|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$22.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.98
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: BCBS MAPPO |
$21.59
|
| Rate for Payer: BCBS Trust/PPO |
$70.99
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: BCN Medicare Advantage |
$21.59
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.59
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.76
|
| Rate for Payer: Mclaren Medicaid |
$15.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.67
|
| Rate for Payer: Meridian Medicaid |
$15.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PACE Senior Care Partners |
$20.51
|
| Rate for Payer: PACE SWMI |
$21.59
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.12
|
| Rate for Payer: Priority Health Medicare |
$21.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.10
|
| Rate for Payer: Railroad Medicare Medicare |
$21.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.99
|
| Rate for Payer: UHC Core |
$72.10
|
| Rate for Payer: UHC Exchange |
$21.59
|
| Rate for Payer: UHC Medicaid |
$15.22
|
| Rate for Payer: UHC Medicare Advantage |
$21.59
|
| Rate for Payer: UHCCP Medicaid |
$15.22
|
| Rate for Payer: VA VA |
$21.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.76
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
OP
|
$88.08
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$79.27 |
| Rate for Payer: Aetna Commercial |
$74.87
|
| Rate for Payer: Aetna Medicare |
$22.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.52
|
| Rate for Payer: BCBS Complete |
$16.30
|
| Rate for Payer: BCBS MAPPO |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$72.41
|
| Rate for Payer: BCN Commercial |
$72.41
|
| Rate for Payer: BCN Medicare Advantage |
$22.02
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$79.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.06
|
| Rate for Payer: Mclaren Medicaid |
$15.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.12
|
| Rate for Payer: Meridian Medicaid |
$16.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.87
|
| Rate for Payer: Nomi Health Commercial |
$72.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.06
|
| Rate for Payer: PACE Senior Care Partners |
$20.92
|
| Rate for Payer: PACE SWMI |
$22.02
|
| Rate for Payer: PHP Commercial |
$74.87
|
| Rate for Payer: PHP Medicare Advantage |
$22.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.63
|
| Rate for Payer: Priority Health Medicare |
$22.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.30
|
| Rate for Payer: Railroad Medicare Medicare |
$22.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.51
|
| Rate for Payer: UHC Core |
$73.55
|
| Rate for Payer: UHC Exchange |
$22.02
|
| Rate for Payer: UHC Medicaid |
$15.53
|
| Rate for Payer: UHC Medicare Advantage |
$22.02
|
| Rate for Payer: UHCCP Medicaid |
$15.53
|
| Rate for Payer: VA VA |
$22.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.06
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
IP
|
$88.08
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$79.27 |
| Rate for Payer: Aetna Commercial |
$74.87
|
| Rate for Payer: BCBS Trust/PPO |
$72.75
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Healthscope Commercial |
$79.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.87
|
| Rate for Payer: Nomi Health Commercial |
$72.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.06
|
| Rate for Payer: PHP Commercial |
$74.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.51
|
| Rate for Payer: UHC Core |
$73.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.06
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.21
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS MAPPO |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$58.43
|
| Rate for Payer: BCN Commercial |
$58.43
|
| Rate for Payer: BCN Medicare Advantage |
$17.77
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.30
|
| Rate for Payer: Mclaren Medicaid |
$12.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.66
|
| Rate for Payer: Meridian Medicaid |
$13.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Senior Care Partners |
$16.88
|
| Rate for Payer: PACE SWMI |
$17.77
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: PHP Medicare Advantage |
$17.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.83
|
| Rate for Payer: Priority Health Medicare |
$17.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.54
|
| Rate for Payer: UHC Core |
$59.34
|
| Rate for Payer: UHC Exchange |
$17.77
|
| Rate for Payer: UHC Medicaid |
$12.53
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: UHCCP Medicaid |
$12.53
|
| Rate for Payer: VA VA |
$17.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.30
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$58.70
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.54
|
| Rate for Payer: UHC Core |
$59.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.30
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$58.70
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.54
|
| Rate for Payer: UHC Core |
$59.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.30
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.21
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS MAPPO |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$58.43
|
| Rate for Payer: BCN Commercial |
$58.43
|
| Rate for Payer: BCN Medicare Advantage |
$17.77
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.30
