|
HC PEDS ECHO COMPLETE
|
Facility
|
OP
|
$2,008.38
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$388.40 |
| 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 |
$407.85
|
| 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 |
$1,506.28
|
| Rate for Payer: Mclaren Medicaid |
$388.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$527.20
|
| Rate for Payer: Meridian Medicaid |
$407.85
|
| 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 |
$388.40
|
| 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 |
$388.40
|
| Rate for Payer: VA VA |
$502.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.28
|
|
|
HC PEDS ECHO LIMITED
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300006
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$171.23 |
| 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 |
$179.80
|
| 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 |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.71
|
| Rate for Payer: Meridian Medicaid |
$179.80
|
| 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 |
$171.23
|
| 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 |
$171.23
|
| Rate for Payer: VA VA |
$206.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.16
|
|
|
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 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 |
$587.68
|
| 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 |
$559.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.76
|
| Rate for Payer: Meridian Medicaid |
$587.68
|
| 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 |
$559.66
|
| 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 |
$559.66
|
| 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 |
$39.10
|
| Rate for Payer: BCBS Trust/PPO |
$128.56
|
| Rate for Payer: BCN Commercial |
$121.59
|
| Rate for Payer: BCN Medicare Advantage |
$39.10
|
| 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 |
$39.10
|
| 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 |
$39.10
|
| Rate for Payer: PHP Commercial |
$132.92
|
| Rate for Payer: PHP Medicare Advantage |
$39.10
|
| 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 |
$39.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.61
|
| Rate for Payer: UHC Core |
$130.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.10
|
| Rate for Payer: UHC Exchange |
$39.10
|
| Rate for Payer: UHC Medicare Advantage |
$39.10
|
| Rate for Payer: VA VA |
$39.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.28
|
|
|
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
|
|
|
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 |
$491.76
|
| 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 |
$468.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.39
|
| Rate for Payer: Meridian Medicaid |
$491.76
|
| 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 |
$468.31
|
| 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 |
$468.31
|
| Rate for Payer: VA VA |
$380.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,141.12
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
IP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$854.89 |
| Max. Negotiated Rate |
$1,183.69 |
| Rate for Payer: Aetna Commercial |
$1,117.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.61
|
| Rate for Payer: BCN Commercial |
$1,016.39
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,131.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Healthscope Commercial |
$1,183.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$986.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: Nomi Health Commercial |
$1,078.47
|
| Rate for Payer: PHP Commercial |
$1,117.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1,144.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$881.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,157.38
|
| Rate for Payer: UHC Core |
$1,098.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$986.41
|
|
|
HC PEDS VENT SUB DAY
|
Facility
|
OP
|
$1,315.21
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$312.36 |
| Max. Negotiated Rate |
$1,183.69 |
| Rate for Payer: Aetna Commercial |
$1,117.93
|
| Rate for Payer: Aetna Medicare |
$341.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.00
|
| Rate for Payer: BCBS Complete |
$491.76
|
| Rate for Payer: BCBS MAPPO |
$328.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.23
|
| Rate for Payer: BCN Commercial |
$1,022.58
|
| Rate for Payer: BCN Medicare Advantage |
$328.80
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cash Price |
$1,052.17
|
| Rate for Payer: Cofinity Commercial |
$1,131.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.80
|
| Rate for Payer: Healthscope Commercial |
$1,183.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$986.41
|
| Rate for Payer: Mclaren Medicaid |
$468.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.24
|
| Rate for Payer: Meridian Medicaid |
