|
HC RECOVERY PHASE 1 COMPLEX BASE CHARGE
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
71000039
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna Commercial |
$98.60
|
| Rate for Payer: Aetna Medicare |
$30.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.25
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$29.00
|
| Rate for Payer: BCBS Trust/PPO |
$95.36
|
| Rate for Payer: BCN Commercial |
$90.19
|
| Rate for Payer: BCN Medicare Advantage |
$29.00
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.00
|
| Rate for Payer: Healthscope Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.60
|
| Rate for Payer: Nomi Health Commercial |
$95.12
|
| Rate for Payer: PACE Senior Care Partners |
$27.55
|
| Rate for Payer: PACE SWMI |
$29.00
|
| Rate for Payer: PHP Commercial |
$98.60
|
| Rate for Payer: PHP Medicare Advantage |
$29.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health HMO/PPO |
$100.92
|
| Rate for Payer: Priority Health Medicare |
$29.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.72
|
| Rate for Payer: Railroad Medicare Medicare |
$29.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.08
|
| Rate for Payer: UHC Core |
$96.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.00
|
| Rate for Payer: UHC Exchange |
$29.00
|
| Rate for Payer: UHC Medicare Advantage |
$29.00
|
| Rate for Payer: VA VA |
$29.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.00
|
|
|
HC RECOVERY PHASE 1 COMPLEX BASE CHARGE
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
71000039
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna Commercial |
$98.60
|
| Rate for Payer: BCBS Trust/PPO |
$94.69
|
| Rate for Payer: BCN Commercial |
$89.64
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.80
|
| Rate for Payer: Healthscope Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.60
|
| Rate for Payer: Nomi Health Commercial |
$95.12
|
| Rate for Payer: PHP Commercial |
$98.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health HMO/PPO |
$100.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.08
|
| Rate for Payer: UHC Core |
$96.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.00
|
|
|
HC RECOVERY PHASE 1 COMPLEX EA MIN CHARGE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
71000034
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.24
|
| Rate for Payer: BCN Commercial |
$11.59
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
HC RECOVERY PHASE 1 COMPLEX EA MIN CHARGE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
71000034
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.69
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$12.33
|
| Rate for Payer: BCN Commercial |
$11.66
|
| Rate for Payer: BCN Medicare Advantage |
$3.75
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: PACE Senior Care Partners |
$3.56
|
| Rate for Payer: PACE SWMI |
$3.75
|
| Rate for Payer: PHP Commercial |
$12.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health HMO/PPO |
$13.05
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.05
|
| Rate for Payer: Railroad Medicare Medicare |
$3.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$12.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.75
|
| Rate for Payer: UHC Exchange |
$3.75
|
| Rate for Payer: UHC Medicare Advantage |
$3.75
|
| Rate for Payer: VA VA |
$3.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.25
|
|
|
HC RECOVERY PHASE 1 STANDARD BASE CHARGE
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
71000035
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: BCBS Trust/PPO |
$79.18
|
| Rate for Payer: BCN Commercial |
$74.96
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: PHP Commercial |
$82.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO |
$84.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.36
|
| Rate for Payer: UHC Core |
$81.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.75
|
|
|
HC RECOVERY PHASE 1 STANDARD BASE CHARGE
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
71000035
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Aetna Medicare |
$25.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.31
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS MAPPO |
$24.25
|
| Rate for Payer: BCBS Trust/PPO |
$79.74
|
| Rate for Payer: BCN Commercial |
$75.42
|
| Rate for Payer: BCN Medicare Advantage |
$24.25
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.25
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: PACE Senior Care Partners |
$23.04
|
| Rate for Payer: PACE SWMI |
$24.25
|
| Rate for Payer: PHP Commercial |
$82.45
|
| Rate for Payer: PHP Medicare Advantage |
$24.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO |
$84.39
|
| Rate for Payer: Priority Health Medicare |
$24.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.99
|
| Rate for Payer: Railroad Medicare Medicare |
$24.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.36
|
| Rate for Payer: UHC Core |
$81.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.25
|
| Rate for Payer: UHC Exchange |
$24.25
|
| Rate for Payer: UHC Medicare Advantage |
$24.25
|
| Rate for Payer: VA VA |
$24.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.75
|
|
|
HC RECOVERY PHASE 1 STANDARD EA MIN CHARGE
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
71000036
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.75
