|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.52 |
| Max. Negotiated Rate |
$3,841.56 |
| Rate for Payer: Aetna Commercial |
$3,628.14
|
| Rate for Payer: Aetna Medicare |
$1,109.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,333.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,333.88
|
| Rate for Payer: BCBS Complete |
$790.08
|
| Rate for Payer: BCBS MAPPO |
$1,067.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,509.05
|
| Rate for Payer: BCN Commercial |
$3,509.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,067.10
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Commercial |
$3,670.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,067.10
|
| Rate for Payer: Healthscope Commercial |
$3,841.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,201.30
|
| Rate for Payer: Mclaren Medicaid |
$752.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,120.45
|
| Rate for Payer: Meridian Medicaid |
$790.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,227.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,173.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Nomi Health Commercial |
$3,500.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: PACE Senior Care Partners |
$1,013.75
|
| Rate for Payer: PACE SWMI |
$1,067.10
|
| Rate for Payer: PHP Commercial |
$3,628.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,067.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$752.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,713.51
|
| Rate for Payer: Priority Health Medicare |
$1,077.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,970.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,067.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,756.19
|
| Rate for Payer: UHC Core |
$3,564.11
|
| Rate for Payer: UHC Exchange |
$1,067.10
|
| Rate for Payer: UHC Medicaid |
$752.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,067.10
|
| Rate for Payer: UHCCP Medicaid |
$752.52
|
| Rate for Payer: VA VA |
$1,067.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,201.30
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna Medicare |
$29.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.98
|
| Rate for Payer: BCBS Complete |
$20.72
|
| Rate for Payer: BCBS MAPPO |
$27.99
|
| Rate for Payer: BCBS Trust/PPO |
$92.03
|
| Rate for Payer: BCN Commercial |
$92.03
|
| Rate for Payer: BCN Medicare Advantage |
$27.99
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.99
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.96
|
| Rate for Payer: Mclaren Medicaid |
$19.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.39
|
| Rate for Payer: Meridian Medicaid |
$20.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: PACE Senior Care Partners |
$26.59
|
| Rate for Payer: PACE SWMI |
$27.99
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: PHP Medicare Advantage |
$27.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.40
|
| Rate for Payer: Priority Health Medicare |
$28.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.92
|
| Rate for Payer: Railroad Medicare Medicare |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.52
|
| Rate for Payer: UHC Core |
$93.48
|
| Rate for Payer: UHC Exchange |
$27.99
|
| Rate for Payer: UHC Medicaid |
$19.74
|
| Rate for Payer: UHC Medicare Advantage |
$27.99
|
| Rate for Payer: UHCCP Medicaid |
$19.74
|
| Rate for Payer: VA VA |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.96
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.92 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: BCBS Trust/PPO |
$92.46
|
| Rate for Payer: BCN Commercial |
$92.46
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.52
|
| Rate for Payer: UHC Core |
$93.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.96
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$163.89 |
| Rate for Payer: Aetna Commercial |
$154.78
|
| Rate for Payer: Aetna Medicare |
$47.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.91
|
| Rate for Payer: BCBS Complete |
$33.71
|
| Rate for Payer: BCBS MAPPO |
$45.52
|
| Rate for Payer: BCBS Trust/PPO |
$149.70
|
| Rate for Payer: BCN Commercial |
$149.70
|
| Rate for Payer: BCN Medicare Advantage |
$45.52
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Commercial |
$156.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.52
|
| Rate for Payer: Healthscope Commercial |
$163.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.57
|
| Rate for Payer: Mclaren Medicaid |
$32.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.80
|
| Rate for Payer: Meridian Medicaid |
$33.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Nomi Health Commercial |
$149.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: PACE Senior Care Partners |
$43.25
|
| Rate for Payer: PACE SWMI |
$45.52
|
| Rate for Payer: PHP Commercial |
$154.78
|
| Rate for Payer: PHP Medicare Advantage |
$45.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.43
|
| Rate for Payer: Priority Health Medicare |
$45.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.74
|
| Rate for Payer: Railroad Medicare Medicare |
$45.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.25
|
| Rate for Payer: UHC Core |
$152.05
|
| Rate for Payer: UHC Exchange |
$45.52
|
| Rate for Payer: UHC Medicaid |
