|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
IP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.77 |
| Max. Negotiated Rate |
$277.99 |
| Rate for Payer: Aetna Commercial |
$262.55
|
| Rate for Payer: BCBS Trust/PPO |
$252.14
|
| Rate for Payer: BCN Commercial |
$238.70
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$265.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Healthscope Commercial |
$277.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: PHP Commercial |
$262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health HMO/PPO |
$268.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.81
|
| Rate for Payer: UHC Core |
$257.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.66
|
|
|
HC NUSHIELD 2X4 PER SQ CM
|
Facility
|
OP
|
$308.88
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$277.99 |
| Rate for Payer: Aetna Commercial |
$262.55
|
| Rate for Payer: Aetna Medicare |
$80.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.52
|
| Rate for Payer: BCBS Complete |
$123.55
|
| Rate for Payer: BCBS MAPPO |
$77.22
|
| Rate for Payer: BCBS Trust/PPO |
$253.93
|
| Rate for Payer: BCN Commercial |
$240.15
|
| Rate for Payer: BCN Medicare Advantage |
$77.22
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cofinity Commercial |
$265.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.22
|
| Rate for Payer: Healthscope Commercial |
$277.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.55
|
| Rate for Payer: Nomi Health Commercial |
$253.28
|
| Rate for Payer: PACE Senior Care Partners |
$73.36
|
| Rate for Payer: PACE SWMI |
$77.22
|
| Rate for Payer: PHP Commercial |
$262.55
|
| Rate for Payer: PHP Medicare Advantage |
$77.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.77
|
| Rate for Payer: Priority Health HMO/PPO |
$268.73
|
| Rate for Payer: Priority Health Medicare |
$77.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.95
|
| Rate for Payer: Railroad Medicare Medicare |
$77.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.81
|
| Rate for Payer: UHC Core |
$257.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.22
|
| Rate for Payer: UHC Exchange |
$77.22
|
| Rate for Payer: UHC Medicare Advantage |
$77.22
|
| Rate for Payer: VA VA |
$77.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.66
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
IP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.72 |
| Max. Negotiated Rate |
$268.23 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: BCBS Trust/PPO |
$243.28
|
| Rate for Payer: BCN Commercial |
$230.32
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$256.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Healthscope Commercial |
$268.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: PHP Commercial |
$253.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health HMO/PPO |
$259.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.27
|
| Rate for Payer: UHC Core |
$248.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.52
|
|
|
HC NUSHIELD 3X4 PER SQ CM
|
Facility
|
OP
|
$298.03
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.78 |
| Max. Negotiated Rate |
$268.23 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Aetna Medicare |
$77.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.13
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS MAPPO |
$74.51
|
| Rate for Payer: BCBS Trust/PPO |
$245.01
|
| Rate for Payer: BCN Commercial |
$231.72
|
| Rate for Payer: BCN Medicare Advantage |
$74.51
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cofinity Commercial |
$256.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.51
|
| Rate for Payer: Healthscope Commercial |
$268.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.33
|
| Rate for Payer: Nomi Health Commercial |
$244.38
|
| Rate for Payer: PACE Senior Care Partners |
$70.78
|
| Rate for Payer: PACE SWMI |
$74.51
|
| Rate for Payer: PHP Commercial |
$253.33
|
| Rate for Payer: PHP Medicare Advantage |
$74.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.72
|
| Rate for Payer: Priority Health HMO/PPO |
$259.29
|
| Rate for Payer: Priority Health Medicare |
$75.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.68
|
| Rate for Payer: Railroad Medicare Medicare |
$74.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.27
|
| Rate for Payer: UHC Core |
$248.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.51
|
| Rate for Payer: UHC Exchange |
$74.51
|
| Rate for Payer: UHC Medicare Advantage |
$74.51
|
| Rate for Payer: VA VA |
$74.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.52
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
IP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$208.48 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: BCBS Trust/PPO |
$189.10
|
| Rate for Payer: BCN Commercial |
$179.02
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$208.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health HMO/PPO |
$201.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.85
|
| Rate for Payer: UHC Core |
$193.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC NUSHIELD 4X4 PER SQ CM
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
CPT Q4160
|
| Hospital Charge Code |
63600177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$208.48 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Medicare |
$60.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.39
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: BCBS MAPPO |
$57.91
|
| Rate for Payer: BCBS Trust/PPO |
$190.44
|
| Rate for Payer: BCN Commercial |
$180.11
|
| Rate for Payer: BCN Medicare Advantage |
$57.91
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.91
|
| Rate for Payer: Healthscope Commercial |
$208.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Nomi Health Commercial |
$189.95
|
| Rate for Payer: PACE Senior Care Partners |
$55.02
|
| Rate for Payer: PACE SWMI |
$57.91
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Medicare Advantage |
$57.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health HMO/PPO |
$201.54
|
| Rate for Payer: Priority Health Medicare |
$58.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.21
|
| Rate for Payer: Railroad Medicare Medicare |
$57.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.85
|
| Rate for Payer: UHC Core |
$193.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.91
|
| Rate for Payer: UHC Exchange |