|
| Rate for Payer: Mclaren Medicaid |
$12.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.66
|
| Rate for Payer: Meridian Medicaid |
$13.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Senior Care Partners |
$16.88
|
| Rate for Payer: PACE SWMI |
$17.77
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: PHP Medicare Advantage |
$17.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.83
|
| Rate for Payer: Priority Health Medicare |
$17.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.54
|
| Rate for Payer: UHC Core |
$59.34
|
| Rate for Payer: UHC Exchange |
$17.77
|
| Rate for Payer: UHC Medicaid |
$12.53
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: UHCCP Medicaid |
$12.53
|
| Rate for Payer: VA VA |
$17.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.30
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$58.70
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.54
|
| Rate for Payer: UHC Core |
$59.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.30
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.21
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS MAPPO |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$58.43
|
| Rate for Payer: BCN Commercial |
$58.43
|
| Rate for Payer: BCN Medicare Advantage |
$17.77
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.30
|
| Rate for Payer: Mclaren Medicaid |
$12.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.66
|
| Rate for Payer: Meridian Medicaid |
$13.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$58.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Senior Care Partners |
$16.88
|
| Rate for Payer: PACE SWMI |
$17.77
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: PHP Medicare Advantage |
$17.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.83
|
| Rate for Payer: Priority Health Medicare |
$17.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.54
|
| Rate for Payer: UHC Core |
$59.34
|
| Rate for Payer: UHC Exchange |
$17.77
|
| Rate for Payer: UHC Medicaid |
$12.53
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: UHCCP Medicaid |
$12.53
|
| Rate for Payer: VA VA |
$17.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.30
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,091.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.51 |
| Max. Negotiated Rate |
$982.76 |
| Rate for Payer: Aetna Commercial |
$928.17
|
| Rate for Payer: Aetna Medicare |
$283.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.24
|
| Rate for Payer: BCBS Complete |
$202.12
|
| Rate for Payer: BCBS MAPPO |
$272.99
|
| Rate for Payer: BCBS Trust/PPO |
$897.70
|
| Rate for Payer: BCN Commercial |
$897.70
|
| Rate for Payer: BCN Medicare Advantage |
$272.99
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cofinity Commercial |
$939.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.99
|
| Rate for Payer: Healthscope Commercial |
$982.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.97
|
| Rate for Payer: Mclaren Medicaid |
$192.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.64
|
| Rate for Payer: Meridian Medicaid |
$202.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$300.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.17
|
| Rate for Payer: Nomi Health Commercial |
$895.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.97
|
| Rate for Payer: PACE Senior Care Partners |
$259.34
|
| Rate for Payer: PACE SWMI |
$272.99
|
| Rate for Payer: PHP Commercial |
$928.17
|
| Rate for Payer: PHP Medicare Advantage |
$272.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$950.01
|
| Rate for Payer: Priority Health Medicare |
$275.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.00
|
| Rate for Payer: Railroad Medicare Medicare |
$272.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.92
|
| Rate for Payer: UHC Core |
$911.79
|
| Rate for Payer: UHC Exchange |
$272.99
|
| Rate for Payer: UHC Medicaid |
$192.51
|
| Rate for Payer: UHC Medicare Advantage |
$272.99
|
| Rate for Payer: UHCCP Medicaid |
$192.51
|
| Rate for Payer: VA VA |
$272.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.97
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,091.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$982.76 |
| Rate for Payer: Aetna Commercial |
$928.17
|
| Rate for Payer: BCBS Trust/PPO |
$901.85
|
| Rate for Payer: BCN Commercial |
$901.85
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cofinity Commercial |
$939.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.57
|
| Rate for Payer: Healthscope Commercial |
$982.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.17
|
| Rate for Payer: Nomi Health Commercial |
$895.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.97
|
| Rate for Payer: PHP Commercial |
$928.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$950.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.92
|
| Rate for Payer: UHC Core |
$911.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.97
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS MAPPO |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.27
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.93
|
| Rate for Payer: Meridian Medicaid |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.27
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Medicare |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: UHCCP Medicaid |
$9.35
|
| Rate for Payer: VA VA |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,910.14
