|
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 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 |
$615.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.75
|
|
|
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 |
$615.39
|
| 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 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 |
$69.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
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 |
$69.31
|
| 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 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
|
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 |
$82.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
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 |
$82.67
|
| 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 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 |
$92.69
|
| 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 |
$92.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.25
|
|
|
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 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 |
$367.13
|
| 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 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 |
$101.03
|
| 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
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna Commercial |
$102.85
|
| Rate for Payer: BCBS Trust/PPO |
$98.77
|
| Rate for Payer: BCN Commercial |
$93.51
|
| 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: Healthscope Commercial |
$108.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.85
|
| Rate for Payer: Nomi Health Commercial |
$99.22
|
| Rate for Payer: PHP Commercial |
$102.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health HMO/PPO |
$105.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.48
|
| Rate for Payer: UHC Core |
$101.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.75
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health HMO/PPO |
$26.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.55
|
| Rate for Payer: UHC Core |
$25.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$7.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.43
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS MAPPO |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$24.80
|
| Rate for Payer: BCN Commercial |
$23.46
|
| Rate for Payer: BCN Medicare Advantage |
$7.54
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.54
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: PACE Senior Care Partners |
$7.17
|
| Rate for Payer: PACE SWMI |
$7.54
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: PHP Medicare Advantage |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health HMO/PPO |
$26.25
|
| Rate for Payer: Priority Health Medicare |
$7.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.21
|
| Rate for Payer: Railroad Medicare Medicare |
$7.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.55
|
| Rate for Payer: UHC Core |
$25.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.54
|
| Rate for Payer: UHC Exchange |
$7.54
|
| Rate for Payer: UHC Medicare Advantage |
$7.54
|
| Rate for Payer: VA VA |
$7.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.63
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
IP
|
$123.27
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$80.13 |
| Max. Negotiated Rate |
$110.94 |
| Rate for Payer: Aetna Commercial |
$104.78
|
| Rate for Payer: BCBS Trust/PPO |
$100.63
|
| Rate for Payer: BCN Commercial |
$95.26
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cofinity Commercial |
$106.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.62
|
| Rate for Payer: Healthscope Commercial |
$110.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.78
|
| Rate for Payer: Nomi Health Commercial |
$101.08
|
| Rate for Payer: PHP Commercial |
$104.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.13
|
| Rate for Payer: Priority Health HMO/PPO |
$107.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.48
|
| Rate for Payer: UHC Core |
$102.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.45
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
OP
|
$123.27
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$110.94 |
| Rate for Payer: Aetna Commercial |
$104.78
|
| Rate for Payer: Aetna Medicare |
$32.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.52
|
| Rate for Payer: BCBS Complete |
$38.95
|
| Rate for Payer: BCBS MAPPO |
$30.82
|
| Rate for Payer: BCBS Trust/PPO |
$101.34
|
| Rate for Payer: BCN Commercial |
$95.84
|
| Rate for Payer: BCN Medicare Advantage |
$30.82
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cofinity Commercial |
$106.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.82
|
| Rate for Payer: Healthscope Commercial |
$110.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.45
|
| Rate for Payer: Mclaren Medicaid |
$37.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.36
|
| Rate for Payer: Meridian Medicaid |
$38.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.78
|
| Rate for Payer: Nomi Health Commercial |
$101.08
|
| Rate for Payer: PACE Senior Care Partners |
$29.28
|
| Rate for Payer: PACE SWMI |
$30.82
|
| Rate for Payer: PHP Commercial |
$104.78
|
| Rate for Payer: PHP Medicare Advantage |
$30.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.13
|
| Rate for Payer: Priority Health HMO/PPO |
$107.24
|
| Rate for Payer: Priority Health Medicare |
$31.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.59
|
| Rate for Payer: Railroad Medicare Medicare |
$30.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.48
|
| Rate for Payer: UHC Core |
$102.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.82
|
| Rate for Payer: UHC Exchange |
$30.82
|
| Rate for Payer: UHC Medicare Advantage |
$30.82
|
| Rate for Payer: UHCCP Medicaid |
$37.10
|
| Rate for Payer: VA VA |
$30.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.45
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$38.95
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.89
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$37.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: Meridian Medicaid |
$38.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Exchange |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.12
|
| Rate for Payer: UHCCP Medicaid |
$37.10
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$62.45
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
OP
|
$129.45
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna Commercial |
$110.03
|
| Rate for Payer: Aetna Medicare |
$33.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.45
|
| Rate for Payer: BCBS Complete |
$51.78
|
| Rate for Payer: BCBS MAPPO |
$32.36
|
| Rate for Payer: BCBS Trust/PPO |
$106.42
|
| Rate for Payer: BCN Commercial |
$100.65
|
| Rate for Payer: BCN Medicare Advantage |
$32.36
|
| Rate for Payer: Cash Price |
$103.56
|
| Rate for Payer: Cofinity Commercial |
$111.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.36
|
| Rate for Payer: Healthscope Commercial |
$116.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.03
|
| Rate for Payer: Nomi Health Commercial |
$106.15
|
| Rate for Payer: PACE Senior Care Partners |
$30.74
|
| Rate for Payer: PACE SWMI |
$32.36
|
| Rate for Payer: PHP Commercial |
$110.03
|
| Rate for Payer: PHP Medicare Advantage |
$32.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.14
|
| Rate for Payer: Priority Health HMO/PPO |
$112.62
|
| Rate for Payer: Priority Health Medicare |
$32.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.73
|
| Rate for Payer: Railroad Medicare Medicare |
$32.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.92
|
| Rate for Payer: UHC Core |
$108.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.36
|
| Rate for Payer: UHC Exchange |
$32.36
|
| Rate for Payer: UHC Medicare Advantage |
$32.36
|
| Rate for Payer: VA VA |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.09
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
IP
|
$129.45
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna Commercial |
$110.03
|
| Rate for Payer: BCBS Trust/PPO |
$105.67
|
| Rate for Payer: BCN Commercial |
$100.04
|
| Rate for Payer: Cash Price |
$103.56
|
| Rate for Payer: Cofinity Commercial |
$111.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.56
|
| Rate for Payer: Healthscope Commercial |
$116.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.03
|
| Rate for Payer: Nomi Health Commercial |
$106.15
|
| Rate for Payer: PHP Commercial |
$110.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.14
|
| Rate for Payer: Priority Health HMO/PPO |
$112.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.92
|
| Rate for Payer: UHC Core |
$108.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.09
|
|
