|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: BCBS Trust/PPO |
$74.74
|
| Rate for Payer: BCN Commercial |
$70.76
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO |
$79.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.57
|
| Rate for Payer: UHC Core |
$76.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.61
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS MAPPO |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$75.27
|
| Rate for Payer: BCN Commercial |
$71.19
|
| Rate for Payer: BCN Medicare Advantage |
$22.89
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.89
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: PACE Senior Care Partners |
$21.75
|
| Rate for Payer: PACE SWMI |
$22.89
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: PHP Medicare Advantage |
$22.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO |
$79.66
|
| Rate for Payer: Priority Health Medicare |
$23.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: Railroad Medicare Medicare |
$22.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.57
|
| Rate for Payer: UHC Core |
$76.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.89
|
| Rate for Payer: UHC Exchange |
$22.89
|
| Rate for Payer: UHC Medicare Advantage |
$22.89
|
| Rate for Payer: VA VA |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: BCBS Trust/PPO |
$74.74
|
| Rate for Payer: BCN Commercial |
$70.76
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO |
$79.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.57
|
| Rate for Payer: UHC Core |
$76.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.61
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS MAPPO |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$75.27
|
| Rate for Payer: BCN Commercial |
$71.19
|
| Rate for Payer: BCN Medicare Advantage |
$22.89
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.89
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: PACE Senior Care Partners |
$21.75
|
| Rate for Payer: PACE SWMI |
$22.89
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: PHP Medicare Advantage |
$22.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO |
$79.66
|
| Rate for Payer: Priority Health Medicare |
$23.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: Railroad Medicare Medicare |
$22.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.57
|
| Rate for Payer: UHC Core |
$76.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.89
|
| Rate for Payer: UHC Exchange |
$22.89
|
| Rate for Payer: UHC Medicare Advantage |
$22.89
|
| Rate for Payer: VA VA |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.61
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS MAPPO |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$75.27
|
| Rate for Payer: BCN Commercial |
$71.19
|
| Rate for Payer: BCN Medicare Advantage |
$22.89
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.89
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: PACE Senior Care Partners |
$21.75
|
| Rate for Payer: PACE SWMI |
$22.89
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: PHP Medicare Advantage |
$22.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO |
$79.66
|
| Rate for Payer: Priority Health Medicare |
$23.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: Railroad Medicare Medicare |
$22.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.57
|
| Rate for Payer: UHC Core |
$76.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.89
|
| Rate for Payer: UHC Exchange |
$22.89
|
| Rate for Payer: UHC Medicare Advantage |
$22.89
|
| Rate for Payer: VA VA |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OPTISON 3RD ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: BCBS Trust/PPO |
$74.74
|
| Rate for Payer: BCN Commercial |
$70.76
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO |
$79.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.57
|
| Rate for Payer: UHC Core |
$76.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.67
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna Medicare |
$40.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.33
|
| Rate for Payer: BCBS Complete |
$61.86
|
| Rate for Payer: BCBS MAPPO |
$38.66
|
| Rate for Payer: BCBS Trust/PPO |
$127.14
|
| Rate for Payer: BCN Commercial |
$120.24
|
| Rate for Payer: BCN Medicare Advantage |
$38.66
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.66
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: PACE Senior Care Partners |
$36.73
|
| Rate for Payer: PACE SWMI |
$38.66
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: PHP Medicare Advantage |
$38.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: Priority Health HMO/PPO |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$39.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.62
|
| Rate for Payer: Railroad Medicare Medicare |
$38.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.09
|
| Rate for Payer: UHC Core |
$129.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.66
|
| Rate for Payer: UHC Exchange |
$38.66
|
| Rate for Payer: UHC Medicare Advantage |
$38.66
|
| Rate for Payer: VA VA |
$38.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.52 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: BCBS Trust/PPO |
$126.24
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: Priority Health HMO/PPO |
$134.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.09
|
| Rate for Payer: UHC Core |
$129.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: Aetna Medicare |
$45.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.40
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: BCBS MAPPO |
$43.52
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCN Commercial |
$135.35
|
| Rate for Payer: BCN Medicare Advantage |
$43.52
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.52
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: PACE Senior Care Partners |
$41.35
|
| Rate for Payer: PACE SWMI |
$43.52
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: PHP Medicare Advantage |
$43.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: Priority Health HMO/PPO |
