|
HC PED MINOR TREATMENT RM
|
Facility
|
IP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: BCBS Trust/PPO |
$105.32
|
| Rate for Payer: BCN Commercial |
$99.71
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO |
$112.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.54
|
| Rate for Payer: UHC Core |
$107.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.77
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$135.15
|
| Rate for Payer: BCN Commercial |
$127.95
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: Nomi Health Commercial |
$135.77
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health HMO/PPO |
$144.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.70
|
| Rate for Payer: UHC Core |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.18
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
OP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: Aetna Medicare |
$43.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.74
|
| Rate for Payer: BCBS Complete |
$66.23
|
| Rate for Payer: BCBS MAPPO |
$41.39
|
| Rate for Payer: BCBS Trust/PPO |
$136.12
|
| Rate for Payer: BCN Commercial |
$128.73
|
| Rate for Payer: BCN Medicare Advantage |
$41.39
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.39
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: Nomi Health Commercial |
$135.77
|
| Rate for Payer: PACE Senior Care Partners |
$39.32
|
| Rate for Payer: PACE SWMI |
$41.39
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: PHP Medicare Advantage |
$41.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health HMO/PPO |
$144.05
|
| Rate for Payer: Priority Health Medicare |
$41.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.93
|
| Rate for Payer: Railroad Medicare Medicare |
$41.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.70
|
| Rate for Payer: UHC Core |
$138.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.39
|
| Rate for Payer: UHC Exchange |
$41.39
|
| Rate for Payer: UHC Medicare Advantage |
$41.39
|
| Rate for Payer: VA VA |
$41.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.18
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$3,461.64 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,347.29
|
| Rate for Payer: BCN Commercial |
$4,115.62
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health HMO/PPO |
$4,633.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,568.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,686.53
|
| Rate for Payer: UHC Core |
$4,446.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.20
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$3,461.64 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,347.29
|
| Rate for Payer: BCN Commercial |
$4,115.62
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health HMO/PPO |
$4,633.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,568.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,686.53
|
| Rate for Payer: UHC Core |
$4,446.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.20
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.08
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.02
|
| Rate for Payer: BCBS Complete |
$8.98
|
| Rate for Payer: BCBS MAPPO |
$5.61
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCN Commercial |
$17.45
|
| Rate for Payer: BCN Medicare Advantage |
$5.61
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.61
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: PACE Senior Care Partners |
$5.33
|
| Rate for Payer: PACE SWMI |
$5.61
|
| Rate for Payer: PHP Commercial |
$19.08
|
| Rate for Payer: PHP Medicare Advantage |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health HMO/PPO |
$19.53
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.04
|
| Rate for Payer: Railroad Medicare Medicare |
$5.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.76
|
| Rate for Payer: UHC Core |
$18.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.61
|
| Rate for Payer: UHC Exchange |
$5.61
|
| Rate for Payer: UHC Medicare Advantage |
$5.61
|
| Rate for Payer: VA VA |
$5.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.84
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.08
|
| Rate for Payer: BCBS Trust/PPO |
$18.33
|
| Rate for Payer: BCN Commercial |
$17.35
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$19.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: PHP Commercial |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health HMO/PPO |
$19.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.76
|
| Rate for Payer: UHC Core |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.84
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna Medicare |
$42.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.65
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS MAPPO |
$41.32
|
| Rate for Payer: BCBS Trust/PPO |
$135.88
|
| Rate for Payer: BCN Commercial |
$128.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.32
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$142.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.32
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.97
|
| Rate for Payer: Mclaren Medicaid |
$17.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.39
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: Nomi Health Commercial |
$135.54
|
| Rate for Payer: PACE Senior Care Partners |
$39.26
|
| Rate for Payer: PACE SWMI |
$41.32
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: PHP Medicare Advantage |
$41.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health HMO/PPO |
$143.80
|
| Rate for Payer: Priority Health Medicare |
$41.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.74
|
| Rate for Payer: Railroad Medicare Medicare |
$41.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.46
|
| Rate for Payer: UHC Core |
$138.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.32
|
| Rate for Payer: UHC Exchange |
$41.32
|
| Rate for Payer: UHC Medicare Advantage |
$41.32
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
| Rate for Payer: VA VA |
$41.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.97
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: BCBS Trust/PPO |
$134.93
|
| Rate for Payer: BCN Commercial |
$127.74
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$142.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: Nomi Health Commercial |
