22.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.93
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$91.91
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna Commercial |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$75.91
|
| Rate for Payer: BCN Commercial |
$75.91
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$82.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: Nomi Health Commercial |
$75.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.93
|
| Rate for Payer: PHP Commercial |
$78.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.88
|
| Rate for Payer: UHC Core |
$76.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.93
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
OP
|
$274.46
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.39 |
| Max. Negotiated Rate |
$247.01 |
| Rate for Payer: Aetna Commercial |
$233.29
|
| Rate for Payer: Aetna Medicare |
$71.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.77
|
| Rate for Payer: BCBS Complete |
$50.80
|
| Rate for Payer: BCBS MAPPO |
$68.61
|
| Rate for Payer: BCBS Trust/PPO |
$225.63
|
| Rate for Payer: BCN Commercial |
$225.63
|
| Rate for Payer: BCN Medicare Advantage |
$68.61
|
| Rate for Payer: Cash Price |
$219.57
|
| Rate for Payer: Cofinity Commercial |
$236.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.61
|
| Rate for Payer: Healthscope Commercial |
$247.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.84
|
| Rate for Payer: Mclaren Medicaid |
$48.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.05
|
| Rate for Payer: Meridian Medicaid |
$50.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.29
|
| Rate for Payer: Nomi Health Commercial |
$225.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.84
|
| Rate for Payer: PACE Senior Care Partners |
$65.18
|
| Rate for Payer: PACE SWMI |
$68.61
|
| Rate for Payer: PHP Commercial |
$233.29
|
| Rate for Payer: PHP Medicare Advantage |
$68.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.78
|
| Rate for Payer: Priority Health Medicare |
$69.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.02
|
| Rate for Payer: Railroad Medicare Medicare |
$68.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.52
|
| Rate for Payer: UHC Core |
$229.17
|
| Rate for Payer: UHC Exchange |
$68.61
|
| Rate for Payer: UHC Medicaid |
$48.39
|
| Rate for Payer: UHC Medicare Advantage |
$68.61
|
| Rate for Payer: UHCCP Medicaid |
$48.39
|
| Rate for Payer: VA VA |
$68.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.84
|
|
