|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: BCBS Trust/PPO |
$69.11
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.50
|
| Rate for Payer: UHC Core |
$70.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.50
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$22.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.46
|
| Rate for Payer: BCBS Complete |
$12.54
|
| Rate for Payer: BCBS MAPPO |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$69.60
|
| Rate for Payer: BCN Commercial |
$65.82
|
| Rate for Payer: BCN Medicare Advantage |
$21.16
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.16
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.50
|
| Rate for Payer: Mclaren Medicaid |
$11.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.22
|
| Rate for Payer: Meridian Medicaid |
$12.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PACE Senior Care Partners |
$20.11
|
| Rate for Payer: PACE SWMI |
$21.16
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health Medicare |
$21.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: Railroad Medicare Medicare |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.50
|
| Rate for Payer: UHC Core |
$70.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.16
|
| Rate for Payer: UHC Exchange |
$21.16
|
| Rate for Payer: UHC Medicare Advantage |
$21.16
|
| Rate for Payer: UHCCP Medicaid |
$11.94
|
| Rate for Payer: VA VA |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.50
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.23
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$13.78
|
| Rate for Payer: BCBS Trust/PPO |
$45.33
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: BCN Medicare Advantage |
$13.78
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.36
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.47
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PACE Senior Care Partners |
$13.10
|
| Rate for Payer: PACE SWMI |
$13.78
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: PHP Medicare Advantage |
$13.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Medicare |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.78
|
| Rate for Payer: UHC Exchange |
$13.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.78
|
| Rate for Payer: UHCCP Medicaid |
$11.62
|
| Rate for Payer: VA VA |
$13.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.36
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: BCBS Trust/PPO |
$45.01
|
| Rate for Payer: BCN Commercial |
$42.61
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.36
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
IP
|
$54.10
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: BCBS Trust/PPO |
$44.16
|
| Rate for Payer: BCN Commercial |
$41.81
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Healthscope Commercial |
$48.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: Nomi Health Commercial |
$44.36
|
| Rate for Payer: PHP Commercial |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health HMO/PPO |
$47.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.61
|
| Rate for Payer: UHC Core |
$45.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.58
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
OP
|
$54.10
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare |
$14.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.91
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$44.48
|
| Rate for Payer: BCN Commercial |
$42.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.52
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$48.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.58
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.20
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: Nomi Health Commercial |
$44.36
|
| Rate for Payer: PACE Senior Care Partners |
$12.85
|
| Rate for Payer: PACE SWMI |
$13.52
|
| Rate for Payer: PHP Commercial |
$45.98
|
| Rate for Payer: PHP Medicare Advantage |
$13.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health HMO/PPO |
$47.07
|
| Rate for Payer: Priority Health Medicare |
$13.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.25
|
| Rate for Payer: Railroad Medicare Medicare |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.61
|
| Rate for Payer: UHC Core |
$45.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.52
|
| Rate for Payer: UHC Exchange |
$13.52
|
| Rate for Payer: UHC Medicare Advantage |
$13.52
|
| Rate for Payer: UHCCP Medicaid |
$11.62
|
| Rate for Payer: VA VA |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.58
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
IP
|
$282.13
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$183.38 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$239.81
|
| Rate for Payer: BCBS Trust/PPO |
$230.30
|
| Rate for Payer: BCN Commercial |
$218.03
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cofinity Commercial |
$242.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.70
|
| Rate for Payer: Healthscope Commercial |
$253.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.81
|
| Rate for Payer: Nomi Health Commercial |
$231.35
|
| Rate for Payer: PHP Commercial |
$239.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.38
|
| Rate for Payer: Priority Health HMO/PPO |
$245.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.27
|
| Rate for Payer: UHC Core |
$235.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.60
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
OP
|
$282.13
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$239.81
|
| Rate for Payer: Aetna Medicare |
$73.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.17
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$70.53
|
| Rate for Payer: BCBS Trust/PPO |
$231.94
|
| Rate for Payer: BCN Commercial |
$219.36
|
| Rate for Payer: BCN Medicare Advantage |
$70.53
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cofinity Commercial |
$242.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.53
|
| Rate for Payer: Healthscope Commercial |
$253.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.60
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.06
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.81
|
| Rate for Payer: Nomi Health Commercial |
$231.35
|
| Rate for Payer: PACE Senior Care Partners |
$67.01
|
| Rate for Payer: PACE SWMI |
$70.53
|
| Rate for Payer: PHP Commercial |