$135.54
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health HMO/PPO |
$143.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.46
|
| Rate for Payer: UHC Core |
$138.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.97
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.57 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna Commercial |
$76.59
|
| Rate for Payer: BCBS Trust/PPO |
$73.56
|
| Rate for Payer: BCN Commercial |
$69.64
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$81.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: Nomi Health Commercial |
$73.89
|
| Rate for Payer: PHP Commercial |
$76.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: Priority Health HMO/PPO |
$78.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.30
|
| Rate for Payer: UHC Core |
$75.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.58
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
OP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna Commercial |
$76.59
|
| Rate for Payer: Aetna Medicare |
$23.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.16
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$22.53
|
| Rate for Payer: BCBS Trust/PPO |
$74.08
|
| Rate for Payer: BCN Commercial |
$70.06
|
| Rate for Payer: BCN Medicare Advantage |
$22.53
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$77.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.53
|
| Rate for Payer: Healthscope Commercial |
$81.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.58
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.65
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: Nomi Health Commercial |
$73.89
|
| Rate for Payer: PACE Senior Care Partners |
$21.40
|
| Rate for Payer: PACE SWMI |
$22.53
|
| Rate for Payer: PHP Commercial |
$76.59
|
| Rate for Payer: PHP Medicare Advantage |
$22.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: Priority Health HMO/PPO |
$78.40
|
| Rate for Payer: Priority Health Medicare |
$22.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.37
|
| Rate for Payer: Railroad Medicare Medicare |
$22.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.30
|
| Rate for Payer: UHC Core |
$75.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.53
|
| Rate for Payer: UHC Exchange |
$22.53
|
| Rate for Payer: UHC Medicare Advantage |
$22.53
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$22.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.58
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna Medicare |
$69.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.09
|
| Rate for Payer: BCBS Complete |
$28.64
|
| Rate for Payer: BCBS MAPPO |
$67.27
|
| Rate for Payer: BCBS Trust/PPO |
$221.21
|
| Rate for Payer: BCN Commercial |
$209.21
|
| Rate for Payer: BCN Medicare Advantage |
$67.27
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.27
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Mclaren Medicaid |
$27.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.63
|
| Rate for Payer: Meridian Medicaid |
$28.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| Rate for Payer: PACE Senior Care Partners |
$63.91
|
| Rate for Payer: PACE SWMI |
$67.27
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: PHP Medicare Advantage |
$67.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health HMO/PPO |
$234.10
|
| Rate for Payer: Priority Health Medicare |
$67.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.28
|
| Rate for Payer: Railroad Medicare Medicare |
$67.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.79
|
| Rate for Payer: UHC Core |
$224.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.27
|
| Rate for Payer: UHC Exchange |
$67.27
|
| Rate for Payer: UHC Medicare Advantage |
$67.27
|
| Rate for Payer: UHCCP Medicaid |
$27.28
|
| Rate for Payer: VA VA |
$67.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 3
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
30200499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$174.90 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: BCBS Trust/PPO |
$219.65
|
| Rate for Payer: BCN Commercial |
$207.95
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health HMO/PPO |
$234.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.79
|
| Rate for Payer: UHC Core |
$224.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
OP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: Aetna Medicare |
$69.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.09
|
| Rate for Payer: BCBS Complete |
$28.64
|
| Rate for Payer: BCBS MAPPO |
$67.27
|
| Rate for Payer: BCBS Trust/PPO |
$221.21
|
| Rate for Payer: BCN Commercial |
$209.21
|
| Rate for Payer: BCN Medicare Advantage |
$67.27
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.27
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Mclaren Medicaid |
$27.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.63
|
| Rate for Payer: Meridian Medicaid |
$28.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| Rate for Payer: PACE Senior Care Partners |
$63.91
|
| Rate for Payer: PACE SWMI |
$67.27
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: PHP Medicare Advantage |
$67.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health HMO/PPO |
$234.10
|
| Rate for Payer: Priority Health Medicare |
$67.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.28
|
| Rate for Payer: Railroad Medicare Medicare |
$67.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.79
|
| Rate for Payer: UHC Core |
$224.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.27
|
| Rate for Payer: UHC Exchange |
$67.27
|
| Rate for Payer: UHC Medicare Advantage |
$67.27
|
| Rate for Payer: UHCCP Medicaid |
$27.28
|
| Rate for Payer: VA VA |
$67.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 4
|
Facility
|
IP
|
$269.08
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
30200500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$174.90 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$228.72
|
| Rate for Payer: BCBS Trust/PPO |
$219.65
|
| Rate for Payer: BCN Commercial |
$207.95
|
| Rate for Payer: Cash Price |
$215.26
|
| Rate for Payer: Cofinity Commercial |
$231.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.26
|
| Rate for Payer: Healthscope Commercial |