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4,113.46 |
| Max. Negotiated Rate |
$5,319.13 |
| Rate for Payer: Aetna Commercial |
$5,023.62
|
| Rate for Payer: BCBS Trust/PPO |
$4,881.18
|
| Rate for Payer: BCN Commercial |
$4,881.18
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cofinity Commercial |
$5,082.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,728.11
|
| Rate for Payer: Healthscope Commercial |
$5,319.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,432.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,023.62
|
| Rate for Payer: Nomi Health Commercial |
$4,846.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,432.60
|
| Rate for Payer: PHP Commercial |
$5,023.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,141.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,113.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,200.92
|
| Rate for Payer: UHC Core |
$4,934.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,432.60
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,910.14
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,041.96 |
| Max. Negotiated Rate |
$5,319.13 |
| Rate for Payer: Aetna Commercial |
$5,023.62
|
| Rate for Payer: Aetna Medicare |
$1,536.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,846.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,846.92
|
| Rate for Payer: BCBS Complete |
$1,093.97
|
| Rate for Payer: BCBS MAPPO |
$1,477.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,858.73
|
| Rate for Payer: BCN Commercial |
$4,858.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,477.54
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cofinity Commercial |
$5,082.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,728.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,477.54
|
| Rate for Payer: Healthscope Commercial |
$5,319.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,432.60
|
| Rate for Payer: Mclaren Medicaid |
$1,041.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,551.41
|
| Rate for Payer: Meridian Medicaid |
$1,093.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,699.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,625.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,023.62
|
| Rate for Payer: Nomi Health Commercial |
$4,846.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,432.60
|
| Rate for Payer: PACE Senior Care Partners |
$1,403.66
|
| Rate for Payer: PACE SWMI |
$1,477.54
|
| Rate for Payer: PHP Commercial |
$5,023.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,477.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,041.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,141.82
|
| Rate for Payer: Priority Health Medicare |
$1,492.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,113.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,477.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,200.92
|
| Rate for Payer: UHC Core |
$4,934.97
|
| Rate for Payer: UHC Exchange |
$1,477.54
|
| Rate for Payer: UHC Medicaid |
$1,041.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,477.54
|
| Rate for Payer: UHCCP Medicaid |
$1,041.96
|
| Rate for Payer: VA VA |
$1,477.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,432.60
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$6,102.68
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4,247.47 |
| Max. Negotiated Rate |
$5,492.41 |
| Rate for Payer: Aetna Commercial |
$5,187.28
|
| Rate for Payer: BCBS Trust/PPO |
$5,040.20
|
| Rate for Payer: BCN Commercial |
$5,040.20
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cofinity Commercial |
$5,248.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,882.14
|
| Rate for Payer: Healthscope Commercial |
$5,492.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,577.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,187.28
|
| Rate for Payer: Nomi Health Commercial |
$5,004.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,577.01
|
| Rate for Payer: PHP Commercial |
$5,187.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,309.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,247.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,370.36
|
| Rate for Payer: UHC Core |
$5,095.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,577.01
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$6,102.68
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,075.90 |
| Max. Negotiated Rate |
$5,492.41 |
| Rate for Payer: Aetna Commercial |
$5,187.28
|
| Rate for Payer: Aetna Medicare |
$1,586.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,907.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,907.09
|
| Rate for Payer: BCBS Complete |
$1,129.61
|
| Rate for Payer: BCBS MAPPO |
$1,525.67
|
| Rate for Payer: BCBS Trust/PPO |
$5,017.01
|
| Rate for Payer: BCN Commercial |
$5,017.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,525.67
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cofinity Commercial |
$5,248.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,882.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,525.67
|
| Rate for Payer: Healthscope Commercial |
$5,492.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,577.01
|
| Rate for Payer: Mclaren Medicaid |
$1,075.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,601.95
|
| Rate for Payer: Meridian Medicaid |
$1,129.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,754.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,678.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,187.28
