|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$35.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.10
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS MAPPO |
$33.68
|
| Rate for Payer: BCBS Trust/PPO |
$110.75
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$104.74
|
| Rate for Payer: BCN Medicare Advantage |
$33.68
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.68
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: PACE Senior Care Partners |
$31.99
|
| Rate for Payer: PACE SWMI |
$33.68
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Medicare |
$34.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.26
|
| Rate for Payer: Railroad Medicare Medicare |
$33.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.68
|
| Rate for Payer: UHC Exchange |
$33.68
|
| Rate for Payer: UHC Medicare Advantage |
$33.68
|
| Rate for Payer: VA VA |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.56 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$109.96
|
| Rate for Payer: BCN Commercial |
$104.10
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO |
$117.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
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 ORCHARD GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
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 ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna Medicare |
$19.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.59
|
| Rate for Payer: BCBS Complete |
$17.92
|
| Rate for Payer: BCBS MAPPO |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$62.05
|
| Rate for Payer: BCN Commercial |
$58.69
|
| Rate for Payer: BCN Medicare Advantage |
$18.87
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.61
|
| Rate for Payer: Mclaren Medicaid |
$17.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.81
|
| Rate for Payer: Meridian Medicaid |
$17.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: PACE Senior Care Partners |
$17.93
|
| Rate for Payer: PACE SWMI |
$18.87
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: PHP Medicare Advantage |
$18.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health HMO/PPO |
$65.67
|
| Rate for Payer: Priority Health Medicare |
$19.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.57
|
| Rate for Payer: Railroad Medicare Medicare |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.42
|
| Rate for Payer: UHC Core |
$63.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.87
|
| Rate for Payer: UHC Exchange |
$18.87
|
| Rate for Payer: UHC Medicare Advantage |
$18.87
|
| Rate for Payer: UHCCP Medicaid |
$17.06
|
| Rate for Payer: VA VA |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.61
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: BCBS Trust/PPO |
$61.61
|
| Rate for Payer: BCN Commercial |
$58.33
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health HMO/PPO |
$65.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.42
|
| Rate for Payer: UHC Core |
$63.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.61
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: BCBS Trust/PPO |
$224.48
|
| Rate for Payer: BCN Commercial |
$212.52
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: Nomi Health Commercial |
$225.50
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health HMO/PPO |
$239.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.94
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCBS Trust/PPO |
$226.08
|
| Rate for Payer: BCN Commercial |
$213.81
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: Nomi Health Commercial |
$225.50
|
| Rate for Payer: PACE Senior Care Partners |
$65.31
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health HMO/PPO |
$239.25
|
| Rate for Payer: Priority Health Medicare |
$69.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.25
|
| Rate for Payer: Railroad Medicare Medicare |
$68.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Exchange |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$68.75
|
| Rate for Payer: VA VA |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$48.98
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$49.20
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health HMO/PPO |
$52.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$49.33
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$49.20
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health HMO/PPO |
$52.20
|
| Rate for Payer: Priority Health Medicare |
$15.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Exchange |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.00
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
OP
|
$737.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.04 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Aetna Commercial |
$626.45
|
| Rate for Payer: Aetna Medicare |
$191.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.31
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: BCBS MAPPO |
$184.25
|
| Rate for Payer: BCBS Trust/PPO |
$605.89
|
| Rate for Payer: BCN Commercial |
$573.02
|
| Rate for Payer: BCN Medicare Advantage |
$184.25
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$633.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.25
|
| Rate for Payer: Healthscope Commercial |
$663.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: PACE Senior Care Partners |
$175.04
|
| Rate for Payer: PACE SWMI |
$184.25
|
| Rate for Payer: PHP Commercial |
$626.45
|
| Rate for Payer: PHP Medicare Advantage |
$184.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health HMO/PPO |
$641.19
|
| Rate for Payer: Priority Health Medicare |
$186.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.79
|
| Rate for Payer: Railroad Medicare Medicare |
$184.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.56
|
| Rate for Payer: UHC Core |
$615.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.25
|
| Rate for Payer: UHC Exchange |
$184.25
|
| Rate for Payer: UHC Medicare Advantage |
$184.25
|
| Rate for Payer: VA VA |
$184.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.75
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
IP
|
$737.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.05 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Aetna Commercial |
$626.45
|
| Rate for Payer: BCBS Trust/PPO |
$601.61
|
| Rate for Payer: BCN Commercial |
$569.55
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$633.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Healthscope Commercial |
$663.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: PHP Commercial |