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$3.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Commercial |
$9.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.00
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: PACE Senior Care Partners |
$2.85
|
| Rate for Payer: PACE SWMI |
$3.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO |
$10.44
|
| Rate for Payer: Priority Health Medicare |
$3.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.00
|
| Rate for Payer: UHC Exchange |
$3.00
|
| Rate for Payer: UHC Medicare Advantage |
$3.00
|
| Rate for Payer: VA VA |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC RECOVERY PHASE 1 STANDARD EA MIN CHARGE
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
71000036
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$9.80
|
| Rate for Payer: BCN Commercial |
$9.27
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO |
$10.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
HC RECOVERY PHASE 2 EA MIN CHARGE
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
71000037
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$7.35
|
| Rate for Payer: BCN Commercial |
$6.96
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$7.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.65
|
| Rate for Payer: Nomi Health Commercial |
$7.38
|
| Rate for Payer: PHP Commercial |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: Priority Health HMO/PPO |
$7.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.92
|
| Rate for Payer: UHC Core |
$7.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.75
|
|
|
HC RECOVERY PHASE 2 EA MIN CHARGE
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
71000037
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$7.40
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$7.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.65
|
| Rate for Payer: Nomi Health Commercial |
$7.38
|
| Rate for Payer: PACE Senior Care Partners |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$7.65
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: Priority Health HMO/PPO |
$7.83
|
| Rate for Payer: Priority Health Medicare |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.03
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.92
|
| Rate for Payer: UHC Core |
$7.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.25
|
| Rate for Payer: UHC Exchange |
$2.25
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
| Rate for Payer: VA VA |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.75
|
|
|
HC RED CEDAR IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
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 RED CEDAR IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
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 RED CELL GENO MI BLD
|
Facility
|
OP
|
$302.94
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.95 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.67
|
| Rate for Payer: BCBS Complete |
$140.60
|
| Rate for Payer: BCBS MAPPO |
$75.73
|
| Rate for Payer: BCBS Trust/PPO |
$249.05
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: BCN Medicare Advantage |
$75.73
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.73
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.21
|
| Rate for Payer: Mclaren Medicaid |
$133.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.52
|
| Rate for Payer: Meridian Medicaid |
$140.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: Nomi Health Commercial |
$248.41
|
| Rate for Payer: PACE Senior Care Partners |
$71.95
|
| Rate for Payer: PACE SWMI |
$75.73
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: PHP Medicare Advantage |
$75.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health HMO/PPO |
$263.56
|
| Rate for Payer: Priority Health Medicare |
$76.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.97
|
| Rate for Payer: Railroad Medicare Medicare |
$75.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.59
|
| Rate for Payer: UHC Core |
$252.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.73
|
| Rate for Payer: UHC Exchange |
$75.73
|
| Rate for Payer: UHC Medicare Advantage |
$75.73
|
| Rate for Payer: UHCCP Medicaid |
$133.90
|
| Rate for Payer: VA VA |
$75.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.21
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
IP
|
$302.94
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$196.91 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: BCBS Trust/PPO |
$247.29
|
| Rate for Payer: BCN Commercial |
$234.11
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: Nomi Health Commercial |
$248.41
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health HMO/PPO |
$263.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.59
|
| Rate for Payer: UHC Core |
$252.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.21
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
OP
|
$218.10
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$196.29 |
| Rate for Payer: Aetna Commercial |
$185.38
|
| Rate for Payer: Aetna Medicare |
$56.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.16
|
| Rate for Payer: BCBS Complete |
$87.24
|
| Rate for Payer: BCBS MAPPO |
$54.52
|
| Rate for Payer: BCBS Trust/PPO |
$179.30
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: BCN Medicare Advantage |
$54.52
|
| Rate for Payer: Cash Price |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$187.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$196.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.38