|
| Rate for Payer: Nomi Health Commercial |
$5,004.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,577.01
|
| Rate for Payer: PACE Senior Care Partners |
$1,449.39
|
| Rate for Payer: PACE SWMI |
$1,525.67
|
| Rate for Payer: PHP Commercial |
$5,187.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,525.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,309.33
|
| Rate for Payer: Priority Health Medicare |
$1,540.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,247.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,525.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,370.36
|
| Rate for Payer: UHC Core |
$5,095.74
|
| Rate for Payer: UHC Exchange |
$1,525.67
|
| Rate for Payer: UHC Medicaid |
$1,075.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,525.67
|
| Rate for Payer: UHCCP Medicaid |
$1,075.90
|
| Rate for Payer: VA VA |
$1,525.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,577.01
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$387.87 |
| Max. Negotiated Rate |
$1,980.05 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: Aetna Medicare |
$572.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$687.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$687.52
|
| Rate for Payer: BCBS Complete |
$407.23
|
| Rate for Payer: BCBS MAPPO |
$550.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.66
|
| Rate for Payer: BCN Commercial |
$1,808.66
|
| Rate for Payer: BCN Medicare Advantage |
$550.01
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.01
|
| Rate for Payer: Healthscope Commercial |
$1,980.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,650.04
|
| Rate for Payer: Mclaren Medicaid |
$387.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.51
|
| Rate for Payer: Meridian Medicaid |
$407.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$632.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.04
|
| Rate for Payer: PACE Senior Care Partners |
$522.51
|
| Rate for Payer: PACE SWMI |
$550.01
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: PHP Medicare Advantage |
$550.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,914.04
|
| Rate for Payer: Priority Health Medicare |
$555.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,531.23
|
| Rate for Payer: Railroad Medicare Medicare |
$550.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,936.04
|
| Rate for Payer: UHC Core |
$1,837.04
|
| Rate for Payer: UHC Exchange |
$550.01
|
| Rate for Payer: UHC Medicaid |
$387.87
|
| Rate for Payer: UHC Medicare Advantage |
$550.01
|
| Rate for Payer: UHCCP Medicaid |
$387.87
|
| Rate for Payer: VA VA |
$550.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,650.04
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,531.23 |
| Max. Negotiated Rate |
$1,980.05 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,817.02
|
| Rate for Payer: BCN Commercial |
$1,817.02
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Healthscope Commercial |
$1,980.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,650.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.04
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,914.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,531.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,936.04
|
| Rate for Payer: UHC Core |
$1,837.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,650.04
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,283.28
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,589.16 |
| Max. Negotiated Rate |
$2,054.95 |
| Rate for Payer: Aetna Commercial |
$1,940.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,885.76
|
| Rate for Payer: BCN Commercial |
$1,885.76
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cofinity Commercial |
$1,963.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,826.62
|
| Rate for Payer: Healthscope Commercial |
$2,054.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,712.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,940.79
|
| Rate for Payer: Nomi Health Commercial |
$1,872.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,712.46
|
| Rate for Payer: PHP Commercial |
$1,940.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,986.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,589.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,009.29
|
| Rate for Payer: UHC Core |
$1,906.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,712.46
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,283.28
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$402.54 |
| Max. Negotiated Rate |
$2,054.95 |
| Rate for Payer: Aetna Commercial |
$1,940.79
|
| Rate for Payer: Aetna Medicare |
$593.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$713.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$713.52
|
| Rate for Payer: BCBS Complete |
$422.64
|
| Rate for Payer: BCBS MAPPO |
$570.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.08
|
| Rate for Payer: BCN Commercial |
$1,877.08
|
| Rate for Payer: BCN Medicare Advantage |
$570.82
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cofinity Commercial |
$1,963.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,826.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.82
|
| Rate for Payer: Healthscope Commercial |
$2,054.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,712.46
|
| Rate for Payer: Mclaren Medicaid |
$402.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.36