$626.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health HMO/PPO |
$641.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.56
|
| Rate for Payer: UHC Core |
$615.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.75
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.94
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$20.75
|
| Rate for Payer: BCBS Trust/PPO |
$68.23
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: BCN Medicare Advantage |
$20.75
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: Nomi Health Commercial |
$68.06
|
| Rate for Payer: PACE Senior Care Partners |
$19.71
|
| Rate for Payer: PACE SWMI |
$20.75
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: PHP Medicare Advantage |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health HMO/PPO |
$72.21
|
| Rate for Payer: Priority Health Medicare |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.61
|
| Rate for Payer: Railroad Medicare Medicare |
$20.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.04
|
| Rate for Payer: UHC Core |
$69.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.75
|
| Rate for Payer: UHC Exchange |
$20.75
|
| Rate for Payer: UHC Medicare Advantage |
$20.75
|
| Rate for Payer: VA VA |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: BCBS Trust/PPO |
$67.75
|
| Rate for Payer: BCN Commercial |
$64.14
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: Nomi Health Commercial |
$68.06
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health HMO/PPO |
$72.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.04
|
| Rate for Payer: UHC Core |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: Aetna Medicare |
$222.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$267.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$267.81
|
| Rate for Payer: BCBS Complete |
$342.80
|
| Rate for Payer: BCBS MAPPO |
$214.25
|
| Rate for Payer: BCBS Trust/PPO |
$704.54
|
| Rate for Payer: BCN Commercial |
$666.32
|
| Rate for Payer: BCN Medicare Advantage |
$214.25
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.25
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Nomi Health Commercial |
$702.74
|
| Rate for Payer: PACE Senior Care Partners |
$203.54
|
| Rate for Payer: PACE SWMI |
$214.25
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: PHP Medicare Advantage |
$214.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: Priority Health HMO/PPO |
$745.59
|
| Rate for Payer: Priority Health Medicare |
$216.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$574.19
|
| Rate for Payer: Railroad Medicare Medicare |
$214.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.16
|
| Rate for Payer: UHC Core |
$715.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.25
|
| Rate for Payer: UHC Exchange |
$214.25
|
| Rate for Payer: UHC Medicare Advantage |
$214.25
|
| Rate for Payer: VA VA |
$214.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$557.05 |
| Max. Negotiated Rate |
$771.30 |
| Rate for Payer: Aetna Commercial |
$728.45
|
| Rate for Payer: BCBS Trust/PPO |
$699.57
|
| Rate for Payer: BCN Commercial |
$662.29
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$737.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$771.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Nomi Health Commercial |
$702.74
|
| Rate for Payer: PHP Commercial |
$728.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: Priority Health HMO/PPO |
$745.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$574.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.16
|
| Rate for Payer: UHC Core |
$715.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.75
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Medicare |
$25.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.94
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS MAPPO |
$24.75
|
| Rate for Payer: BCBS Trust/PPO |
$81.39
|
| Rate for Payer: BCN Commercial |
$76.97
|
| Rate for Payer: BCN Medicare Advantage |
$24.75
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.75
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.15
|
| Rate for Payer: Nomi Health Commercial |
$81.18
|
| Rate for Payer: PACE Senior Care Partners |
$23.51
|
| Rate for Payer: PACE SWMI |
$24.75
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: PHP Medicare Advantage |
$24.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health HMO/PPO |
$86.13
|
| Rate for Payer: Priority Health Medicare |
$25.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.33
|
| Rate for Payer: Railroad Medicare Medicare |
$24.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.12
|
| Rate for Payer: UHC Core |
$82.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.75
|
| Rate for Payer: UHC Exchange |
$24.75
|
| Rate for Payer: UHC Medicare Advantage |
$24.75
|
| Rate for Payer: VA VA |
$24.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: BCBS Trust/PPO |
$80.81
|
| Rate for Payer: BCN Commercial |
$76.51
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.15
|
| Rate for Payer: Nomi Health Commercial |
$81.18
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health HMO/PPO |
$86.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.12
|
| Rate for Payer: UHC Core |
$82.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.18 |
| Max. Negotiated Rate |
$1,103.40 |
| Rate for Payer: Aetna Commercial |
$1,042.10
|
| Rate for Payer: Aetna Medicare |
$318.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$383.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$383.12
|
| Rate for Payer: BCBS Complete |
$490.40
|
| Rate for Payer: BCBS MAPPO |
$306.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.89
|
| Rate for Payer: BCN Commercial |
$953.22
|
| Rate for Payer: BCN Medicare Advantage |
$306.50
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cofinity Commercial |
$1,054.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.50
|
| Rate for Payer: Healthscope Commercial |
$1,103.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.10
|
| Rate for Payer: Nomi Health Commercial |
$1,005.32
|
| Rate for Payer: PACE Senior Care Partners |
$291.18
|
| Rate for Payer: PACE SWMI |
$306.50
|
| Rate for Payer: PHP Commercial |
$1,042.10
|
| Rate for Payer: PHP Medicare Advantage |
$306.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,066.62
|
| Rate for Payer: Priority Health Medicare |
$309.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$821.42
|
| Rate for Payer: Railroad Medicare Medicare |
$306.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,078.88
|
| Rate for Payer: UHC Core |
$1,023.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.50