$242.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.72
|
| Rate for Payer: Nomi Health Commercial |
$220.65
|
| Rate for Payer: PHP Commercial |
$228.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.90
|
| Rate for Payer: Priority Health HMO/PPO |
$234.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.79
|
| Rate for Payer: UHC Core |
$224.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.81
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
IP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,305.45 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.44
|
| Rate for Payer: BCN Commercial |
$1,552.08
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.37
|
| Rate for Payer: UHC Core |
$1,677.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$396.42 |
| Max. Negotiated Rate |
$1,807.54 |
| Rate for Payer: Aetna Commercial |
$1,707.12
|
| Rate for Payer: Aetna Medicare |
$522.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$627.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$627.62
|
| Rate for Payer: BCBS Complete |
$416.27
|
| Rate for Payer: BCBS MAPPO |
$502.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,651.09
|
| Rate for Payer: BCN Commercial |
$1,561.52
|
| Rate for Payer: BCN Medicare Advantage |
$502.10
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cash Price |
$1,606.70
|
| Rate for Payer: Cofinity Commercial |
$1,727.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.10
|
| Rate for Payer: Healthscope Commercial |
$1,807.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.29
|
| Rate for Payer: Mclaren Medicaid |
$396.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.20
|
| Rate for Payer: Meridian Medicaid |
$416.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.12
|
| Rate for Payer: Nomi Health Commercial |
$1,646.87
|
| Rate for Payer: PACE Senior Care Partners |
$476.99
|
| Rate for Payer: PACE SWMI |
$502.10
|
| Rate for Payer: PHP Commercial |
$1,707.12
|
| Rate for Payer: PHP Medicare Advantage |
$502.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,747.29
|
| Rate for Payer: Priority Health Medicare |
$507.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.61
|
| Rate for Payer: Railroad Medicare Medicare |
$502.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.37
|
| Rate for Payer: UHC Core |
$1,677.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.10
|
| Rate for Payer: UHC Exchange |
$502.10
|
| Rate for Payer: UHC Medicare Advantage |
$502.10
|
| Rate for Payer: UHCCP Medicaid |
$396.42
|
| Rate for Payer: VA VA |
$502.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.29
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
IP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$536.61 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: BCBS Trust/PPO |
$673.90
|
| Rate for Payer: BCN Commercial |
$637.99
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$676.95
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health HMO/PPO |
$718.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.48
|
| Rate for Payer: UHC Core |
$689.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.16
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna Medicare |
$214.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$257.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$257.98
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$206.39
|
| Rate for Payer: BCBS Trust/PPO |
$678.68
|
| Rate for Payer: BCN Commercial |
$641.87
|
| Rate for Payer: BCN Medicare Advantage |
$206.39
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.39
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.16
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.71
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$676.95
|
| Rate for Payer: PACE Senior Care Partners |
$196.07
|
| Rate for Payer: PACE SWMI |
$206.39
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: PHP Medicare Advantage |
$206.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health HMO/PPO |
$718.23
|
| Rate for Payer: Priority Health Medicare |
$208.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.12
|
| Rate for Payer: Railroad Medicare Medicare |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.48
|
| Rate for Payer: UHC Core |
$689.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.39
|
| Rate for Payer: UHC Exchange |
$206.39
|
| Rate for Payer: UHC Medicare Advantage |
$206.39
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$206.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.16
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
IP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,081.50 |
| Max. Negotiated Rate |
$1,497.46 |
| Rate for Payer: Aetna Commercial |
$1,414.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,358.19
|
| Rate for Payer: BCN Commercial |
$1,285.82
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,430.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Healthscope Commercial |
$1,497.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,247.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: Nomi Health Commercial |
$1,364.35
|
| Rate for Payer: PHP Commercial |
$1,414.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,447.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,464.18
|
| Rate for Payer: UHC Core |
$1,389.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,247.88
|
|
|
HC PEDS ECHO W/DEFINITY
|
Facility
|
OP
|
$1,663.84
|
|
|
Service Code
|
HCPCS C8921
|
| Hospital Charge Code |
48000028
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$395.16 |
| Max. Negotiated Rate |
$1,497.46 |
| Rate for Payer: Aetna Commercial |
$1,414.26
|
| Rate for Payer: Aetna Medicare |
$432.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.95
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$415.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.84
|
| Rate for Payer: BCN Commercial |
$1,293.64
|
| Rate for Payer: BCN Medicare Advantage |
$415.96
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cash Price |
$1,331.07
|
| Rate for Payer: Cofinity Commercial |
$1,430.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,331.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.96
|
| Rate for Payer: Healthscope Commercial |
$1,497.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,247.88
