|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
IP
|
$274.46
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$191.02 |
| Max. Negotiated Rate |
$247.01 |
| Rate for Payer: Aetna Commercial |
$233.29
|
| Rate for Payer: BCBS Trust/PPO |
$226.68
|
| Rate for Payer: BCN Commercial |
$226.68
|
| 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: Healthscope Commercial |
$247.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.84
|
| 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: PHP Commercial |
$233.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.52
|
| Rate for Payer: UHC Core |
$229.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.84
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$274.46
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
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
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$274.46
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$191.02 |
| Max. Negotiated Rate |
$247.01 |
| Rate for Payer: Aetna Commercial |
$233.29
|
| Rate for Payer: BCBS Trust/PPO |
$226.68
|
| Rate for Payer: BCN Commercial |
$226.68
|
| 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: Healthscope Commercial |
$247.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.84
|
| 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: PHP Commercial |
$233.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.52
|
| Rate for Payer: UHC Core |
$229.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.84
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$361.16 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: Aetna Medicare |
$532.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$640.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$640.17
|
| Rate for Payer: BCBS Complete |
$379.19
|
| Rate for Payer: BCBS MAPPO |
$512.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.11
|
| Rate for Payer: BCN Commercial |
$1,684.11
|
| Rate for Payer: BCN Medicare Advantage |
$512.14
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.14
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Mclaren Medicaid |
$361.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.74
|
| Rate for Payer: Meridian Medicaid |
$379.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$563.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PACE Senior Care Partners |
$486.53
|
| Rate for Payer: PACE SWMI |
$512.14
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: PHP Medicare Advantage |
$512.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,782.24
|
| Rate for Payer: Priority Health Medicare |
$517.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.79
|
| Rate for Payer: Railroad Medicare Medicare |
$512.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.72
|
| Rate for Payer: UHC Core |
$1,710.54
|
| Rate for Payer: UHC Exchange |
$512.14
|
| Rate for Payer: UHC Medicaid |
$361.16
|
| Rate for Payer: UHC Medicare Advantage |
$512.14
|
| Rate for Payer: UHCCP Medicaid |
$361.16
|
| Rate for Payer: VA VA |
$512.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,425.79 |
| Max. Negotiated Rate |
$1,843.69 |
| Rate for Payer: Aetna Commercial |
$1,741.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.90
|
| Rate for Payer: BCN Commercial |
$1,691.90
|
| Rate for Payer: Cash Price |
$1,638.84
|
| Rate for Payer: Cofinity Commercial |
$1,761.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,638.84
|
| Rate for Payer: Healthscope Commercial |
$1,843.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,536.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.27
|
| Rate for Payer: Nomi Health Commercial |
$1,679.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.41
|
| Rate for Payer: PHP Commercial |
$1,741.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,782.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,802.72
|
| Rate for Payer: UHC Core |
$1,710.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,536.41
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$757.85 |
| Rate for Payer: Aetna Commercial |
$715.75
|
| Rate for Payer: Aetna Medicare |
$218.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.14
|
| Rate for Payer: BCBS Complete |
$155.87
|
| Rate for Payer: BCBS MAPPO |
$210.51
|
| Rate for Payer: BCBS Trust/PPO |
$692.26
|
| Rate for Payer: BCN Commercial |
$692.26
|
| Rate for Payer: BCN Medicare Advantage |
$210.51
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Commercial |
$724.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.51
|
| Rate for Payer: Healthscope Commercial |
$757.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.54
|
| Rate for Payer: Mclaren Medicaid |
$148.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.04
|
| Rate for Payer: Meridian Medicaid |
$155.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$231.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.75
|
| Rate for Payer: Nomi Health Commercial |
$690.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: PACE Senior Care Partners |
$199.99
|
| Rate for Payer: PACE SWMI |
$210.51
|
| Rate for Payer: PHP Commercial |
$715.75
|
| Rate for Payer: PHP Medicare Advantage |
$210.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$732.59