|
| Rate for Payer: UHC Exchange |
$306.50
|
| Rate for Payer: UHC Medicare Advantage |
$306.50
|
| Rate for Payer: VA VA |
$306.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.50
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$796.90 |
| Max. Negotiated Rate |
$1,103.40 |
| Rate for Payer: Aetna Commercial |
$1,042.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,000.78
|
| Rate for Payer: BCN Commercial |
$947.45
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cofinity Commercial |
$1,054.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.80
|
| Rate for Payer: Healthscope Commercial |
$1,103.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.10
|
| Rate for Payer: Nomi Health Commercial |
$1,005.32
|
| Rate for Payer: PHP Commercial |
$1,042.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,066.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$821.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,078.88
|
| Rate for Payer: UHC Core |
$1,023.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.50
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.36 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna Medicare |
$28.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.69
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$91.25
|
| Rate for Payer: BCN Commercial |
$86.30
|
| Rate for Payer: BCN Medicare Advantage |
$27.75
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.75
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: Nomi Health Commercial |
$91.02
|
| Rate for Payer: PACE Senior Care Partners |
$26.36
|
| Rate for Payer: PACE SWMI |
$27.75
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: PHP Medicare Advantage |
$27.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health HMO/PPO |
$96.57
|
| Rate for Payer: Priority Health Medicare |
$28.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.37
|
| Rate for Payer: Railroad Medicare Medicare |
$27.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.68
|
| Rate for Payer: UHC Core |
$92.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.75
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicare Advantage |
$27.75
|
| Rate for Payer: VA VA |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.15 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: BCBS Trust/PPO |
$90.61
|
| Rate for Payer: BCN Commercial |
$85.78
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: Nomi Health Commercial |
$91.02
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health HMO/PPO |
$96.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.68
|
| Rate for Payer: UHC Core |
$92.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$345.32 |
| Max. Negotiated Rate |
$1,308.60 |
| Rate for Payer: Aetna Commercial |
$1,235.90
|
| Rate for Payer: Aetna Medicare |
$378.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$454.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$454.38
|
| Rate for Payer: BCBS Complete |
$581.60
|
| Rate for Payer: BCBS MAPPO |
$363.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,195.33
|
| Rate for Payer: BCN Commercial |
$1,130.48
|
| Rate for Payer: BCN Medicare Advantage |
$363.50
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,250.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.50
|
| Rate for Payer: Healthscope Commercial |
$1,308.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$418.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.90
|
| Rate for Payer: Nomi Health Commercial |
$1,192.28
|
| Rate for Payer: PACE Senior Care Partners |
$345.32
|
| Rate for Payer: PACE SWMI |
$363.50
|
| Rate for Payer: PHP Commercial |
$1,235.90
|
| Rate for Payer: PHP Medicare Advantage |
$363.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,264.98
|
| Rate for Payer: Priority Health Medicare |
$367.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$974.18
|
| Rate for Payer: Railroad Medicare Medicare |
$363.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,279.52
|
| Rate for Payer: UHC Core |
$1,214.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.50
|
| Rate for Payer: UHC Exchange |
$363.50
|
| Rate for Payer: UHC Medicare Advantage |
$363.50
|
| Rate for Payer: VA VA |
$363.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.50
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$945.10 |
| Max. Negotiated Rate |
$1,308.60 |
| Rate for Payer: Aetna Commercial |
$1,235.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.90
|
| Rate for Payer: BCN Commercial |
$1,123.65
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,250.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,163.20
|
| Rate for Payer: Healthscope Commercial |
$1,308.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.90
|
| Rate for Payer: Nomi Health Commercial |
$1,192.28
|
| Rate for Payer: PHP Commercial |
$1,235.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,264.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$974.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,279.52
|
| Rate for Payer: UHC Core |
$1,214.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.50
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.74 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna Commercial |
$102.85
|
| Rate for Payer: Aetna Medicare |
$31.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.81
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS MAPPO |
$30.25
|
| Rate for Payer: BCBS Trust/PPO |
$99.47
|
| Rate for Payer: BCN Commercial |
$94.08
|
| Rate for Payer: BCN Medicare Advantage |
$30.25
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$104.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.25
|
| Rate for Payer: Healthscope Commercial |
$108.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.85
|
| Rate for Payer: Nomi Health Commercial |
$99.22
|
| Rate for Payer: PACE Senior Care Partners |
$28.74
|
| Rate for Payer: PACE SWMI |
$30.25
|
| Rate for Payer: PHP Commercial |
$102.85
|
| Rate for Payer: PHP Medicare Advantage |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health HMO/PPO |
$105.27
|
| Rate for Payer: Priority Health Medicare |
$30.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.07
|
| Rate for Payer: Railroad Medicare Medicare |
$30.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.48
|
| Rate for Payer: UHC Core |
$101.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.25
|
| Rate for Payer: UHC Exchange |
$30.25
|
| Rate for Payer: UHC Medicare Advantage |
$30.25
|
| Rate for Payer: VA VA |
$30.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.75
|
|