|
| Rate for Payer: Nomi Health Commercial |
$178.84
|
| Rate for Payer: PACE Senior Care Partners |
$51.80
|
| Rate for Payer: PACE SWMI |
$54.52
|
| Rate for Payer: PHP Commercial |
$185.38
|
| Rate for Payer: PHP Medicare Advantage |
$54.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.76
|
| Rate for Payer: Priority Health HMO/PPO |
$189.75
|
| Rate for Payer: Priority Health Medicare |
$55.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.13
|
| Rate for Payer: Railroad Medicare Medicare |
$54.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.93
|
| Rate for Payer: UHC Core |
$182.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.52
|
| Rate for Payer: UHC Exchange |
$54.52
|
| Rate for Payer: UHC Medicare Advantage |
$54.52
|
| Rate for Payer: VA VA |
$54.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.57
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
IP
|
$218.10
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$141.76 |
| Max. Negotiated Rate |
$196.29 |
| Rate for Payer: Aetna Commercial |
$185.38
|
| Rate for Payer: BCBS Trust/PPO |
$178.04
|
| Rate for Payer: BCN Commercial |
$168.55
|
| Rate for Payer: Cash Price |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$187.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.48
|
| Rate for Payer: Healthscope Commercial |
$196.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.38
|
| Rate for Payer: Nomi Health Commercial |
$178.84
|
| Rate for Payer: PHP Commercial |
$185.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.76
|
| Rate for Payer: Priority Health HMO/PPO |
$189.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.93
|
| Rate for Payer: UHC Core |
$182.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.57
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
IP
|
$1,106.29
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$719.09 |
| Max. Negotiated Rate |
$995.66 |
| Rate for Payer: Aetna Commercial |
$940.35
|
| Rate for Payer: BCBS Trust/PPO |
$903.06
|
| Rate for Payer: BCN Commercial |
$854.94
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cofinity Commercial |
$951.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.03
|
| Rate for Payer: Healthscope Commercial |
$995.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$829.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.35
|
| Rate for Payer: Nomi Health Commercial |
$907.16
|
| Rate for Payer: PHP Commercial |
$940.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.09
|
| Rate for Payer: Priority Health HMO/PPO |
$962.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$741.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.54
|
| Rate for Payer: UHC Core |
$923.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$829.72
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,106.29
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$995.66 |
| Rate for Payer: Aetna Commercial |
$940.35
|
| Rate for Payer: Aetna Medicare |
$287.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$345.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$345.72
|
| Rate for Payer: BCBS Complete |
$138.17
|
| Rate for Payer: BCBS MAPPO |
$276.57
|
| Rate for Payer: BCBS Trust/PPO |
$909.48
|
| Rate for Payer: BCN Commercial |
$860.14
|
| Rate for Payer: BCN Medicare Advantage |
$276.57
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cash Price |
$885.03
|
| Rate for Payer: Cofinity Commercial |
$951.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.57
|
| Rate for Payer: Healthscope Commercial |
$995.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$829.72
|
| Rate for Payer: Mclaren Medicaid |
$131.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.40
|
| Rate for Payer: Meridian Medicaid |
$138.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.35
|
| Rate for Payer: Nomi Health Commercial |
$907.16
|
| Rate for Payer: PACE Senior Care Partners |
$262.74
|
| Rate for Payer: PACE SWMI |
$276.57
|
| Rate for Payer: PHP Commercial |
$940.35
|
| Rate for Payer: PHP Medicare Advantage |
$276.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.09
|
| Rate for Payer: Priority Health HMO/PPO |
$962.47
|
| Rate for Payer: Priority Health Medicare |
$279.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$741.21
|
| Rate for Payer: Railroad Medicare Medicare |
$276.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.54
|
| Rate for Payer: UHC Core |
$923.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.57
|
| Rate for Payer: UHC Exchange |
$276.57
|
| Rate for Payer: UHC Medicare Advantage |
$276.57
|
| Rate for Payer: UHCCP Medicaid |
$131.59
|
| Rate for Payer: VA VA |
$276.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$829.72
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
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 REDTOP BENT GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
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 REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$7.49
|
| Rate for Payer: BCN Commercial |
$7.09
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health HMO/PPO |
$7.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.08
|
| Rate for Payer: UHC Core |
$7.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Medicare |
$2.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.87