|
| Rate for Payer: Priority Health Medicare |
$212.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.07
|
| Rate for Payer: Railroad Medicare Medicare |
$210.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.01
|
| Rate for Payer: UHC Core |
$703.12
|
| Rate for Payer: UHC Exchange |
$210.51
|
| Rate for Payer: UHC Medicaid |
$148.46
|
| Rate for Payer: UHC Medicare Advantage |
$210.51
|
| Rate for Payer: UHCCP Medicaid |
$148.46
|
| Rate for Payer: VA VA |
$210.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.54
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$842.06
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$586.07 |
| Max. Negotiated Rate |
$757.85 |
| Rate for Payer: Aetna Commercial |
$715.75
|
| Rate for Payer: BCBS Trust/PPO |
$695.46
|
| Rate for Payer: BCN Commercial |
$695.46
|
| Rate for Payer: Cash Price |
$673.65
|
| Rate for Payer: Cofinity Commercial |
$724.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.65
|
| Rate for Payer: Healthscope Commercial |
$757.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.75
|
| Rate for Payer: Nomi Health Commercial |
$690.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.54
|
| Rate for Payer: PHP Commercial |
$715.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$732.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.01
|
| Rate for Payer: UHC Core |
$703.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.54
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,697.12
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,181.20 |
| Max. Negotiated Rate |
$1,527.41 |
| Rate for Payer: Aetna Commercial |
$1,442.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.65
|
| Rate for Payer: BCN Commercial |
$1,401.65
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cofinity Commercial |
$1,459.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.70
|
| Rate for Payer: Healthscope Commercial |
$1,527.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,272.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.55
|
| Rate for Payer: Nomi Health Commercial |
$1,391.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,272.84
|
| Rate for Payer: PHP Commercial |
$1,442.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,476.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,493.47
|
| Rate for Payer: UHC Core |
$1,417.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,272.84
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,697.12
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$1,527.41 |
| Rate for Payer: Aetna Commercial |
$1,442.55
|
| Rate for Payer: Aetna Medicare |
$441.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$530.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$530.35
|
| Rate for Payer: BCBS Complete |
$314.14
|
| Rate for Payer: BCBS MAPPO |
$424.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.20
|
| Rate for Payer: BCN Commercial |
$1,395.20
|
| Rate for Payer: BCN Medicare Advantage |
$424.28
|
| Rate for Payer: Cash Price |
$1,357.70
|
| Rate for Payer: Cofinity Commercial |
$1,459.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.28
|
| Rate for Payer: Healthscope Commercial |
$1,527.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,272.84
|
| Rate for Payer: Mclaren Medicaid |
$299.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.49
|
| Rate for Payer: Meridian Medicaid |
$314.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$487.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$466.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.55
|
| Rate for Payer: Nomi Health Commercial |
$1,391.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,272.84
|
| Rate for Payer: PACE Senior Care Partners |
$403.07
|
| Rate for Payer: PACE SWMI |
$424.28
|
| Rate for Payer: PHP Commercial |
$1,442.55
|
| Rate for Payer: PHP Medicare Advantage |
$424.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,476.49
|
| Rate for Payer: Priority Health Medicare |
$428.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.20
|
| Rate for Payer: Railroad Medicare Medicare |
$424.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,493.47
|
| Rate for Payer: UHC Core |
$1,417.10
|
| Rate for Payer: UHC Exchange |
$424.28
|
| Rate for Payer: UHC Medicaid |
$299.20
|
| Rate for Payer: UHC Medicare Advantage |
$424.28
|
| Rate for Payer: UHCCP Medicaid |
$299.20
|
| Rate for Payer: VA VA |
$424.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,272.84
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.54
|
| Rate for Payer: BCN Commercial |
$131.54
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$28.21
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,551.92
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$1,396.73 |
| Rate for Payer: Aetna Commercial |
$1,319.13
|
| Rate for Payer: Aetna Medicare |
$403.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$484.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$484.98
|
| Rate for Payer: BCBS Complete |
$287.26
|
| Rate for Payer: BCBS MAPPO |
$387.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,275.83
|
| Rate for Payer: BCN Commercial |
$1,275.83
|
| Rate for Payer: BCN Medicare Advantage |
$387.98