$491.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.93
|
| Rate for Payer: Nomi Health Commercial |
$1,078.47
|
| Rate for Payer: PACE Senior Care Partners |
$312.36
|
| Rate for Payer: PACE SWMI |
$328.80
|
| Rate for Payer: PHP Commercial |
$1,117.93
|
| Rate for Payer: PHP Medicare Advantage |
$328.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$468.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1,144.23
|
| Rate for Payer: Priority Health Medicare |
$332.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$881.19
|
| Rate for Payer: Railroad Medicare Medicare |
$328.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,157.38
|
| Rate for Payer: UHC Core |
$1,098.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.80
|
| Rate for Payer: UHC Exchange |
$328.80
|
| Rate for Payer: UHC Medicare Advantage |
$328.80
|
| Rate for Payer: UHCCP Medicaid |
$468.31
|
| Rate for Payer: VA VA |
$328.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$986.41
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
OP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$287.58 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$1,029.22
|
| Rate for Payer: Aetna Medicare |
$314.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$378.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$378.39
|
| Rate for Payer: BCBS Complete |
$484.34
|
| Rate for Payer: BCBS MAPPO |
$302.71
|
| Rate for Payer: BCBS Trust/PPO |
$995.44
|
| Rate for Payer: BCN Commercial |
$941.44
|
| Rate for Payer: BCN Medicare Advantage |
$302.71
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,041.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.71
|
| Rate for Payer: Healthscope Commercial |
$1,089.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$348.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: Nomi Health Commercial |
$992.90
|
| Rate for Payer: PACE Senior Care Partners |
$287.58
|
| Rate for Payer: PACE SWMI |
$302.71
|
| Rate for Payer: PHP Commercial |
$1,029.22
|
| Rate for Payer: PHP Medicare Advantage |
$302.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,053.44
|
| Rate for Payer: Priority Health Medicare |
$305.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$811.27
|
| Rate for Payer: Railroad Medicare Medicare |
$302.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,065.55
|
| Rate for Payer: UHC Core |
$1,011.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.71
|
| Rate for Payer: UHC Exchange |
$302.71
|
| Rate for Payer: UHC Medicare Advantage |
$302.71
|
| Rate for Payer: VA VA |
$302.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.14
|
|
|
HC PEG TUBE INSERTION/TRAY
|
Facility
|
IP
|
$1,210.85
|
|
| Hospital Charge Code |
36000079
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$787.05 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$1,029.22
|
| Rate for Payer: BCBS Trust/PPO |
$988.42
|
| Rate for Payer: BCN Commercial |
$935.74
|
| Rate for Payer: Cash Price |
$968.68
|
| Rate for Payer: Cofinity Commercial |
$1,041.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.68
|
| Rate for Payer: Healthscope Commercial |
$1,089.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$908.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.22
|
| Rate for Payer: Nomi Health Commercial |
$992.90
|
| Rate for Payer: PHP Commercial |
$1,029.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,053.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$811.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,065.55
|
| Rate for Payer: UHC Core |
$1,011.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$908.14
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
OP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$362.19 |
| Max. Negotiated Rate |
$1,372.53 |
| Rate for Payer: Aetna Commercial |
$1,296.28
|
| Rate for Payer: Aetna Medicare |
$396.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$476.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$476.57
|
| Rate for Payer: BCBS Complete |
$610.01
|
| Rate for Payer: BCBS MAPPO |
$381.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.73
|
| Rate for Payer: BCN Commercial |
$1,185.71
|
| Rate for Payer: BCN Medicare Advantage |
$381.26
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,311.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.26
|
| Rate for Payer: Healthscope Commercial |
$1,372.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,143.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: Nomi Health Commercial |
$1,250.52
|
| Rate for Payer: PACE Senior Care Partners |
$362.19
|
| Rate for Payer: PACE SWMI |
$381.26
|
| Rate for Payer: PHP Commercial |
$1,296.28
|
| Rate for Payer: PHP Medicare Advantage |
$381.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,326.78
|
| Rate for Payer: Priority Health Medicare |
$385.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,021.77
|
| Rate for Payer: Railroad Medicare Medicare |