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.76
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$478.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,414.26
|
| Rate for Payer: Nomi Health Commercial |
$1,364.35
|
| Rate for Payer: PACE Senior Care Partners |
$395.16
|
| Rate for Payer: PACE SWMI |
$415.96
|
| Rate for Payer: PHP Commercial |
$1,414.26
|
| Rate for Payer: PHP Medicare Advantage |
$415.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,447.54
|
| Rate for Payer: Priority Health Medicare |
$420.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.77
|
| Rate for Payer: Railroad Medicare Medicare |
$415.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,464.18
|
| Rate for Payer: UHC Core |
$1,389.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.96
|
| Rate for Payer: UHC Exchange |
$415.96
|
| Rate for Payer: UHC Medicare Advantage |
$415.96
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$415.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,247.88
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
IP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$101.65 |
| Max. Negotiated Rate |
$140.74 |
| Rate for Payer: Aetna Commercial |
$132.92
|
| Rate for Payer: BCBS Trust/PPO |
$127.65
|
| Rate for Payer: BCN Commercial |
$120.85
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$134.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$140.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: PHP Commercial |
$132.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health HMO/PPO |
$136.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.61
|
| Rate for Payer: UHC Core |
$130.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.28
|
|
|
HC PEDS OBS OVERFLOW PER HR
|
Facility
|
OP
|
$156.38
|
|
| Hospital Charge Code |
76900003
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$37.14 |
| Max. Negotiated Rate |
$140.74 |
| Rate for Payer: Aetna Commercial |
$132.92
|
| Rate for Payer: Aetna Medicare |
$40.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.87
|
| Rate for Payer: BCBS Complete |
$62.55
|
| Rate for Payer: BCBS MAPPO |
$39.09
|
| Rate for Payer: BCBS Trust/PPO |
$128.56
|
| Rate for Payer: BCN Commercial |
$121.59
|
| Rate for Payer: BCN Medicare Advantage |
$39.09
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cofinity Commercial |
$134.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.09
|
| Rate for Payer: Healthscope Commercial |
$140.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.92
|
| Rate for Payer: Nomi Health Commercial |
$128.23
|
| Rate for Payer: PACE Senior Care Partners |
$37.14
|
| Rate for Payer: PACE SWMI |
$39.09
|
| Rate for Payer: PHP Commercial |
$132.92
|
| Rate for Payer: PHP Medicare Advantage |
$39.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health HMO/PPO |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$39.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.77
|
| Rate for Payer: Railroad Medicare Medicare |
$39.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.61
|
| Rate for Payer: UHC Core |
$130.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.09
|
| Rate for Payer: UHC Exchange |
$39.09
|
| Rate for Payer: UHC Medicare Advantage |
$39.09
|
| Rate for Payer: VA VA |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.28
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
OP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$361.35 |
| Max. Negotiated Rate |
$1,369.34 |
| Rate for Payer: Aetna Commercial |
$1,293.27
|
| Rate for Payer: Aetna Medicare |
$395.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$475.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$475.47
|
| Rate for Payer: BCBS Complete |
$501.91
|
| Rate for Payer: BCBS MAPPO |
$380.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,250.82
|
| Rate for Payer: BCN Commercial |
$1,182.96
|
| Rate for Payer: BCN Medicare Advantage |
$380.37
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,308.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.37
|
| Rate for Payer: Healthscope Commercial |
$1,369.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,141.12
|
| Rate for Payer: Mclaren Medicaid |
$477.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.39
|
| Rate for Payer: Meridian Medicaid |
$501.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$437.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: Nomi Health Commercial |
$1,247.62
|
| Rate for Payer: PACE Senior Care Partners |
$361.35
|
| Rate for Payer: PACE SWMI |
$380.37
|
| Rate for Payer: PHP Commercial |
$1,293.27
|
| Rate for Payer: PHP Medicare Advantage |
$380.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1,323.70
|
| Rate for Payer: Priority Health Medicare |
$384.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,019.40
|
| Rate for Payer: Railroad Medicare Medicare |
$380.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,338.91
|
| Rate for Payer: UHC Core |
$1,270.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.37
|
| Rate for Payer: UHC Exchange |
$380.37
|
| Rate for Payer: UHC Medicare Advantage |
$380.37
|
| Rate for Payer: UHCCP Medicaid |
$477.98
|
| Rate for Payer: VA VA |
$380.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,141.12
|
|
|
HC PEDS VENT INIT DAY
|
Facility
|
IP
|
$1,521.49
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$988.97 |
| Max. Negotiated Rate |
$1,369.34 |
| Rate for Payer: Aetna Commercial |
$1,293.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,241.99
|
| Rate for Payer: BCN Commercial |
$1,175.81
|
| Rate for Payer: Cash Price |
$1,217.19
|
| Rate for Payer: Cofinity Commercial |
$1,308.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.19
|
| Rate for Payer: Healthscope Commercial |
$1,369.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,141.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.27
|
| Rate for Payer: Nomi Health Commercial |
$1,247.62
|
| Rate for Payer: PHP Commercial |
$1,293.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$988.97
|
| Rate for Payer: Priority Health HMO/PPO |
$1,323.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,019.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,338.91
|
| Rate for Payer: UHC Core |
$1,270.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,141.12
|
|