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cofinity Commercial |
$1,334.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.98
|
| Rate for Payer: Healthscope Commercial |
$1,396.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,163.94
|
| Rate for Payer: Mclaren Medicaid |
$273.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.38
|
| Rate for Payer: Meridian Medicaid |
$287.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$446.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$426.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.13
|
| Rate for Payer: Nomi Health Commercial |
$1,272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.94
|
| Rate for Payer: PACE Senior Care Partners |
$368.58
|
| Rate for Payer: PACE SWMI |
$387.98
|
| Rate for Payer: PHP Commercial |
$1,319.13
|
| Rate for Payer: PHP Medicare Advantage |
$387.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,350.17
|
| Rate for Payer: Priority Health Medicare |
$391.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,080.14
|
| Rate for Payer: Railroad Medicare Medicare |
$387.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,365.69
|
| Rate for Payer: UHC Core |
$1,295.85
|
| Rate for Payer: UHC Exchange |
$387.98
|
| Rate for Payer: UHC Medicaid |
$273.60
|
| Rate for Payer: UHC Medicare Advantage |
$387.98
|
| Rate for Payer: UHCCP Medicaid |
$273.60
|
| Rate for Payer: VA VA |
$387.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,163.94
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,551.92
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,080.14 |
| Max. Negotiated Rate |
$1,396.73 |
| Rate for Payer: Aetna Commercial |
$1,319.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.73
|
| Rate for Payer: BCN Commercial |
$1,281.73
|
| Rate for Payer: Cash Price |
$1,241.54
|
| Rate for Payer: Cofinity Commercial |
$1,334.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.54
|
| Rate for Payer: Healthscope Commercial |
$1,396.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,163.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.13
|
| Rate for Payer: Nomi Health Commercial |
$1,272.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,163.94
|
| Rate for Payer: PHP Commercial |
$1,319.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,350.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,080.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,365.69
|
| Rate for Payer: UHC Core |
$1,295.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,163.94
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,341.51
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$236.51 |
| Max. Negotiated Rate |
$1,207.36 |
| Rate for Payer: Aetna Commercial |
$1,140.28
|
| Rate for Payer: Aetna Medicare |
$348.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$419.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$419.22
|
| Rate for Payer: BCBS Complete |
$248.31
|
| Rate for Payer: BCBS MAPPO |
$335.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.86
|
| Rate for Payer: BCN Commercial |
$1,102.86
|
| Rate for Payer: BCN Medicare Advantage |
$335.38
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cofinity Commercial |
$1,153.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.38
|
| Rate for Payer: Healthscope Commercial |
$1,207.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.13
|
| Rate for Payer: Mclaren Medicaid |
$236.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.15
|
| Rate for Payer: Meridian Medicaid |
$248.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$368.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.28
|
| Rate for Payer: Nomi Health Commercial |
$1,100.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.13
|
| Rate for Payer: PACE Senior Care Partners |
$318.61
|
| Rate for Payer: PACE SWMI |
$335.38
|
| Rate for Payer: PHP Commercial |
$1,140.28
|
| Rate for Payer: PHP Medicare Advantage |
$335.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,167.11
|
| Rate for Payer: Priority Health Medicare |
$338.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$933.69
|
| Rate for Payer: Railroad Medicare Medicare |
$335.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,180.53
|
| Rate for Payer: UHC Core |
$1,120.16
|
| Rate for Payer: UHC Exchange |
$335.38
|
| Rate for Payer: UHC Medicaid |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$335.38
|
| Rate for Payer: UHCCP Medicaid |
$236.51
|
| Rate for Payer: VA VA |
$335.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.13
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,341.51
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$933.69 |
| Max. Negotiated Rate |
$1,207.36 |
| Rate for Payer: Aetna Commercial |
$1,140.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.95
|
| Rate for Payer: BCN Commercial |
$1,107.95
|
| Rate for Payer: Cash Price |
$1,073.21
|
| Rate for Payer: Cofinity Commercial |
$1,153.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.21
|
| Rate for Payer: Healthscope Commercial |
$1,207.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.28
|
| Rate for Payer: Nomi Health Commercial |
$1,100.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.13
|