$381.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,342.03
|
| Rate for Payer: UHC Core |
$1,273.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$381.26
|
| Rate for Payer: UHC Exchange |
$381.26
|
| Rate for Payer: UHC Medicare Advantage |
$381.26
|
| Rate for Payer: VA VA |
$381.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,143.77
|
|
|
HC PEJ FDG TUBE INSERTION/REPLACE
|
Facility
|
IP
|
$1,525.03
|
|
| Hospital Charge Code |
36000059
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.27 |
| Max. Negotiated Rate |
$1,372.53 |
| Rate for Payer: Aetna Commercial |
$1,296.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,244.88
|
| Rate for Payer: BCN Commercial |
$1,178.54
|
| Rate for Payer: Cash Price |
$1,220.02
|
| Rate for Payer: Cofinity Commercial |
$1,311.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,220.02
|
| Rate for Payer: Healthscope Commercial |
$1,372.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,143.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.28
|
| Rate for Payer: Nomi Health Commercial |
$1,250.52
|
| Rate for Payer: PHP Commercial |
$1,296.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,326.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,021.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,342.03
|
| Rate for Payer: UHC Core |
$1,273.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,143.77
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: Aetna Medicare |
$12.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.69
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$11.75
|
| Rate for Payer: BCBS Trust/PPO |
$38.64
|
| Rate for Payer: BCCCP Commercial |
$19.64
|
| Rate for Payer: BCN Commercial |
$36.54
|
| Rate for Payer: BCN Medicare Advantage |
$11.75
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.75
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: PACE Senior Care Partners |
$11.16
|
| Rate for Payer: PACE SWMI |
$11.75
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO |
$40.89
|
| Rate for Payer: Priority Health Medicare |
$11.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.36
|
| Rate for Payer: UHC Core |
$39.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.75
|
| Rate for Payer: UHC Exchange |
$11.75
|
| Rate for Payer: UHC Medicare Advantage |
$11.75
|
| Rate for Payer: VA VA |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC PELVIC EXAMINATION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
51000129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$38.37
|
| Rate for Payer: BCN Commercial |
$36.32
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.95
|
| Rate for Payer: Nomi Health Commercial |
$38.54
|
| Rate for Payer: PHP Commercial |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO |
$40.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.36
|
| Rate for Payer: UHC Core |
$39.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.25
|
|
|
HC PENICILLIUM IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC PENICILLIUM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200055
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
IP
|
$1,033.55
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$671.81 |
| Max. Negotiated Rate |
$930.20 |
| Rate for Payer: Aetna Commercial |
$878.52
|
| Rate for Payer: BCBS Trust/PPO |
$843.69
|
| Rate for Payer: BCN Commercial |
$798.73
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cofinity Commercial |
$888.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.84
|
| Rate for Payer: Healthscope Commercial |
$930.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$775.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.52
|
| Rate for Payer: Nomi Health Commercial |
$847.51
|
| Rate for Payer: PHP Commercial |
$878.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.81
|
| Rate for Payer: Priority Health HMO/PPO |
$899.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$692.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$909.52
|
| Rate for Payer: UHC Core |
$863.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$775.16
|
|
|
HC PENTAMIDINE THERAPY
|
Facility
|
OP
|
$1,033.55
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
41000005
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$930.20 |
| Rate for Payer: Aetna Commercial |
$878.52
|
| Rate for Payer: Aetna Medicare |
$268.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.98
|
| Rate for Payer: BCBS Complete |
$151.29
|
| Rate for Payer: BCBS MAPPO |
$258.39
|
| Rate for Payer: BCBS Trust/PPO |
$849.68
|
| Rate for Payer: BCN Commercial |
$803.59
|
| Rate for Payer: BCN Medicare Advantage |
$258.39
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cash Price |
$826.84
|
| Rate for Payer: Cofinity Commercial |
$888.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.39
|
| Rate for Payer: Healthscope Commercial |
$930.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$775.16