|
| Rate for Payer: Meridian Medicaid |
$422.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$656.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$627.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,940.79
|
| Rate for Payer: Nomi Health Commercial |
$1,872.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,712.46
|
| Rate for Payer: PACE Senior Care Partners |
$542.28
|
| Rate for Payer: PACE SWMI |
$570.82
|
| Rate for Payer: PHP Commercial |
$1,940.79
|
| Rate for Payer: PHP Medicare Advantage |
$570.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,986.45
|
| Rate for Payer: Priority Health Medicare |
$576.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,589.16
|
| Rate for Payer: Railroad Medicare Medicare |
$570.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,009.29
|
| Rate for Payer: UHC Core |
$1,906.54
|
| Rate for Payer: UHC Exchange |
$570.82
|
| Rate for Payer: UHC Medicaid |
$402.54
|
| Rate for Payer: UHC Medicare Advantage |
$570.82
|
| Rate for Payer: UHCCP Medicaid |
$402.54
|
| Rate for Payer: VA VA |
$570.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,712.46
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$91.26
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna Medicare |
$23.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.52
|
| Rate for Payer: BCBS Complete |
$16.89
|
| Rate for Payer: BCBS MAPPO |
$22.82
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: BCN Commercial |
$75.02
|
| Rate for Payer: BCN Medicare Advantage |
$22.82
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.44
|
| Rate for Payer: Mclaren Medicaid |
$16.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.96
|
| Rate for Payer: Meridian Medicaid |
$16.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$74.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PACE Senior Care Partners |
$21.67
|
| Rate for Payer: PACE SWMI |
$22.82
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: PHP Medicare Advantage |
$22.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.40
|
| Rate for Payer: Priority Health Medicare |
$23.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.52
|
| Rate for Payer: Railroad Medicare Medicare |
$22.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.31
|
| Rate for Payer: UHC Core |
$76.20
|
| Rate for Payer: UHC Exchange |
$22.82
|
| Rate for Payer: UHC Medicaid |
$16.09
|
| Rate for Payer: UHC Medicare Advantage |
$22.82
|
| Rate for Payer: UHCCP Medicaid |
$16.09
|
| Rate for Payer: VA VA |
$22.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.44
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$91.26
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: BCBS Trust/PPO |
$75.37
|
| Rate for Payer: BCN Commercial |
$75.37
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$74.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.31
|
| Rate for Payer: UHC Core |
$76.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.44
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$97.63
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$87.87 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Medicare |
$25.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.51
|
| Rate for Payer: BCBS Complete |
$18.07
|
| Rate for Payer: BCBS MAPPO |
$24.41
|
| Rate for Payer: BCBS Trust/PPO |
$80.26
|
| Rate for Payer: BCN Commercial |
$80.26
|
| Rate for Payer: BCN Medicare Advantage |
$24.41
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cofinity Commercial |
$83.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$87.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.22
|
| Rate for Payer: Mclaren Medicaid |
$17.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.63
|
| Rate for Payer: Meridian Medicaid |
$18.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.99
|
| Rate for Payer: Nomi Health Commercial |
$80.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.22
|
| Rate for Payer: PACE Senior Care Partners |
$23.19
|
| Rate for Payer: PACE SWMI |
$24.41
|
| Rate for Payer: PHP Commercial |
$82.99
|
| Rate for Payer: PHP Medicare Advantage |
$24.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.94
|
| Rate for Payer: Priority Health Medicare |
$24.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.95
|
| Rate for Payer: Railroad Medicare Medicare |
$24.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.91
|
| Rate for Payer: UHC Core |
$81.52
|
| Rate for Payer: UHC Exchange |
$24.41
|
| Rate for Payer: UHC Medicaid |
$17.21
|
| Rate for Payer: UHC Medicare Advantage |
$24.41
|
| Rate for Payer: UHCCP Medicaid |
$17.21
|
| Rate for Payer: VA VA |
$24.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.22
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$97.63
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$87.87 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: BCBS Trust/PPO |
$80.63
|
| Rate for Payer: BCN Commercial |
$80.63
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cofinity Commercial |
$83.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.10
|
| Rate for Payer: Healthscope Commercial |
$87.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.99
|
| Rate for Payer: Nomi Health Commercial |
$80.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.22
|
| Rate for Payer: PHP Commercial |
$82.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.91
|
| Rate for Payer: UHC Core |
$81.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.22
|
|