| Rate for Payer: PHP Commercial |
$1,140.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,167.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$933.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,180.53
|
| Rate for Payer: UHC Core |
$1,120.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.13
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,235.07
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.74 |
| Max. Negotiated Rate |
$1,111.56 |
| Rate for Payer: Aetna Commercial |
$1,049.81
|
| Rate for Payer: Aetna Medicare |
$321.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$385.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$385.96
|
| Rate for Payer: BCBS Complete |
$228.61
|
| Rate for Payer: BCBS MAPPO |
$308.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.35
|
| Rate for Payer: BCN Commercial |
$1,015.35
|
| Rate for Payer: BCN Medicare Advantage |
$308.77
|
| Rate for Payer: Cash Price |
$988.06
|
| Rate for Payer: Cofinity Commercial |
$1,062.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.77
|
| Rate for Payer: Healthscope Commercial |
$1,111.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$926.30
|
| Rate for Payer: Mclaren Medicaid |
$217.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.21
|
| Rate for Payer: Meridian Medicaid |
$228.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$355.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$339.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.81
|
| Rate for Payer: Nomi Health Commercial |
$1,012.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.30
|
| Rate for Payer: PACE Senior Care Partners |
$293.33
|
| Rate for Payer: PACE SWMI |
$308.77
|
| Rate for Payer: PHP Commercial |
$1,049.81
|
| Rate for Payer: PHP Medicare Advantage |
$308.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,074.51
|
| Rate for Payer: Priority Health Medicare |
$311.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$859.61
|
| Rate for Payer: Railroad Medicare Medicare |
$308.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.86
|
| Rate for Payer: UHC Core |
$1,031.28
|
| Rate for Payer: UHC Exchange |
$308.77
|
| Rate for Payer: UHC Medicaid |
$217.74
|
| Rate for Payer: UHC Medicare Advantage |
$308.77
|
| Rate for Payer: UHCCP Medicaid |
$217.74
|
| Rate for Payer: VA VA |
$308.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$926.30
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,235.07
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$859.61 |
| Max. Negotiated Rate |
$1,111.56 |
| Rate for Payer: Aetna Commercial |
$1,049.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,020.04
|
| Rate for Payer: BCN Commercial |
$1,020.04
|
| Rate for Payer: Cash Price |
$988.06
|
| Rate for Payer: Cofinity Commercial |
$1,062.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.06
|
| Rate for Payer: Healthscope Commercial |
$1,111.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$926.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.81
|
| Rate for Payer: Nomi Health Commercial |
$1,012.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.30
|
| Rate for Payer: PHP Commercial |
$1,049.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,074.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$859.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,086.86
|
| Rate for Payer: UHC Core |
$1,031.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$926.30
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,555.53
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,082.65 |
| Max. Negotiated Rate |
$1,399.98 |
| Rate for Payer: Aetna Commercial |
$1,322.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.71
|
| Rate for Payer: BCN Commercial |
$1,284.71
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cofinity Commercial |
$1,337.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,244.42
|
| Rate for Payer: Healthscope Commercial |
$1,399.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,166.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.20
|
| Rate for Payer: Nomi Health Commercial |
$1,275.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,166.65
|
| Rate for Payer: PHP Commercial |
$1,322.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,353.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,082.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,368.87
|
| Rate for Payer: UHC Core |
$1,298.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,166.65
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,555.53
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$274.24 |
| Max. Negotiated Rate |
$1,399.98 |
| Rate for Payer: Aetna Commercial |
$1,322.20
|
| Rate for Payer: Aetna Medicare |
$404.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.10
|
| Rate for Payer: BCBS Complete |
$287.93
|
| Rate for Payer: BCBS MAPPO |
$388.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.80
|
| Rate for Payer: BCN Commercial |
$1,278.80
|
| Rate for Payer: BCN Medicare Advantage |
$388.88
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cofinity Commercial |
$1,337.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,244.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.88