$151.46
|
| Rate for Payer: Priority Health Medicare |
$43.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.64
|
| Rate for Payer: Railroad Medicare Medicare |
$43.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.20
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.52
|
| Rate for Payer: UHC Exchange |
$43.52
|
| Rate for Payer: UHC Medicare Advantage |
$43.52
|
| Rate for Payer: VA VA |
$43.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: BCBS Trust/PPO |
$142.11
|
| Rate for Payer: BCN Commercial |
$134.54
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: Priority Health HMO/PPO |
$151.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.20
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
IP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.31 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: BCBS Trust/PPO |
$172.44
|
| Rate for Payer: BCN Commercial |
$163.25
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Nomi Health Commercial |
$173.22
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.31
|
| Rate for Payer: Priority Health HMO/PPO |
$183.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.90
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
OP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.17 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna Medicare |
$54.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.02
|
| Rate for Payer: BCBS Complete |
$84.50
|
| Rate for Payer: BCBS MAPPO |
$52.81
|
| Rate for Payer: BCBS Trust/PPO |
$173.67
|
| Rate for Payer: BCN Commercial |
$164.25
|
| Rate for Payer: BCN Medicare Advantage |
$52.81
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.81
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Nomi Health Commercial |
$173.22
|
| Rate for Payer: PACE Senior Care Partners |
$50.17
|
| Rate for Payer: PACE SWMI |
$52.81
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: PHP Medicare Advantage |
$52.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.31
|
| Rate for Payer: Priority Health HMO/PPO |
$183.79
|
| Rate for Payer: Priority Health Medicare |
$53.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.54
|
| Rate for Payer: Railroad Medicare Medicare |
$52.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.90
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.81
|
| Rate for Payer: UHC Exchange |
$52.81
|
| Rate for Payer: UHC Medicare Advantage |
$52.81
|
| Rate for Payer: VA VA |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
IP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.19 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: BCBS Trust/PPO |
$247.64
|
| Rate for Payer: BCN Commercial |
$234.44
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.19
|
| Rate for Payer: Priority Health HMO/PPO |
$263.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.97
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
OP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.05 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$78.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.80
|
| Rate for Payer: BCBS Complete |
$121.35
|
| Rate for Payer: BCBS MAPPO |
$75.84
|
| Rate for Payer: BCBS Trust/PPO |
$249.40
|
| Rate for Payer: BCN Commercial |
$235.87
|
| Rate for Payer: BCN Medicare Advantage |
$75.84
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.84
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: PACE Senior Care Partners |
$72.05
|
| Rate for Payer: PACE SWMI |
$75.84
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: PHP Medicare Advantage |
$75.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.19
|
| Rate for Payer: Priority Health HMO/PPO |
$263.93
|
| Rate for Payer: Priority Health Medicare |
$76.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.26
|
| Rate for Payer: Railroad Medicare Medicare |
$75.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.97
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.84
|
| Rate for Payer: UHC Exchange |
$75.84
|
| Rate for Payer: UHC Medicare Advantage |
$75.84
|
| Rate for Payer: VA VA |
$75.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
OP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCBS Trust/PPO |
$415.28
|
| Rate for Payer: BCN Commercial |
$392.75
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Nomi Health Commercial |
$414.21
|
| Rate for Payer: PACE Senior Care Partners |
$119.97
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.34
|
| Rate for Payer: Priority Health HMO/PPO |
$439.47
|
| Rate for Payer: Priority Health Medicare |
$127.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.44
|
| Rate for Payer: Railroad Medicare Medicare |
$126.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.52
|
| Rate for Payer: UHC Core |
$421.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.28
|
| Rate for Payer: UHC Exchange |
$126.28
|
| Rate for Payer: UHC Medicare Advantage |
$126.28
|
| Rate for Payer: VA VA |
$126.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
IP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$328.34 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: BCBS Trust/PPO |
$412.35
|
| Rate for Payer: BCN Commercial |
$390.37
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Nomi Health Commercial |
$414.21
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.34
|
| Rate for Payer: Priority Health HMO/PPO |
$439.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.52
|
| Rate for Payer: UHC Core |
$421.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
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 ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.99 |
| 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: BCN Commercial |
$104.74
|
| Rate for Payer: BCN Medicare Advantage |
$33.68
|
| 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 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 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 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
|
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
|
|