$57.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.91
|
| Rate for Payer: VA VA |
$57.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
IP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.67 |
| Max. Negotiated Rate |
$146.31 |
| Rate for Payer: Aetna Commercial |
$138.18
|
| Rate for Payer: BCBS Trust/PPO |
$132.71
|
| Rate for Payer: BCN Commercial |
$125.63
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$139.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Healthscope Commercial |
$146.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: PHP Commercial |
$138.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health HMO/PPO |
$141.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.06
|
| Rate for Payer: UHC Core |
$135.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.93
|
|
|
HC NUSHIELD 4X6 PER SQ CM
|
Facility
|
OP
|
$162.57
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$146.31 |
| Rate for Payer: Aetna Commercial |
$138.18
|
| Rate for Payer: Aetna Medicare |
$42.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.80
|
| Rate for Payer: BCBS Complete |
$65.03
|
| Rate for Payer: BCBS MAPPO |
$40.64
|
| Rate for Payer: BCBS Trust/PPO |
$133.65
|
| Rate for Payer: BCN Commercial |
$126.40
|
| Rate for Payer: BCN Medicare Advantage |
$40.64
|
| Rate for Payer: Cash Price |
$130.06
|
| Rate for Payer: Cofinity Commercial |
$139.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.64
|
| Rate for Payer: Healthscope Commercial |
$146.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.18
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: PACE Senior Care Partners |
$38.61
|
| Rate for Payer: PACE SWMI |
$40.64
|
| Rate for Payer: PHP Commercial |
$138.18
|
| Rate for Payer: PHP Medicare Advantage |
$40.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health HMO/PPO |
$141.44
|
| Rate for Payer: Priority Health Medicare |
$41.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.92
|
| Rate for Payer: Railroad Medicare Medicare |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.06
|
| Rate for Payer: UHC Core |
$135.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.64
|
| Rate for Payer: UHC Exchange |
$40.64
|
| Rate for Payer: UHC Medicare Advantage |
$40.64
|
| Rate for Payer: VA VA |
$40.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.93
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
IP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.55 |
| Max. Negotiated Rate |
$129.54 |
| Rate for Payer: Aetna Commercial |
$122.34
|
| Rate for Payer: BCBS Trust/PPO |
$117.49
|
| Rate for Payer: BCN Commercial |
$111.23
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$123.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Healthscope Commercial |
$129.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: Nomi Health Commercial |
$118.02
|
| Rate for Payer: PHP Commercial |
$122.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: Priority Health HMO/PPO |
$125.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.66
|
| Rate for Payer: UHC Core |
$120.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.95
|
|
|
HC NUSHIELD 6X6 PER SQ CM
|
Facility
|
OP
|
$143.93
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$129.54 |
| Rate for Payer: Aetna Commercial |
$122.34
|
| Rate for Payer: Aetna Medicare |
$37.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.98
|
| Rate for Payer: BCBS Complete |
$57.57
|
| Rate for Payer: BCBS MAPPO |
$35.98
|
| Rate for Payer: BCBS Trust/PPO |
$118.32
|
| Rate for Payer: BCN Commercial |
$111.91
|
| Rate for Payer: BCN Medicare Advantage |
$35.98
|
| Rate for Payer: Cash Price |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$123.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.98
|
| Rate for Payer: Healthscope Commercial |
$129.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.34
|
| Rate for Payer: Nomi Health Commercial |
$118.02
|
| Rate for Payer: PACE Senior Care Partners |
$34.18
|
| Rate for Payer: PACE SWMI |
$35.98
|
| Rate for Payer: PHP Commercial |
$122.34
|
| Rate for Payer: PHP Medicare Advantage |
$35.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.55
|
| Rate for Payer: Priority Health HMO/PPO |
$125.22
|
| Rate for Payer: Priority Health Medicare |
$36.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.43
|
| Rate for Payer: Railroad Medicare Medicare |
$35.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.66
|
| Rate for Payer: UHC Core |
$120.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.98
|
| Rate for Payer: UHC Exchange |
$35.98
|
| Rate for Payer: UHC Medicare Advantage |
$35.98
|
| Rate for Payer: VA VA |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.95
|
|
|
HC NUT ALLERGEN PANEL
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
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 NUT ALLERGEN PANEL
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200123
|
|
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 NVU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.43
|
| Rate for Payer: BCN Commercial |
$112.12
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC NVU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200004
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC OAK IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
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 OAK IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200050
|
|
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 OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
OP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$48.77 |
| Rate for Payer: Aetna Commercial |
$46.06
|
| Rate for Payer: Aetna Medicare |
$14.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.93
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: BCBS MAPPO |
$13.55
|
| Rate for Payer: BCBS Trust/PPO |
$44.55
|
| Rate for Payer: BCN Commercial |
$42.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.55
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$46.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: PACE Senior Care Partners |
$12.87
|
| Rate for Payer: PACE SWMI |
$13.55
|
| Rate for Payer: PHP Commercial |
$46.06
|
| Rate for Payer: PHP Medicare Advantage |
$13.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: Priority Health HMO/PPO |
$47.15
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.31
|
| Rate for Payer: Railroad Medicare Medicare |