$32.10
|
| Rate for Payer: UHC Medicare Advantage |
$45.52
|
| Rate for Payer: UHCCP Medicaid |
$32.10
|
| Rate for Payer: VA VA |
$45.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.57
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.74 |
| Max. Negotiated Rate |
$163.89 |
| Rate for Payer: Aetna Commercial |
$154.78
|
| Rate for Payer: BCBS Trust/PPO |
$150.40
|
| Rate for Payer: BCN Commercial |
$150.40
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Commercial |
$156.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Healthscope Commercial |
$163.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Nomi Health Commercial |
$149.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: PHP Commercial |
$154.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.25
|
| Rate for Payer: UHC Core |
$152.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.57
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: BCBS Trust/PPO |
$65.21
|
| Rate for Payer: BCN Commercial |
$65.21
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.48
|
| Rate for Payer: UHC Core |
$65.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.68
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$19.74
|
| Rate for Payer: BCBS Trust/PPO |
$64.91
|
| Rate for Payer: BCN Commercial |
$64.91
|
| Rate for Payer: BCN Medicare Advantage |
$19.74
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.73
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PACE Senior Care Partners |
$18.75
|
| Rate for Payer: PACE SWMI |
$19.74
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: PHP Medicare Advantage |
$19.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Medicare |
$19.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: Railroad Medicare Medicare |
$19.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.48
|
| Rate for Payer: UHC Core |
$65.93
|
| Rate for Payer: UHC Exchange |
$19.74
|
| Rate for Payer: UHC Medicaid |
$13.92
|
| Rate for Payer: UHC Medicare Advantage |
$19.74
|
| Rate for Payer: UHCCP Medicaid |
$13.92
|
| Rate for Payer: VA VA |
$19.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$93.73 |
| Max. Negotiated Rate |
$478.49 |
| Rate for Payer: Aetna Commercial |
$451.91
|
| Rate for Payer: Aetna Medicare |
$138.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.14
|
| Rate for Payer: BCBS Complete |
$98.41
|
| Rate for Payer: BCBS MAPPO |
$132.91
|
| Rate for Payer: BCBS Trust/PPO |
$437.08
|
| Rate for Payer: BCN Commercial |
$437.08
|
| Rate for Payer: BCN Medicare Advantage |
$132.91
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Commercial |
$457.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.91
|
| Rate for Payer: Healthscope Commercial |
$478.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.75
|
| Rate for Payer: Mclaren Medicaid |
$93.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.56
|
| Rate for Payer: Meridian Medicaid |
$98.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$146.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Nomi Health Commercial |
$435.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: PACE Senior Care Partners |
$126.27
|
| Rate for Payer: PACE SWMI |
$132.91
|
| Rate for Payer: PHP Commercial |
$451.91
|
| Rate for Payer: PHP Medicare Advantage |
$132.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$462.54
|
| Rate for Payer: Priority Health Medicare |
$134.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.04
|
| Rate for Payer: Railroad Medicare Medicare |
$132.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.86
|
| Rate for Payer: UHC Core |
$443.94
|
| Rate for Payer: UHC Exchange |
$132.91
|
| Rate for Payer: UHC Medicaid |
$93.73
|
| Rate for Payer: UHC Medicare Advantage |
$132.91
|
| Rate for Payer: UHCCP Medicaid |
$93.73
|
| Rate for Payer: VA VA |
$132.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.75
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$370.04 |
| Max. Negotiated Rate |
$478.49 |
| Rate for Payer: Aetna Commercial |
$451.91
|
| Rate for Payer: BCBS Trust/PPO |
$439.10
|
| Rate for Payer: BCN Commercial |
$439.10
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Commercial |
$457.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Healthscope Commercial |
$478.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Nomi Health Commercial |
$435.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: PHP Commercial |
$451.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$462.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.86
|
| Rate for Payer: UHC Core |
$443.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.75
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$380.12 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Aetna Medicare |
$109.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.99
|
| Rate for Payer: BCBS Complete |
$78.18
|
| Rate for Payer: BCBS MAPPO |
$105.59
|
| Rate for Payer: BCBS Trust/PPO |
$347.22
|
| Rate for Payer: BCN Commercial |
$347.22
|
| Rate for Payer: BCN Medicare Advantage |
$105.59
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Commercial |
$363.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.59
|
| Rate for Payer: Healthscope Commercial |
$380.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.77