|
| Rate for Payer: Healthscope Commercial |
$1,399.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,166.65
|
| Rate for Payer: Mclaren Medicaid |
$274.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.33
|
| Rate for Payer: Meridian Medicaid |
$287.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$427.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.20
|
| Rate for Payer: Nomi Health Commercial |
$1,275.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,166.65
|
| Rate for Payer: PACE Senior Care Partners |
$369.44
|
| Rate for Payer: PACE SWMI |
$388.88
|
| Rate for Payer: PHP Commercial |
$1,322.20
|
| Rate for Payer: PHP Medicare Advantage |
$388.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,353.31
|
| Rate for Payer: Priority Health Medicare |
$392.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,082.65
|
| Rate for Payer: Railroad Medicare Medicare |
$388.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,368.87
|
| Rate for Payer: UHC Core |
$1,298.87
|
| Rate for Payer: UHC Exchange |
$388.88
|
| Rate for Payer: UHC Medicaid |
$274.24
|
| Rate for Payer: UHC Medicare Advantage |
$388.88
|
| Rate for Payer: UHCCP Medicaid |
$274.24
|
| Rate for Payer: VA VA |
$388.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,166.65
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCCCP Commercial |
$16.76
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Mclaren Medicaid |
$8.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$8.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.39
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.71
|
| Rate for Payer: Priority Health Medicare |
$12.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.19
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicaid |
$8.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$8.45
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.59
|
| Rate for Payer: BCN Commercial |
$39.59
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.95
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.19
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.95
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
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 PENICILLIUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
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 PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,054.22
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$733.74 |
| Max. Negotiated Rate |
$948.80 |
| Rate for Payer: Aetna Commercial |
$896.09
|
| Rate for Payer: BCBS Trust/PPO |
$870.68
|
| Rate for Payer: BCN Commercial |
$870.68
|
| Rate for Payer: Cash Price |
$843.38
|
| Rate for Payer: Cofinity Commercial |
$906.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.38
|
| Rate for Payer: Healthscope Commercial |
$948.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.09
|
| Rate for Payer: Nomi Health Commercial |
$864.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.66
|
| Rate for Payer: PHP Commercial |
$896.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$917.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$733.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.71
|
| Rate for Payer: UHC Core |
$880.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.66
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,054.22
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$185.86 |
| Max. Negotiated Rate |
$948.80 |
| Rate for Payer: Aetna Commercial |
$896.09
|
| Rate for Payer: Aetna Medicare |
$274.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.44
|
| Rate for Payer: BCBS Complete |
$195.14
|
| Rate for Payer: BCBS MAPPO |
$263.56
|
| Rate for Payer: BCBS Trust/PPO |
$866.67
|
| Rate for Payer: BCN Commercial |
$866.67
|
| Rate for Payer: BCN Medicare Advantage |
$263.56
|
| Rate for Payer: Cash Price |
$843.38
|
| Rate for Payer: Cofinity Commercial |
$906.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.56
|
| Rate for Payer: Healthscope Commercial |
$948.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.66
|
| Rate for Payer: Mclaren Medicaid |
$185.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.73
|
| Rate for Payer: Meridian Medicaid |
$195.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$289.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.09
|
| Rate for Payer: Nomi Health Commercial |
$864.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.66
|
| Rate for Payer: PACE Senior Care Partners |
$250.38
|
| Rate for Payer: PACE SWMI |
$263.56
|
| Rate for Payer: PHP Commercial |
$896.09
|
| Rate for Payer: PHP Medicare Advantage |
$263.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$917.17
|
| Rate for Payer: Priority Health Medicare |
$266.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$733.74
|
| Rate for Payer: Railroad Medicare Medicare |
$263.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.71
|
| Rate for Payer: UHC Core |
$880.27
|
| Rate for Payer: UHC Exchange |
$263.56
|
| Rate for Payer: UHC Medicaid |
$185.86
|
| Rate for Payer: UHC Medicare Advantage |
$263.56
|
| Rate for Payer: UHCCP Medicaid |
$185.86
|
| Rate for Payer: VA VA |
$263.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.66
|
|