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS MAPPO |
$2.29
|
| Rate for Payer: BCBS Trust/PPO |
$7.55
|
| Rate for Payer: BCN Commercial |
$7.14
|
| Rate for Payer: BCN Medicare Advantage |
$2.29
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$7.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.18
|
| Rate for Payer: PACE SWMI |
$2.29
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: PHP Medicare Advantage |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.97
|
| Rate for Payer: Priority Health HMO/PPO |
$7.99
|
| Rate for Payer: Priority Health Medicare |
$2.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.15
|
| Rate for Payer: Railroad Medicare Medicare |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.08
|
| Rate for Payer: UHC Core |
$7.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.29
|
| Rate for Payer: UHC Exchange |
$2.29
|
| Rate for Payer: UHC Medicare Advantage |
$2.29
|
| Rate for Payer: VA VA |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$438.65
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$394.79 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: Aetna Medicare |
$114.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.08
|
| Rate for Payer: BCBS Complete |
$159.96
|
| Rate for Payer: BCBS MAPPO |
$109.66
|
| Rate for Payer: BCBS Trust/PPO |
$360.61
|
| Rate for Payer: BCN Commercial |
$341.05
|
| Rate for Payer: BCN Medicare Advantage |
$109.66
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.66
|
| Rate for Payer: Healthscope Commercial |
$394.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.99
|
| Rate for Payer: Mclaren Medicaid |
$152.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.15
|
| Rate for Payer: Meridian Medicaid |
$159.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: Nomi Health Commercial |
$359.69
|
| Rate for Payer: PACE Senior Care Partners |
$104.18
|
| Rate for Payer: PACE SWMI |
$109.66
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: PHP Medicare Advantage |
$109.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health HMO/PPO |
$381.63
|
| Rate for Payer: Priority Health Medicare |
$110.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.90
|
| Rate for Payer: Railroad Medicare Medicare |
$109.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.01
|
| Rate for Payer: UHC Core |
$366.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.66
|
| Rate for Payer: UHC Exchange |
$109.66
|
| Rate for Payer: UHC Medicare Advantage |
$109.66
|
| Rate for Payer: UHCCP Medicaid |
$152.33
|
| Rate for Payer: VA VA |
$109.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.99
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$438.65
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$285.12 |
| Max. Negotiated Rate |
$394.79 |
| Rate for Payer: Aetna Commercial |
$372.85
|
| Rate for Payer: BCBS Trust/PPO |
$358.07
|
| Rate for Payer: BCN Commercial |
$338.99
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cofinity Commercial |
$377.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.92
|
| Rate for Payer: Healthscope Commercial |
$394.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.85
|
| Rate for Payer: Nomi Health Commercial |
$359.69
|
| Rate for Payer: PHP Commercial |
$372.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.12
|
| Rate for Payer: Priority Health HMO/PPO |
$381.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.01
|
| Rate for Payer: UHC Core |
$366.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.99
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$881.99
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$793.79 |
| Rate for Payer: Aetna Commercial |
$749.69
|
| Rate for Payer: Aetna Medicare |
$229.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.62
|
| Rate for Payer: BCBS Complete |
$159.96
|
| Rate for Payer: BCBS MAPPO |
$220.50
|
| Rate for Payer: BCBS Trust/PPO |
$725.08
|
| Rate for Payer: BCN Commercial |
$685.75
|
| Rate for Payer: BCN Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cash Price |
$705.59
|
| Rate for Payer: Cofinity Commercial |
$758.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.50
|
| Rate for Payer: Healthscope Commercial |
$793.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.49
|
| Rate for Payer: Mclaren Medicaid |
$152.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.52
|
| Rate for Payer: Meridian Medicaid |
$159.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.69
|
| Rate for Payer: Nomi Health Commercial |
$723.23
|
| Rate for Payer: PACE Senior Care Partners |
$209.47
|
| Rate for Payer: PACE SWMI |
$220.50
|
| Rate for Payer: PHP Commercial |
$749.69
|
| Rate for Payer: PHP Medicare Advantage |
$220.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.29
|
| Rate for Payer: Priority Health HMO/PPO |
$767.33
|
| Rate for Payer: Priority Health Medicare |
$222.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.93
|
| Rate for Payer: Railroad Medicare Medicare |
$220.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.15
|
| Rate for Payer: UHC Core |
$736.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.50
|
| Rate for Payer: UHC Exchange |
$220.50
|
| Rate for Payer: UHC Medicare Advantage |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$152.33
|
| Rate for Payer: VA VA |
$220.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.49
|
|