$239.81
|
| Rate for Payer: PHP Medicare Advantage |
$70.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.38
|
| Rate for Payer: Priority Health HMO/PPO |
$245.45
|
| Rate for Payer: Priority Health Medicare |
$71.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.03
|
| Rate for Payer: Railroad Medicare Medicare |
$70.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.27
|
| Rate for Payer: UHC Core |
$235.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.53
|
| Rate for Payer: UHC Exchange |
$70.53
|
| Rate for Payer: UHC Medicare Advantage |
$70.53
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$70.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.60
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
OP
|
$210.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Medicare |
$54.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.66
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$52.53
|
| Rate for Payer: BCBS Trust/PPO |
$172.74
|
| Rate for Payer: BCN Commercial |
$163.37
|
| Rate for Payer: BCN Medicare Advantage |
$52.53
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.53
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.59
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.16
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PACE Senior Care Partners |
$49.90
|
| Rate for Payer: PACE SWMI |
$52.53
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: PHP Medicare Advantage |
$52.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO |
$182.80
|
| Rate for Payer: Priority Health Medicare |
$53.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.78
|
| Rate for Payer: Railroad Medicare Medicare |
$52.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.91
|
| Rate for Payer: UHC Core |
$175.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.53
|
| Rate for Payer: UHC Exchange |
$52.53
|
| Rate for Payer: UHC Medicare Advantage |
$52.53
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$52.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.59
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.52
|
| Rate for Payer: BCN Commercial |
$162.38
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO |
$182.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.91
|
| Rate for Payer: UHC Core |
$175.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.59
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
OP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Medicare |
$54.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.66
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$52.53
|
| Rate for Payer: BCBS Trust/PPO |
$172.74
|
| Rate for Payer: BCN Commercial |
$163.37
|
| Rate for Payer: BCN Medicare Advantage |
$52.53
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.53
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.59
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.16
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PACE Senior Care Partners |
$49.90
|
| Rate for Payer: PACE SWMI |
$52.53
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: PHP Medicare Advantage |
$52.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO |
$182.80
|
| Rate for Payer: Priority Health Medicare |
$53.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.78
|
| Rate for Payer: Railroad Medicare Medicare |
$52.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.91
|
| Rate for Payer: UHC Core |
$175.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.53
|
| Rate for Payer: UHC Exchange |
$52.53
|
| Rate for Payer: UHC Medicare Advantage |
$52.53
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$52.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.59
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.52
|
| Rate for Payer: BCN Commercial |
$162.38
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO |
$182.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.91
|
| Rate for Payer: UHC Core |
$175.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.59
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.54
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$43.52
|
| Rate for Payer: BCN Commercial |
$41.16
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$47.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.70
|
| Rate for Payer: Mclaren Medicaid |
$4.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$4.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: Nomi Health Commercial |
$43.41
|
| Rate for Payer: PACE Senior Care Partners |
$12.57
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$45.00
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: Priority Health HMO/PPO |
$46.06
|
| Rate for Payer: Priority Health Medicare |
$13.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.47
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.59
|
| Rate for Payer: UHC Core |
$44.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Exchange |
$13.24
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$4.18
|
| Rate for Payer: VA VA |
$13.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.70
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.21
|
| Rate for Payer: BCN Commercial |
$40.91
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Healthscope Commercial |
$47.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: Nomi Health Commercial |
$43.41
|
| Rate for Payer: PHP Commercial |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: Priority Health HMO/PPO |
$46.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.59
|
| Rate for Payer: UHC Core |
$44.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.70
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$72.81
|
| Rate for Payer: BCN Medicare Advantage |
$23.41
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.24
|
| Rate for Payer: PACE SWMI |
$23.41
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: Railroad Medicare Medicare |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.41
|
| Rate for Payer: UHC Exchange |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.44
|
| Rate for Payer: BCN Commercial |
$72.36
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC PICC INTRODUCER
|
Facility
|
OP
|
$98.32
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$88.49 |
| Rate for Payer: Aetna Commercial |
$83.57
|
| Rate for Payer: Aetna Medicare |
$25.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.72