|
| Rate for Payer: Mclaren Medicaid |
$144.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.31
|
| Rate for Payer: Meridian Medicaid |
$151.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.52
|
| Rate for Payer: Nomi Health Commercial |
$847.51
|
| Rate for Payer: PACE Senior Care Partners |
$245.47
|
| Rate for Payer: PACE SWMI |
$258.39
|
| Rate for Payer: PHP Commercial |
$878.52
|
| Rate for Payer: PHP Medicare Advantage |
$258.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$671.81
|
| Rate for Payer: Priority Health HMO/PPO |
$899.19
|
| Rate for Payer: Priority Health Medicare |
$260.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$692.48
|
| Rate for Payer: Railroad Medicare Medicare |
$258.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$909.52
|
| Rate for Payer: UHC Core |
$863.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.39
|
| Rate for Payer: UHC Exchange |
$258.39
|
| Rate for Payer: UHC Medicare Advantage |
$258.39
|
| Rate for Payer: UHCCP Medicaid |
$144.08
|
| Rate for Payer: VA VA |
$258.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$775.16
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: Aetna Medicare |
$46.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.78
|
| Rate for Payer: BCBS Complete |
$71.40
|
| Rate for Payer: BCBS MAPPO |
$44.62
|
| Rate for Payer: BCBS Trust/PPO |
$146.74
|
| Rate for Payer: BCN Commercial |
$138.78
|
| Rate for Payer: BCN Medicare Advantage |
$44.62
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.62
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: PACE Senior Care Partners |
$42.39
|
| Rate for Payer: PACE SWMI |
$44.62
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: PHP Medicare Advantage |
$44.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health HMO/PPO |
$155.30
|
| Rate for Payer: Priority Health Medicare |
$45.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.60
|
| Rate for Payer: Railroad Medicare Medicare |
$44.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.08
|
| Rate for Payer: UHC Core |
$149.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.62
|
| Rate for Payer: UHC Exchange |
$44.62
|
| Rate for Payer: UHC Medicare Advantage |
$44.62
|
| Rate for Payer: VA VA |
$44.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC PENTOBARBITOL NEMBUTAL LVL
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna Commercial |
$151.72
|
| Rate for Payer: BCBS Trust/PPO |
$145.71
|
| Rate for Payer: BCN Commercial |
$137.94
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$153.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.80
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.72
|
| Rate for Payer: Nomi Health Commercial |
$146.37
|
| Rate for Payer: PHP Commercial |
$151.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.02
|
| Rate for Payer: Priority Health HMO/PPO |
$155.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.08
|
| Rate for Payer: UHC Core |
$149.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.88
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
IP
|
$54.58
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: BCBS Trust/PPO |
$44.55
|
| Rate for Payer: BCN Commercial |
$42.18
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$49.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: PHP Commercial |
$46.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health HMO/PPO |
$47.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.03
|
| Rate for Payer: UHC Core |
$45.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.94
|
|
|
HC PEP VALVE SUPPLY
|
Facility
|
OP
|
$54.58
|
|
| Hospital Charge Code |
27000134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Aetna Commercial |
$46.39
|
| Rate for Payer: Aetna Medicare |
$14.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.06
|
| Rate for Payer: BCBS Complete |
$21.83
|
| Rate for Payer: BCBS MAPPO |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$44.87
|
| Rate for Payer: BCN Commercial |
$42.44
|
| Rate for Payer: BCN Medicare Advantage |
$13.64
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$49.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: PACE Senior Care Partners |
$12.96
|
| Rate for Payer: PACE SWMI |
$13.64
|
| Rate for Payer: PHP Commercial |
$46.39
|
| Rate for Payer: PHP Medicare Advantage |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health HMO/PPO |
$47.48
|
| Rate for Payer: Priority Health Medicare |
$13.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.57
|
| Rate for Payer: Railroad Medicare Medicare |
$13.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.03
|
| Rate for Payer: UHC Core |
$45.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.64
|
| Rate for Payer: UHC Exchange |
$13.64
|
| Rate for Payer: UHC Medicare Advantage |
$13.64
|
| Rate for Payer: VA VA |
$13.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.94
|
|