$13.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.69
|
| Rate for Payer: UHC Core |
$45.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.55
|
| Rate for Payer: UHC Exchange |
$13.55
|
| Rate for Payer: UHC Medicare Advantage |
$13.55
|
| Rate for Payer: VA VA |
$13.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.64
|
|
|
HC OASIS ULTRA TRI LAYER WD MATRIX PER SQ CM
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
HCPCS Q4124
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$48.77 |
| Rate for Payer: Aetna Commercial |
$46.06
|
| Rate for Payer: BCBS Trust/PPO |
$44.24
|
| Rate for Payer: BCN Commercial |
$41.88
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$46.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: PHP Commercial |
$46.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.22
|
| Rate for Payer: Priority Health HMO/PPO |
$47.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.69
|
| Rate for Payer: UHC Core |
$45.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.64
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
IP
|
$31.92
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: BCBS Trust/PPO |
$26.06
|
| Rate for Payer: BCN Commercial |
$24.67
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$28.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: PHP Commercial |
$27.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health HMO/PPO |
$27.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.09
|
| Rate for Payer: UHC Core |
$26.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.94
|
|
|
HC OASIS WD MATRIX PER SQ CM
|
Facility
|
OP
|
$31.92
|
|
|
Service Code
|
HCPCS Q4102
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: Aetna Medicare |
$8.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.98
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: BCBS MAPPO |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$24.82
|
| Rate for Payer: BCN Medicare Advantage |
$7.98
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.98
|
| Rate for Payer: Healthscope Commercial |
$28.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$26.17
|
| Rate for Payer: PACE Senior Care Partners |
$7.58
|
| Rate for Payer: PACE SWMI |
$7.98
|
| Rate for Payer: PHP Commercial |
$27.13
|
| Rate for Payer: PHP Medicare Advantage |
$7.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.75
|
| Rate for Payer: Priority Health HMO/PPO |
$27.77
|
| Rate for Payer: Priority Health Medicare |
$8.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.39
|
| Rate for Payer: Railroad Medicare Medicare |
$7.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.09
|
| Rate for Payer: UHC Core |
$26.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.98
|
| Rate for Payer: UHC Exchange |
$7.98
|
| Rate for Payer: UHC Medicare Advantage |
$7.98
|
| Rate for Payer: VA VA |
$7.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.94
|
|
|
HC OAT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
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 OAT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200051
|
|
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 OB ANTEPARTUM R&B
|
Facility
|
IP
|
$3,634.61
|
|
| Hospital Charge Code |
20000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$3,271.15 |
| Rate for Payer: Aetna Commercial |
$3,089.42
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,966.93
|
| Rate for Payer: BCN Commercial |
$2,808.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$2,907.69
|
| Rate for Payer: Cash Price |
$2,907.69
|
| Rate for Payer: Cofinity Commercial |
$3,125.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,907.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$3,271.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,725.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.42
|
| Rate for Payer: Nomi Health Commercial |
$2,980.38
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$3,089.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,362.50
|
| Rate for Payer: Priority Health HMO/PPO |
$3,162.11
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,435.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,198.46
|
| Rate for Payer: UHC Core |
$3,034.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,725.96
|
|
|
HC OB DELIVERY R&B
|
Facility
|
IP
|
$1,810.72
|
|
| Hospital Charge Code |
11200001
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,176.97 |
| Max. Negotiated Rate |
$2,337.50 |
| Rate for Payer: Aetna Commercial |
$1,539.11
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.09
|
| Rate for Payer: BCN Commercial |
$1,399.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cash Price |
$1,448.58
|
| Rate for Payer: Cofinity Commercial |
$1,557.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$1,629.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.11
|
| Rate for Payer: Nomi Health Commercial |
$1,484.79
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$1,539.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,176.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1,575.33
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,213.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,593.43
|
| Rate for Payer: UHC Core |
$1,511.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.04
|
|
|
HC OB HIGH RISK R&B
|
Facility
|
IP
|
$3,983.98
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$3,585.58 |
| Rate for Payer: Aetna Commercial |
$3,386.38
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,252.12
|
| Rate for Payer: BCN Commercial |
$3,078.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$3,187.18
|
| Rate for Payer: Cash Price |
$3,187.18
|
| Rate for Payer: Cofinity Commercial |
$3,426.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,187.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$3,585.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,987.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,386.38
|
| Rate for Payer: Nomi Health Commercial |
$3,266.86
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$3,386.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,589.59
|
| Rate for Payer: Priority Health HMO/PPO |
$3,466.06
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,669.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,505.90
|
| Rate for Payer: UHC Core |
$3,326.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,987.98
|
|