|
| Rate for Payer: BCBS Complete |
$39.33
|
| Rate for Payer: BCBS MAPPO |
$24.58
|
| Rate for Payer: BCBS Trust/PPO |
$80.83
|
| Rate for Payer: BCN Commercial |
$76.44
|
| Rate for Payer: BCN Medicare Advantage |
$24.58
|
| Rate for Payer: Cash Price |
$78.66
|
| Rate for Payer: Cofinity Commercial |
$84.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.58
|
| Rate for Payer: Healthscope Commercial |
$88.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.57
|
| Rate for Payer: Nomi Health Commercial |
$80.62
|
| Rate for Payer: PACE Senior Care Partners |
$23.35
|
| Rate for Payer: PACE SWMI |
$24.58
|
| Rate for Payer: PHP Commercial |
$83.57
|
| Rate for Payer: PHP Medicare Advantage |
$24.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.91
|
| Rate for Payer: Priority Health HMO/PPO |
$85.54
|
| Rate for Payer: Priority Health Medicare |
$24.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.87
|
| Rate for Payer: Railroad Medicare Medicare |
$24.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.52
|
| Rate for Payer: UHC Core |
$82.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.58
|
| Rate for Payer: UHC Exchange |
$24.58
|
| Rate for Payer: UHC Medicare Advantage |
$24.58
|
| Rate for Payer: VA VA |
$24.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.74
|
|
|
HC PICC INTRODUCER
|
Facility
|
IP
|
$98.32
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.91 |
| Max. Negotiated Rate |
$88.49 |
| Rate for Payer: Aetna Commercial |
$83.57
|
| Rate for Payer: BCBS Trust/PPO |
$80.26
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.66
|
| Rate for Payer: Cofinity Commercial |
$84.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$88.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.57
|
| Rate for Payer: Nomi Health Commercial |
$80.62
|
| Rate for Payer: PHP Commercial |
$83.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.91
|
| Rate for Payer: Priority Health HMO/PPO |
$85.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.52
|
| Rate for Payer: UHC Core |
$82.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.74
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
IP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$101.33 |
| Rate for Payer: Aetna Commercial |
$95.70
|
| Rate for Payer: BCBS Trust/PPO |
$91.91
|
| Rate for Payer: BCN Commercial |
$87.01
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Healthscope Commercial |
$101.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: PHP Commercial |
$95.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: Priority Health HMO/PPO |
$97.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.08
|
| Rate for Payer: UHC Core |
$94.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.44
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
OP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$101.33 |
| Rate for Payer: Aetna Commercial |
$95.70
|
| Rate for Payer: Aetna Medicare |
$29.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.18
|
| Rate for Payer: BCBS Complete |
$45.04
|
| Rate for Payer: BCBS MAPPO |
$28.15
|
| Rate for Payer: BCBS Trust/PPO |
$92.56
|
| Rate for Payer: BCN Commercial |
$87.54
|
| Rate for Payer: BCN Medicare Advantage |
$28.15
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.15
|
| Rate for Payer: Healthscope Commercial |
$101.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: PACE Senior Care Partners |
$26.74
|
| Rate for Payer: PACE SWMI |
$28.15
|
| Rate for Payer: PHP Commercial |
$95.70
|
| Rate for Payer: PHP Medicare Advantage |
$28.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: Priority Health HMO/PPO |
$97.95
|
| Rate for Payer: Priority Health Medicare |
$28.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.44
|
| Rate for Payer: Railroad Medicare Medicare |
$28.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.08
|
| Rate for Payer: UHC Core |
$94.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.15
|
| Rate for Payer: UHC Exchange |
$28.15
|
| Rate for Payer: UHC Medicare Advantage |
$28.15
|
| Rate for Payer: VA VA |
$28.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.44
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$52.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.79
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS MAPPO |
$50.24
|
| Rate for Payer: BCBS Trust/PPO |
$165.19
|
| Rate for Payer: BCN Commercial |
$156.23
|
| Rate for Payer: BCN Medicare Advantage |
$50.24
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.24
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PACE Senior Care Partners |
$47.72
|
| Rate for Payer: PACE SWMI |
$50.24
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: PHP Medicare Advantage |
$50.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: Railroad Medicare Medicare |
$50.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.24
|
| Rate for Payer: UHC Exchange |
$50.24
|
| Rate for Payer: UHC Medicare Advantage |
$50.24
|
| Rate for Payer: VA VA |
$50.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.70
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: BCBS Trust/PPO |
$164.03
|
| Rate for Payer: BCN Commercial |
$155.29
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.70
|
|
|
HC PICU OR PED CRITICAL CARE R&B
|
Facility
|
IP
|
$7,801.90
|
|
| Hospital Charge Code |
20300001
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$7,021.71 |
| Rate for Payer: Aetna Commercial |
$6,631.62
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,368.69
|
| Rate for Payer: BCN Commercial |
$6,029.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$6,241.52
|
| Rate for Payer: Cash Price |
$6,241.52
|
| Rate for Payer: Cofinity Commercial |
$6,709.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,241.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$7,021.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,851.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,631.62
|
| Rate for Payer: Nomi Health Commercial |
$6,397.56
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$6,631.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,071.24
|
| Rate for Payer: Priority Health HMO/PPO |
$6,787.65
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,227.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,865.67
|
| Rate for Payer: UHC Core |
$6,514.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,851.42
|
|