|
| Rate for Payer: Mclaren Medicaid |
$74.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.87
|
| Rate for Payer: Meridian Medicaid |
$78.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Nomi Health Commercial |
$346.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: PACE Senior Care Partners |
$100.31
|
| Rate for Payer: PACE SWMI |
$105.59
|
| Rate for Payer: PHP Commercial |
$359.01
|
| Rate for Payer: PHP Medicare Advantage |
$105.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.45
|
| Rate for Payer: Priority Health Medicare |
$106.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.96
|
| Rate for Payer: Railroad Medicare Medicare |
$105.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.68
|
| Rate for Payer: UHC Core |
$352.67
|
| Rate for Payer: UHC Exchange |
$105.59
|
| Rate for Payer: UHC Medicaid |
$74.46
|
| Rate for Payer: UHC Medicare Advantage |
$105.59
|
| Rate for Payer: UHCCP Medicaid |
$74.46
|
| Rate for Payer: VA VA |
$105.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.77
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$293.96 |
| Max. Negotiated Rate |
$380.12 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: BCBS Trust/PPO |
$348.83
|
| Rate for Payer: BCN Commercial |
$348.83
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Commercial |
$363.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Healthscope Commercial |
$380.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Nomi Health Commercial |
$346.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: PHP Commercial |
$359.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.68
|
| Rate for Payer: UHC Core |
$352.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.77
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: Aetna Medicare |
$185.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.52
|
| Rate for Payer: BCBS Complete |
$132.39
|
| Rate for Payer: BCBS MAPPO |
$178.81
|
| Rate for Payer: BCBS Trust/PPO |
$588.01
|
| Rate for Payer: BCN Commercial |
$588.01
|
| Rate for Payer: BCN Medicare Advantage |
$178.81
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.81
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Mclaren Medicaid |
$126.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.75
|
| Rate for Payer: Meridian Medicaid |
$132.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Senior Care Partners |
$169.87
|
| Rate for Payer: PACE SWMI |
$178.81
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: PHP Medicare Advantage |
$178.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$622.27
|
| Rate for Payer: Priority Health Medicare |
$180.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.81
|
| Rate for Payer: Railroad Medicare Medicare |
$178.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.42
|
| Rate for Payer: UHC Core |
$597.23
|
| Rate for Payer: UHC Exchange |
$178.81
|
| Rate for Payer: UHC Medicaid |
$126.10
|
| Rate for Payer: UHC Medicare Advantage |
$178.81
|
| Rate for Payer: UHCCP Medicaid |
$126.10
|
| Rate for Payer: VA VA |
$178.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$497.81 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Aetna Commercial |
$607.96
|
| Rate for Payer: BCBS Trust/PPO |
$590.72
|
| Rate for Payer: BCN Commercial |
$590.72
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Commercial |
$615.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Healthscope Commercial |
$643.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$536.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PHP Commercial |
$607.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$622.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.42
|
| Rate for Payer: UHC Core |
$597.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$536.44
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$299.26 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: BCBS Trust/PPO |
$355.11
|
| Rate for Payer: BCN Commercial |
$355.11
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.37
|
| Rate for Payer: UHC Core |
$359.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna Medicare |
$111.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.37
|
| Rate for Payer: BCBS Complete |
$79.59
|
| Rate for Payer: BCBS MAPPO |
$107.49
|
| Rate for Payer: BCBS Trust/PPO |
$353.48
|
| Rate for Payer: BCN Commercial |
$353.48
|
| Rate for Payer: BCN Medicare Advantage |
$107.49
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.49
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.48
|
| Rate for Payer: Mclaren Medicaid |
$75.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.87
|
| Rate for Payer: Meridian Medicaid |
$79.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PACE Senior Care Partners |
$102.12
|
| Rate for Payer: PACE SWMI |
$107.49
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: PHP Medicare Advantage |
$107.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.07
|
| Rate for Payer: Priority Health Medicare |
$108.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.26
|
| Rate for Payer: Railroad Medicare Medicare |
$107.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.37
|
| Rate for Payer: UHC Core |
$359.02
|
| Rate for Payer: UHC Exchange |
$107.49
|
| Rate for Payer: UHC Medicaid |
$75.80
|
| Rate for Payer: UHC Medicare Advantage |
$107.49
|
| Rate for Payer: UHCCP Medicaid |
$75.80
|
| Rate for Payer: VA VA |
$107.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.48
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$212.27 |
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: BCBS Trust/PPO |
$194.80
|
| Rate for Payer: BCN Commercial |
$194.80
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Healthscope Commercial |
$212.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Nomi Health Commercial |
$193.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: PHP Commercial |
$200.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.56
|
| Rate for Payer: UHC Core |
$196.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.90
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$235.86
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$212.27 |
| Rate for Payer: Aetna Commercial |
$200.48
|
| Rate for Payer: Aetna Medicare |
$61.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.71
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS MAPPO |
$58.97
|
| Rate for Payer: BCBS Trust/PPO |
$193.90
|
| Rate for Payer: BCN Commercial |
$193.90
|
| Rate for Payer: BCN Medicare Advantage |
$58.97
|
| Rate for Payer: Cash Price |
$188.69
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.97
|
| Rate for Payer: Healthscope Commercial |
$212.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.90
|
| Rate for Payer: Mclaren Medicaid |
$41.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.91
|
| Rate for Payer: Meridian Medicaid |
$43.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.48
|
| Rate for Payer: Nomi Health Commercial |
$193.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.90
|
| Rate for Payer: PACE Senior Care Partners |
$56.02
|
| Rate for Payer: PACE SWMI |
$58.97
|
| Rate for Payer: PHP Commercial |
$200.48
|
| Rate for Payer: PHP Medicare Advantage |
$58.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.20
|
| Rate for Payer: Priority Health Medicare |
$59.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.16
|
| Rate for Payer: Railroad Medicare Medicare |
$58.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.56
|
| Rate for Payer: UHC Core |
$196.94
|
| Rate for Payer: UHC Exchange |
$58.97
|
| Rate for Payer: UHC Medicaid |
$41.58
|
| Rate for Payer: UHC Medicare Advantage |
$58.97
|
| Rate for Payer: UHCCP Medicaid |
$41.58
|
| Rate for Payer: VA VA |
$58.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.90
|
|
|
HC RO TRTMNT LEVEL 1
|
Facility
|
OP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$44.81 |
| Max. Negotiated Rate |
$228.74 |
| Rate for Payer: Aetna Commercial |
$216.03
|
| Rate for Payer: Aetna Medicare |
$66.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.42
|
| Rate for Payer: BCBS Complete |
$47.04
|
| Rate for Payer: BCBS MAPPO |
$63.54
|
| Rate for Payer: BCBS Trust/PPO |
$208.94
|
| Rate for Payer: BCN Commercial |
$208.94
|
| Rate for Payer: BCN Medicare Advantage |
$63.54
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Commercial |
$218.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.54
|
| Rate for Payer: Healthscope Commercial |
$228.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.61
|
| Rate for Payer: Mclaren Medicaid |
$44.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.71
|
| Rate for Payer: Meridian Medicaid |
$47.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Nomi Health Commercial |
$208.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: PACE Senior Care Partners |
$60.36
|
| Rate for Payer: PACE SWMI |
$63.54
|
| Rate for Payer: PHP Commercial |
$216.03
|
| Rate for Payer: PHP Medicare Advantage |
$63.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.11
|
| Rate for Payer: Priority Health Medicare |
$64.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.89
|
| Rate for Payer: Railroad Medicare Medicare |
$63.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.65
|
| Rate for Payer: UHC Core |
$212.22
|
| Rate for Payer: UHC Exchange |
$63.54
|
| Rate for Payer: UHC Medicaid |
$44.81
|
| Rate for Payer: UHC Medicare Advantage |
$63.54
|
| Rate for Payer: UHCCP Medicaid |
$44.81
|
| Rate for Payer: VA VA |
$63.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.61
|
|
|
HC RO TRTMNT LEVEL 1
|
Facility
|
IP
|
$254.15
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300078
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$228.74 |
| Rate for Payer: Aetna Commercial |
$216.03
|
| Rate for Payer: BCBS Trust/PPO |
$209.90
|
| Rate for Payer: BCN Commercial |
$209.90
|
| Rate for Payer: Cash Price |
$203.32
|
| Rate for Payer: Cofinity Commercial |
$218.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.32
|
| Rate for Payer: Healthscope Commercial |
$228.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.03
|
| Rate for Payer: Nomi Health Commercial |
$208.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.61
|
| Rate for Payer: PHP Commercial |
$216.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.65
|
| Rate for Payer: UHC Core |
$212.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.61
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
OP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$169.38 |
| Max. Negotiated Rate |
$864.68 |
| Rate for Payer: Aetna Commercial |
$816.65
|
| Rate for Payer: Aetna Medicare |
$249.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$300.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$300.24
|
| Rate for Payer: BCBS Complete |
$177.84
|
| Rate for Payer: BCBS MAPPO |
$240.19
|
| Rate for Payer: BCBS Trust/PPO |
$789.84
|
| Rate for Payer: BCN Commercial |
$789.84
|
| Rate for Payer: BCN Medicare Advantage |
$240.19
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Commercial |
$826.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.19
|
| Rate for Payer: Healthscope Commercial |
$864.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.57
|
| Rate for Payer: Mclaren Medicaid |
$169.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.20
|
| Rate for Payer: Meridian Medicaid |
$177.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$264.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Nomi Health Commercial |
$787.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: PACE Senior Care Partners |
$228.18
|
| Rate for Payer: PACE SWMI |
$240.19
|
| Rate for Payer: PHP Commercial |
$816.65
|
| Rate for Payer: PHP Medicare Advantage |
$240.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$835.86
|
| Rate for Payer: Priority Health Medicare |
$242.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$668.69
|
| Rate for Payer: Railroad Medicare Medicare |
$240.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$845.47
|
| Rate for Payer: UHC Core |
$802.23
|
| Rate for Payer: UHC Exchange |
$240.19
|
| Rate for Payer: UHC Medicaid |
$169.38
|
| Rate for Payer: UHC Medicare Advantage |
$240.19
|
| Rate for Payer: UHCCP Medicaid |
$169.38
|
| Rate for Payer: VA VA |
$240.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.57
|
|
|
HC RO TRTMNT LEVEL 2
|
Facility
|
IP
|
$960.76
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300079
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$668.69 |
| Max. Negotiated Rate |
$864.68 |
| Rate for Payer: Aetna Commercial |
$816.65
|
| Rate for Payer: BCBS Trust/PPO |
$793.49
|
| Rate for Payer: BCN Commercial |
$793.49
|
| Rate for Payer: Cash Price |
$768.61
|
| Rate for Payer: Cofinity Commercial |
$826.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$768.61
|
| Rate for Payer: Healthscope Commercial |
$864.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$720.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$816.65
|
| Rate for Payer: Nomi Health Commercial |
$787.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$720.57
|
| Rate for Payer: PHP Commercial |
$816.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$835.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$668.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$845.47
|
| Rate for Payer: UHC Core |
$802.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$720.57
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
OP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$242.66 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna Medicare |
$357.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$430.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$430.12
|
| Rate for Payer: BCBS Complete |
$254.77
|
| Rate for Payer: BCBS MAPPO |
$344.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.54
|
| Rate for Payer: BCN Commercial |
$1,131.54
|
| Rate for Payer: BCN Medicare Advantage |
$344.10
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.10
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: Mclaren Medicaid |
$242.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.31
|
| Rate for Payer: Meridian Medicaid |
$254.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$378.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Nomi Health Commercial |
$1,128.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PACE Senior Care Partners |
$326.89
|
| Rate for Payer: PACE SWMI |
$344.10
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: PHP Medicare Advantage |
$344.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,197.47
|
| Rate for Payer: Priority Health Medicare |
$347.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$957.97
|
| Rate for Payer: Railroad Medicare Medicare |
$344.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.23
|
| Rate for Payer: UHC Core |
$1,149.29
|
| Rate for Payer: UHC Exchange |
$344.10
|
| Rate for Payer: UHC Medicaid |
$242.66
|
| Rate for Payer: UHC Medicare Advantage |
$344.10
|
| Rate for Payer: UHCCP Medicaid |
$242.66
|
| Rate for Payer: VA VA |
$344.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
HC RO TRTMNT LEVEL 3
|
Facility
|
IP
|
$1,376.40
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300080
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$957.97 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,136.77
|
| Rate for Payer: BCN Commercial |
$1,136.77
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Nomi Health Commercial |
$1,128.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,197.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$957.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.23
|
| Rate for Payer: UHC Core |
$1,149.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
